Just another £1.2 Billion to fix the NHS?

[The Don of Croy]

V8 Fettler said:

LucreLout said:

Cleaning may be outsourced. It may be someone else's job. I think we can all agree that it can't be done by the patient - too sick you see.
Patient care IS the nurses responsibility. It is the doctors. It is the hospital managers. When the ward hasn't been cleaned properly, they ALL have a responsibility to clean it. "Not my job" simply isn't good enough. That we've allowed the staff to become too precious is why we are where we are, and we need to change that attitude first, or the nhs as we know it will not survive - its soaked up more money than we can fund, so more money can't be part of the solution.

You would pay a doctor to clean a ward?

LL has a point - you'd expect the MD of any company to help out at the sharp end it it was needed at that time, because circs demanded it. Not everyday/week/month but if required, get on and do it.

I recently had a course of treatment at the GP surgery - nothing drastic but I did have a wound that needed dressing. It was holiday time, and no agency nurses had been procured to cover...so the locum doctor tried to dress it, but couldn't find the correct stuff and co-opted another doctor.

So two GP's spent 20 minutes dressing my wound - a job one nurse would normally handle.

I don't think any amount of money will ever 'fix' the NHS. The same reasoning also says there is no limit to how big Google or Walmart or Amazon or Alibaba might become.

[LucreLout]

V8 Fettler said:

You would pay a doctor to clean a ward?

No, but I'd expect a doctor visiting a patient on a filthy ward to make sure it is cleaned or grab a bucket and set to, with the nurses. Or is it medically better just to treat the hospital acquired infections and hope too many patients don't die as a result? It's certainly going to take more of the doctors time to see the same patient repeatedly to diagnose their next HAI.

Edited by LucreLout on Thursday 20th November 10:44

[andymadmak]

LucreLout said:

V8 Fettler said:

You would pay a doctor to clean a ward?

No, but I'd expect a doctor visiting a patient on a filthy ward to make sure it is cleaned or grab a bucket and set to, with the nurses. Or is it medically better just to treat the hospital acquired infections and hope too many patients don't die as a result? It's certainly going to take more of the doctors time to see the same patient repeatedly to diagnose their next HAI.

Edited by LucreLout on Thursday 20th November 10:44

Yup. Lucrelout sums the situation up perfectly. And the question from V8 Fettler demonstrates the mindset that too many NHS employees have. (Not saying V8 Fettler is an NHS employee, just that the thinking contained in the question is the same kind of logic and "missfocus" that is ingrained in the service.)

[mrpurple]

andymadmak said:

mrpurple said:

I would have to get my OH to respond to this as she is the senior nurse that, up to recently, was directly responsible for over 1200 nurses including matrons, sisters and HCA's. But I can tell you that I have never heard her say nurses not doing cleaning etc is the root cause of the NHS's ills.

However without giving too much away I can say, having been lured out of retirement, she is currently undertaking an interim role to sort out some issues where the, now departed (sideshifted), theatre manager had a background in physiopherapy and had never even been in a theatre before her appointment and, from what I hear, didn't go in them when in post either.....hardly nurses fault I would say.

You might also like to know that when I met her 6 yrs ago she had 12 or so matrons to support her...when she decided to retire (before she had a breakdown)6 months ago this was down to 3 IIRC so this might explain some of the nursing issues if there are any.

I think I am not explaining myself very well. Nurses not cleaning is not in itself the root cause of the NHS's ills. Nurses not cleaning is a symptom of a much wider problem within the NHS. Is there a massive problem with poor quality management within the NHS? Yes, and this is another symptom of the same problem. Is there resistance to change within the NHS? Yes, and this is yet another symptom of the problem.

What is the problem?

Answer: The service is set up for the benefit of the people working in it rather than for the benefit of the patients who need to use it.

So nurses now have degrees and are trained to much higher levels, because that is how we attract and incentivise nurses (apparently) but that means we pass what were considered to be basic, essential nursing tasks to others now - those we decide are only fit for menial duties. And when those people fail then the basics get missed. And because the nurses no longer "do that stuff" then frequently "that stuff " does not get done. Moreover we now see that because nurses are quasi medical practitioners some are beginning to exhibit the same sort of "God complex" that afflicts too many Doctors. Read the reports and see how many patients complain that Nurses these days lack any empathy with their patients......

