Nurses: The NHS is at breaking point

[Digga]

edh said:

Yep, definitely blame Labour, after all they have been out of government since 2010..

Got to pull you up there, because there are facts no one can argue with:

1. The bloat in spend happened very clearly, at a certain point in the recent past of the NHS (see previously linked graph)
2. The NHS is contractually tied into PFI schemes for decades - there is no way out, not for any government
3. Similar contractual obligations and subsequent organisational changes make the personnel changes difficult to reverse or revise

[Luther Blissett]

I know facts don't matter but we're really not that inefficient...

[jjlynn27]

Digga said:

IMHO the NHS was actually, in many ways, better off before New Labour bloated it. What the money went into was rarely 'front line' people or services, but management - layers and layers of it - and PPIs. All scandalous wastes of budget, some of which are easier to get rid of than others, but it is a sobering demonstration of how inflating budgets of public sector organisations can go wrong.

NHS Confederation said:

Management

• Managers and senior managers accounted for 2.35 per cent of the 1.318 million staff employed by HCHS and GP services across the NHS in 2015.
• The number of managers and senior managers increased slightly in 2014 and 2015, having declined in each of the previous four years. However 30,952 was the second lowest total since the new dataset starts in 2009.
• In 2008/09 the management costs of the NHS had fallen from 5.0 per cent in 1997/98 to 3.0 per cent.

Budget for locum staff was £1B in 2015 (iirc), actuall spend £2.7B. And even with all that spend, there are unfilled posts. As per CF research UK spends less than almost any developed nation on health. Yet we have the highest levels of obesity, highest level of teenage pregnancies and so on.

Of the trainee doctors that I know, some left medicine alltogether, as they can earn multiple in 'private sector' some left NHS to work in private hospitals (more money, LOT less work, much better conditions overall). As it stands even more people will leave profession, as they are tired of morons telling them 'OI, I pay your salary'.

IMO, (not in health, not i public sector, if it matters), NHS is unsustainable on the basis that there is explosion in demand, which is not mirrored by increase in spending.

Charging nominal amounts for prescriptions, charging for missed appointments, stop fking about with it and using it as a political football with idiocies like 'full-on 7 days service' that nobody else does for the very simple reason that it would be highly inneficient.

Or you can blame foreigners, coming up with idiotic things like saving 30-50% of the budget without reduction in services (yes, that's what some dimwit on PH was claiming') or wanting to implement equivalent of US system here.

[jjlynn27]

Luther Blissett said:

I know facts don't matter but we're really not that inefficient...

Facts are irrelevant. That table was from Commonwealth Fund, based on OECD data. Your average PHer, whose knowledge on the subject is based on Daily Mail and Telegraph headlines knows much more.

[Digga]

jjlynn27 said:

IMO, (not in health, not i public sector, if it matters), NHS is unsustainable on the basis that there is explosion in demand, which is not mirrored by increase in spending.

As I pointed out earlier, a lot of the problem is, to a very large degree, temporary. The issue is a confluence of demographic factors:

• baby boomers ageing
• people living longer generally
• unhealthy western lifestyles

If you take out the first and last item, both of which will change for the better in the near(ish) future, the rest is not so bad.

Interesting and encouraging to see the stats on the NHS 'winding down' the previous management bloat.

[edh]

Digga said:

edh said:

Yep, definitely blame Labour, after all they have been out of government since 2010..

Got to pull you up there, because there are facts no one can argue with:

1. The bloat in spend happened very clearly, at a certain point in the recent past of the NHS (see previously linked graph)
2. The NHS is contractually tied into PFI schemes for decades - there is no way out, not for any government
3. Similar contractual obligations and subsequent organisational changes make the personnel changes difficult to reverse or revise

"bloat" or maybe catching up on years of underfunding? Depends on your perspective (compare NHS performance in 2010 with 1997, poles apart). It was certainly an objective of Labour to bring UK healthcare spending up to European (EU?) average.

PFI is not being cited as a major factor in the current problems I think? see my last post though - I thought PFI was a bad idea. Probably better than not building any new hospitals though.