Bad Management? Absolutely, but when the whole management structure is set up in such a multi layered, byzantine way it's not surprising that competent managers tend not to stay within the NHS, so we are left too often with the incompetent being in charge of things that they have no ability to manage. Do we change this? No of course not because the various layers of management are there to protect people in their jobs.

Resistance to change? Absolutely. When you think you know better than anyone else, and when you think that any worthwhile change might actually involve yourself then you resist it. The fact that too many changes have gone before (and only a few of them to the good) simply cements your view that change must be resisted. So the good stuff (when it comes) is resisted because resistance is what we do to protect our jobs and protect our beloved NHS. We must not criticise our NHS, we must only accept that everyone in it is an Angel or a God, working in a superhuman way in the face of impossible difficulties and a never ending cash shortage. That is the only truth that will run, because to accept any other truth is to accept that the service really does have to change and that putting patients rather than staff at the top of the priority list should be at the very top of that change agenda.

I think there are many more issues that are higher up on my list than dealing with nursing issues per se and perhaps I should have added that, from my own personal experience of 3 major ops, numerous other minor interventions and procedures I have visited / stayed in 3 different hospitals at least 100 times in the last 4yrs - nurses or nursing issues, in my experiences, were never a problem for me to be honest.

Resistance to change I know only too well and would agree 100% and that applies right across the board in the NHS and many other organisations big and small.... not only do I know this 2nd hand from my OH but, coincidentally, my dissertation was based on this very subject a few years back... I found James Belasco's - Teaching the Elephant to Dance - a very useful reference on the subject.

edited for accuracy.....actually I just realised it is 4 major ops over 5 years.

Edited by mrpurple on Thursday 20th November 11:35

[Bill]

The Don of Croy said:

LL has a point - you'd expect the MD of any company to help out at the sharp end it it was needed at that time, because circs demanded it. Not everyday/week/month but if required, get on and do it.

I recently had a course of treatment at the GP surgery - nothing drastic but I did have a wound that needed dressing. It was holiday time, and no agency nurses had been procured to cover...so the locum doctor tried to dress it, but couldn't find the correct stuff and co-opted another doctor.

So two GP's spent 20 minutes dressing my wound - a job one nurse would normally handle.

I don't think any amount of money will ever 'fix' the NHS. The same reasoning also says there is no limit to how big Google or Walmart or Amazon or Alibaba might become.

This is why the idea that getting Drs mucking in to clean is daft: they wouldn't know where the kit is kept and wouldn't do a decent job (realistically, when was the last time most Drs did any cleaning? ) even if they did notice.

The NHS could be better but compared to other first world healthcare systems it does an OK job for an average amount of money. There's undoubtedly room for improvement, some places could be better managed, there could be a lot less waste and we could put more money into GPs to stop the impending crisis but we also need to ask some hard questions about how much we want the NHS to do.

[alock]

I'm surprised there hasn't been a reference to Yes Minister yet. Over 30 years ago and the comedy is still relevant.

https://www.youtube.com/watch?v=x-5zEb1oS9A

[captainzep]

There's still a major lack of understanding on these pages about what faces the NHS, as opposed to how it operates.

Demand is going up very swiftly. 999 calls, A&E admissions, GP appointments.

A big causal factor of NHS waste lies outside its borders. The average age of someone in an inpatient bed is now 83 or 87 or something close to that. They live at home independently, get sick or fall and end up in hospital. Then they're fixed up and become medically fit (i.e. no longer require hospital care) but are unable to return home yet. Then there's a delay, because social care packages often aren't readily available. So that person stays in hospital until a package is put together, throughput becomes static, beds are occupied and everything backs up to the front door (A&E) where the ambulances stack and the hospital goes "Condition Black" unable to take anyone else. Hospitals sometimes put 'surge' beds in place to meet demand but this costs big money because you need extra agency staff. Others simply run out of room. Elective (planned) operations make way for prioritised urgent ones leading to elongated waiting times and sometimes the deterioration of health of those on the waiting list.