[barryrs]

edh said:

"bloat" or maybe catching up on years of underfunding? Depends on your perspective (compare NHS performance in 2010 with 1997, poles apart). It was certainly an objective of Labour to bring UK healthcare spending up to European (EU?) average.

PFI is not being cited as a major factor in the current problems I think? see my last post though - I thought PFI was a bad idea. Probably better than not building any new hospitals though.

I think PFI payments is circa 2% of annual budget IIRC.

[Derek Smith]

Luther Blissett said:

I know facts don't matter but we're really not that inefficient.

I'm part of the demographic that is increasing the costs for the NHS. I had a couple of lumps removed, non-cancerous/caught in time, in my pre '65 age but since I've retired I've given it a right old hammering.

In the last 30 months I've been to my local hospitals for four ailments, two of which are of longstanding nature. I've been seen within an hour of every appointment, and normally within 30 mins. I've had 4 MRI scans which were dealt with on the day of the appointment and without waiting.

I've nothing but praise for the way I've been treated.

I wish I had gone to my doctor earlier but I'd read so much about how they would not be interested. I've paid £350 to a chiropractor to make my problem worse, probably three times that amount over the years to physios to give temporary relief. After being nagged by my wife, I opted to see a specialist and now, whilst not pain free - it's too far gone for that - I am comfortable most of the time.

My son used to play rugby and I've seen the inside of most A&Es in the south east over the years. He's been treated with care, consideration, good humour and excellent efficiency every time.

As an aside I was told by the chiropractor to cycle as much as I could, and this was encouraged by a physio or two. The MRI scan showed that the damage to my spine had been exacerbated by cycling. Not the sole nor main cause.

My younger daughter is a midwife and the stories she tells of her department's undermanning, as well as that of nursing in the wards, is deeply worrying.

The remarkable thing is that hospitals manage to provide the service they do whilst being understaffed and poorly managed.

[markcoznottz]

Ridgemont said:

shed driver said:

I'll make an admission here. I'm a nurse - I have been for over 30 years. I work in the NHS in a fairly specialist area. We have been at 100% bed occupancy (or above) since before September last year. With only 12 beds there are some times that we admit patients onto the unit, stabilise them and transfer them out to other wards or departments just so that we can admit another patient. Some beds may have three patients in within one day.

However we also have some patients that no matter how hard we try we cannot discharge them due to a lack of effective social care - with an aging and increasingly frail population this will only increase.

I'm not naive enough to believe that there aren't efficiencies to be made, although many of the easy, quick fixes have already been tried. Watching the BBC2 documentary last night showed a surgeon, theatre and associated staff left unused due to a lack of bed capacity - this isn't just isolated to one hospital though, it's endemic at all of them.

Funding alone isn't the answer, neither is a knee jerk "sack all the managers" call as is seen so often. I'm in the twilight of my career - I've never seen it so bad, I can't wait to retire although with a permanently damaged back whether I can continue to work until then is a rather moot point.

SD.

Bed blockage is a key problem. Couple of observations

1) On R4 before Christmas, PM or Today were comparing and there are striking differences between the link up between A&E/General Hospital/Social Services between trusts. Those hospitals that have better utilisation of beds, shorter occupancy times and more surgeries (due to be able to get beds released for waiting list) are running what, in my software delivery business, would be called a war room: all parts of the system sat making allocation decisions especially with regards to Social Service availability. They were literally reacting on an hour by hour basis but because they had all parts (input and outflows) covered off it reduced extended comms and made decision making much more streamlined. Looked pretty impressive.

2) A friend, who will remain anonymous, is a senior manager at a well known Trust. He has had multiple serious conversations with senior colleagues on how best to handle OAPs who are almost in continuous occupancy while social services are unable to provide a solution. This has included something really as basic as well heated warehouse/hangar accommodation which would allow the parking of terminal types. Heartless it may sound, but currently the impact of gerentocare is rendering Hospitals unable to provide basic healthcare provision for the rest of the population: extended waiting lists drive up complications, people discharged inappropriately early because of bed pressure, hospitals having to provide a range of services more appropriate for aged care. You name it its being impacted by a tidal wave of elderly. Simply throwing more money at Social Services won't really address the issue. The warehouse solution never flies because it would be a PR disaster, despite it being probably a sensible solution from a care point of view.