You can pump more money into the system, but soon it won't be enough again because supply tends to create demand in the NHS. You could solve many issues on paper by centralising more NHS services into fewer, bigger hospitals but that means closing down or moving existing services and the public won't have that because they believe they own them and have an entitlement to everything on their doorstep. The topic is so emotive that politicians will get voted in if they oppose such change vvehemently enough so it becomes a political football leading to organisational inertia.

I'm sympathetic to the plight of the NHS, -I'm paid by it. But healthcare in the UK needs a wider discussion. I'm far from being a UKIP voter but at least there seems to be some willingness there to discuss whether we should think the unthinkable and question whether the current model is, or can ever be good enough.

Edited by captainzep on Thursday 20th November 13:05

[mrpurple]

captainzep said:

There's still a major lack of understanding on these pages about what faces the NHS, as opposed to how it operates.

Demand is going up very swiftly. 999 calls, A&E admissions, GP appointments.

A big causal factor of NHS waste lies outside its borders. The average age of someone in an inpatient bed is now 83 or 87 or something close to that. They live at home independently, get sick or fall and end up in hospital. Then they're fixed up and become medically fit (i.e. no longer require hospital care) but are unable to return home yet. Then there's a delay, because social care packages often aren't readily available. So that person stays in hospital until a package is put together, throughput becomes static, beds are occupied and everything backs up to the front door (A&E) where the ambulances stack and the hospital goes "Condition Black" unable to take anyone else. Hospitals sometimes put 'surge' beds in place to meet demand but this costs big money because you need extra agency staff. Others simply run out of room. Elective (planned) operations make way for prioritised urgent ones leading to elongated waiting times and sometimes the deterioration of health of those on the waiting list.

You can pump more money into the system, but soon it won't be enough again because supply tends to create demand in the NHS. You could solve many issues on paper by centralising more NHS services into fewer, bigger hospitals but that means closing down or moving existing services and the public won't have that because they believe they own them and have an entitlement to everything on their doorstep. The topic is so emotive that politicians will get voted in if they oppose such change vvehemently enough so it becomes a political football leading to organisational interia.

I'm sympathetic to the plight of the NHS, -I'm paid by it. But healthcare in the UK needs a wider discussion. I'm far from being a UKIP voter but at least there seems to be some willingness there to discuss whether we should think the unthinkable and question whether the current model is, or can ever be good enough.

Possibly the best post so far on this thread.... bedblocking is just one of the bigger major problems that need addressing, so politics should be put aside and, as now the case with issues such as immigration, wider discussions need to be had on the future of the NHS. Putting in more money will just give short term fixes whereas it is long term solutions that are really needed IMO.

[V8 Fettler]

Bizarre that anyone should even consider employing a doctor to clean a ward, the cost must be something like 20x the cost of employing a cleaner. Firefighting to fix problems is not management.

Average age for an admitted patient will be around 50 years of age (my guess with no supporting info!).

[Sway]

Not suggesting hire a doctor to clean a ward, but if a doctor is with a patient that has soiled themselves, and no-one else is immediately available, help make the patient more comfortable - instead of walking away, leaving the patient wondering when they're going to get help.

That makes a huge difference to a confused elderly person lying in st, and isn't going to cause irreparable damage to the doctor's day.

I speak from experience in seeing this - it wasn't until half an hour later when I kicked up a fuss that any effort was made to make my grandmother more comfortable, and less embarrassed...

Ultimately, what's more important, the doctor's time/cost, or the patient's physical and emotional wellbeing?

In every other part of employed life, if an unsafe situation is noticed, it doesn't matter who you are or your job title/wage/etc., your legal responsibility is to make safe to the best of your ability, before getting someone more appropriate to fully resolve the issue...

[andymadmak]

V8 Fettler said:

Bizarre that anyone should even consider employing a doctor to clean a ward, the cost must be something like 20x the cost of employing a cleaner. Firefighting to fix problems is not management.

.

You are missing the point. Nobody is suggesting that we set out to employ doctors to clean wards. Quite clearly, cleaners should be cleaning wards, and doctors should be doing God-like things ..