Let's be honest privatisation of any kind won't work, most working folk can't afford to live now, they can't pay for a state run AND a private arrangement. And also scrotes who pay F*** all in will just get it free anyway. No party will get voted in if they cut spending so that's a non starter. It's an absolute cluster duck, even if you did something totally left field like charge immigrants a one of fee of say £5k for lifetime use, a) they are from predominantly poor country's so couldn't afford it, b) immigrants wouldn't come so our beloved GDP would fall, and c) the eu wouldn't allow it ( I thought we'd left?).


Besides which apart from a sub group of Muslim communities who are vastly over represented in the benefit system they aren't the problem. The problem is public sector pensions, and too many subhuman dross who get pandered to at every turn, yet disabled people can't get the help and equipment they need. The issue of an entitlement culture of lazy 60-85 yr olds needs addressing too, as they receive far more out of the system than they put in. This cannot carry on. It's galling that the group of society that have always done the bare minimum always seem to get the most back. Don't shoot the messsenger.

[jjlynn27]

Digga said:

jjlynn27 said:

IMO, (not in health, not i public sector, if it matters), NHS is unsustainable on the basis that there is explosion in demand, which is not mirrored by increase in spending.

As I pointed out earlier, a lot of the problem is, to a very large degree, temporary. The issue is a confluence of demographic factors:

• baby boomers ageing
• people living longer generally
• unhealthy western lifestyles

If you take out the first and last item, both of which will change for the better in the near(ish) future, the rest is not so bad.

Interesting and encouraging to see the stats on the NHS 'winding down' the previous management bloat.

<rant>
As someone who has lived and worked in quite a few countries, and experienced different health systems (including the USA), I've never seen the level of vitriol and abused regularly hurled towards medical staff. I don't understand that. Most of them could do significantly better paid job in 'private' sector, Friend (ex-registrar) left NHS and now is working for McKinsey for more than 3x the money. In her words, she misses working with kids (she was paediatric A&E) but she can plan a life with her family, works fewer hours and the job is 'dead easy'. (Added bonus; can have 'normal' nails and doesn't have to wear trainers).
</rant>

I don't see why would you take last bit 'out'. Do you believe that population is getting healthier?

I don't know what the solution is. But if we go down the insurance route, some people are in for rude awakening how much it's going to cost them, how many things are going to be excluded, and the amount that they'll be required to pay (out of pocket/excess) BEFORE insurance kicks in.

Then on top of that you have, and I chose my words carefully, idiotic one-liners how even if '100% of GDP is spent on NHS it wouldn't be enough'. No data, no evidence, no rational thought, just the angry ranting of imbeciles with IQ of a damaged garden gnome.

Edited by jjlynn27 on Thursday 12th January 18:18

[Sheepshanks]

jjlynn27 said:

Most of them could do significantly better paid job in 'private' sector,

I think "most" is an absolutely massive exaggeration.

[Ekona]

Things like the whole PrEP issue isn't helping matters either. I won't get started on just how much that whole court ruling has riled me, but I'm more annoyed it got that far in the first place.

I don't care if that, along with boob jobs and other cosmetic things is just a drop in the ocean, but it's a start. Couple that with refusal to offer certain surgeries to smokers and the very obese unless they change their lifestyle and at least you might be on the way to saving enough to get a few more qualified staff on the floors of hospitals.

Long term, and with a wider view, outside of a massive change in what the NHS prioritises, I genuinely don't have any idea where we go. I'll be amazed if it still exists in the same form in 20 years though.

[jjlynn27]

Sheepshanks said:

jjlynn27 said:

Most of them could do significantly better paid job in 'private' sector,

I think "most" is an absolutely massive exaggeration.

You are quite right, I should qualify that, I was talking about jds. I don't know what career prospects are for other staff within NHS.

[voyds9]

REALIST123 said:

Well, I've just spent the afternoon in a ward at the infirmary of a major midlands city. Yes, the beds are full but there's little sign of urgency or stress. Lots of people walking about, standing about chatting.

I'm reminded of when I was in business; if I'd had a factory running in such a relaxed manner I'd have been worried.

Maybe it's different elsewhere, but the above is my experience today.

This. I went to observe them a couple of weeks ago. No one appeared rush, in fact 1 nurse had time to peruse the Avon catalogue, another nurse was typing at a speed that would have made Joey Deacon look like a touch typist.
One admin was pushing a cart round with records on half full, while being followed by a nurse carrying a single record.
As you stated no one was in a rush.


I also contract for the NHS. They are constantly increasing the number of procedures that have to be performed. Time isn't an issue as the pay for an examination so they don't care how long it takes. However, at negotiation time they always state there is no extra money for all these extra tests (and a below inflation increase for the rest).

[clockworks]

I wonder how much it costs to keep a reasonably OK elderly person in an NHS hospital bed, compared to a care home? I can't believe the hospital is cheaper.

Seems to me that the difference is where the funding comes from - local authority or central government - but the taxpayer ends up paying the bill. Local authority saves money by keeping people in hospital, but we all end up paying more. Time for some joined-up planning?

[jjlynn27]

Ekona said:

<some good stuff>

Long term, and with a wider view, outside of a massive change in what the NHS prioritises, I genuinely don't have any idea where we go. I'll be amazed if it still exists in the same form in 20 years though.

20? I'd be genuinely surprised if it exists in its current form in next 5 to 10.

[markcoznottz]

jjlynn27 said:

Digga said:

jjlynn27 said:

IMO, (not in health, not i public sector, if it matters), NHS is unsustainable on the basis that there is explosion in demand, which is not mirrored by increase in spending.

As I pointed out earlier, a lot of the problem is, to a very large degree, temporary. The issue is a confluence of demographic factors:

• baby boomers ageing
• people living longer generally
• unhealthy western lifestyles

If you take out the first and last item, both of which will change for the better in the near(ish) future, the rest is not so bad.

Interesting and encouraging to see the stats on the NHS 'winding down' the previous management bloat.

<rant>
As someone who has lived and worked in quite a few countries, and experienced different health systems (including the USA), I've never seen the level of vitriol and abused regularly hurled towards medical staff. I don't understand that. Most of them could do significantly better paid job in 'private' sector, Friend (ex-registrar) left NHS and now is working for McKinsey for more than 3x the money. In her words, she misses working with kids (she was paediatric A&E) but she can plan a life with her family, works fewer hours and the job is 'dead easy'. (Added bonus; can have 'normal' nails and doesn't have to wear trainers).
</rant>

I don't see why would you take last bit 'out'. Do you believe that population is getting healthier?

I don't know what the solution is. But if we go down the insurance route, some people are in for rude awakening how much it's going to cost them, how many things are going to be excluded, and the amount that they'll be required to pay (out of pocket/excess) BEFORE insurance kicks in.

Then on top of that you have, and I chose my words carefully, idiotic one-liners how even if '100% of GDP is spent on NHS it wouldn't be enough'. No data, no evidence, no rational thought, just the angry ranting of imbeciles with IQ of a damaged garden gnome.

Edited by jjlynn27 on Thursday 12th January 18:18

Too many people in this country just dint give a fk and have no interpersonal skills. Plus it's all 'free'. It's also too easy to just 'bump along' in this country and do ok, not amazing but not living in a cardboard box.

[TLandCruiser]

Maybe they should introduce things like every gp appointment costs £10 and A&E costs £50 or something along those lines with some fine tuning. Obviously if you turn up to a&e they won't expect payment but maybe 30 days to pay after discharge etc just a little something to help towards the cost.

Unemployed, disabled and oap are exempt etc

[NoddyonNitrous]

Europa1 said:

- a basic appreciation of what the words "Accident" and "Emergency" mean.

"Anything & Everything" obv.

[Cfnteabag]

I have a close link with the NHS but don't work for them or in healthcare. The issues that have been spotted are the trend for families to abandon elderly relatives until death then they are only interested in money. People seem to think that anything their parents own is theirs by right and will fight the NHS and social services in court when that money should be used to give a good standard of post hospital care for the person who has actually earned it.

There is also a reliance on agency staff which can cost wards hundreds of pounds a day for a single nurse when there are better options if hospitals made better use of bank staff without treating them as lower classes