However, to continue with the ward cleaning example, what is being pointed out is that when the ward is obviously filthy, and thus is likely to be causing significant additional health problems for patients, then it stands to reason that all managers and staff should be prepared to do something about it in order to be acting in the best interests of the patients! Its no good them just ignoring the dirt now is it?

Maybe the cleaner is off ill, maybe the cleaner is crap, maybe the management of the cleaning service is woeful, and maybe, just maybe (as I have seen myself) the cleaner has just finished his/her shift and left, only for a bodily fluid spill to occur. In which cases the suitable staff and management responses are obvious., But in the last example of the cleaner having just finished his/her shift, is it not more sensible to clean the crap up straight away? or shall we let patients and clinicians walk the crap through the ward and the hospital "cos it aint our job to clean it up and the next cleaner aint due on shift for 2 hours"?
What is more important? The wellbeing of the patient or the sensitivities of the highly qualified staff and their managers?

I can tell you, the mantra in many private organisations is that if you see a job that needs doing, and it aint being done, then it becomes YOUR job! And that applies right up to board level! So whilst the CEO (or a Doctor) might not be directly employed to clean up poo, if thats what needs to be done for the best interests at that moment of customers/patients, and if he/she's the only bod available, then he/she better be prepared to get the mop out.

Edited to add - beaten to it (and far more eloquently)

Edited by andymadmak on Thursday 20th November 16:03

[captainzep]

V8 Fettler said:

Average age for an admitted patient will be around 50 years of age (my guess with no supporting info!).

Average age of hospital inpatient estimated to be over 80.

http://www.kingsfund.org.uk/sites/files/kf/field/f...

[V8 Fettler]

Sway said:

Not suggesting hire a doctor to clean a ward, but if a doctor is with a patient that has soiled themselves, and no-one else is immediately available, help make the patient more comfortable - instead of walking away, leaving the patient wondering when they're going to get help.

That makes a huge difference to a confused elderly person lying in st, and isn't going to cause irreparable damage to the doctor's day.

I speak from experience in seeing this - it wasn't until half an hour later when I kicked up a fuss that any effort was made to make my grandmother more comfortable, and less embarrassed...

Ultimately, what's more important, the doctor's time/cost, or the patient's physical and emotional wellbeing?

In every other part of employed life, if an unsafe situation is noticed, it doesn't matter who you are or your job title/wage/etc., your legal responsibility is to make safe to the best of your ability, before getting someone more appropriate to fully resolve the issue...

Ultimately, what's more important, a well-managed health service where a doctor's expensive time is used most efficiently (to treat patients), or a health service where a make-do and mend mentality requires doctors to clean wards because NHS management are incompetent?

[V8 Fettler]

andymadmak said:

V8 Fettler said:

Bizarre that anyone should even consider employing a doctor to clean a ward, the cost must be something like 20x the cost of employing a cleaner. Firefighting to fix problems is not management.

.

You are missing the point. Nobody is suggesting that we set out to employ doctors to clean wards. Quite clearly, cleaners should be cleaning wards, and doctors should be doing God-like things ..

However, to continue with the ward cleaning example, what is being pointed out is that when the ward is obviously filthy, and thus is likely to be causing significant additional health problems for patients, then it stands to reason that all managers and staff should be prepared to do something about it in order to be acting in the best interests of the patients! Its no good them just ignoring the dirt now is it?

Maybe the cleaner is off ill, maybe the cleaner is crap, maybe the management of the cleaning service is woeful, and maybe, just maybe (as I have seen myself) the cleaner has just finished his/her shift and left, only for a bodily fluid spill to occur. In which cases the suitable staff and management responses are obvious., But in the last example of the cleaner having just finished his/her shift, is it not more sensible to clean the crap up straight away? or shall we let patients and clinicians walk the crap through the ward and the hospital "cos it aint our job to clean it up and the next cleaner aint due on shift for 2 hours"?
What is more important? The wellbeing of the patient or the sensitivities of the highly qualified staff and their managers?

I can tell you, the mantra in many private organisations is that if you see a job that needs doing, and it aint being done, then it becomes YOUR job! And that applies right up to board level! So whilst the CEO (or a Doctor) might not be directly employed to clean up poo, if thats what needs to be done for the best interests at that moment of customers/patients, and if he/she's the only bod available, then he/she better be prepared to get the mop out.

Edited to add - beaten to it (and far more eloquently)

Edited by andymadmak on Thursday 20th November 16:03

The point you're missing is: why isn't there a cleaner on shift? There's a clear need for it in your scenario. Again, why settle for firefighting cleaning problems with expensive doctors when competent management should ensure that the only involvement an expensive doctor has in the cleaning process is "Please clean this up."

I'm not aware of any private sector organisations of similar size to the NHS where board level directors clean up crap, except perhaps for obscure publicity purposes. Perhaps you can link to a few examples.

Bizarre that posters appear to regard poor management within the NHS as acceptable and that firefighting is a valid option. Fix the problem at the root of the problem.

[Sway]

I can't find it at the moment, but there's a cctv video of a very senior manager/director of Honda cleaning the boot room of one of the plants because the staff worked overtime to meet production when problems occurred during the day...

Why is helping to make a patient more comfortable not treatment? After all, the doctors don't put pills in people's hands/set drips/etc. In fact do doctors do any real 'treatment' at all, or do they diagnose and plan treatment delivery?

In the ideal world, of course there would never be a need. However, we're a long way from that - oh, and by not doing anything, the consequences could he significantly more doctor time and treatment needed due to exacerbated conditions/infections being caught.

Prevention is significantly more efficient than cure.

[V8 Fettler]

captainzep said:

V8 Fettler said:

Average age for an admitted patient will be around 50 years of age (my guess with no supporting info!).

Average age of hospital inpatient estimated to be over 80.

http://www.kingsfund.org.uk/sites/files/kf/field/f...

Tried to make sense of this lot http://www.hscic.gov.uk/pubs/hes0910 but failed miserably.

[captainzep]

V8 Fettler said:

Tried to make sense of this lot http://www.hscic.gov.uk/pubs/hes0910 but failed miserably.

Cor! Getting into the dark underworld realms of HES data flows which underpin the complex commissioner/provider payment streams and waiting time target rules! -Hardcore!

My understanding (and we're stretching my own 16 year NHS knowledge here) is that Finished Consultant Episodes are a unit of activity and cover the period someone is under the care of a consultant. It's not equivalent to people lying in hospital beds. Older, frail people tend to be in beds longer and they occupy the system more.

[mph1977]

Gargamel said:

NHS - Full of clever people doing amazing things. I deal with healthcare systems around the world from an employee costs point of view. Private insurance works great for the employed, healthy population. It is a terrible thing to be long term ill on private insurance.

However the issues with the NHS won't be fixed by money, what is required is a split back to community hospitals (outside the NHS, centrally funded and run by local Medical Boards - including GP's. Then larger Regional centre hospitals offering the FULL range of NHS services at scale.

With specialist centres on a national basis for advanced treatment for spine, heart specialist and researchers to group around.

However - the results of this style of change is that some folk lose "their" local A&E or large hospital, that is always going to be highly controversial.

the biggest problem the NHS has is reverse NIMBYs

They oppose closing the local ambulance station despite the fact it gets used for half an hour twice a day as the day shift hand over to nights and then as nights hand over to days

They oppose the conversion of a semi rural area's Ambulance to an RRV , despite the fact the ambulance gets pulled into the big town / city most of the time where the RRV will stay on the patch ( it takes the local ambulance the same amount of time to get back from the hospital in the big town / city as it does the 'next available' - which is why vehicles get 'trapped' in town )

They oppose "closing the local A+E department" despite the fact the hospital it is in doesn't have the services to support a meaningful Emergency department and you'll be taken to the big hospital anyway if you dialled 999 ( especially if you have a heart attack, stroke or have suffered major trauma ) and for significant proprtion ofthe things you'd make your own way to A+E for ( sprains and strains, wounds that might need gluing or suturing) a Minor Injuries unit staffed by Nurse practitioners / Paramedic practitioners and GPs is more than adequate ( do you want to be stitched up by someone who has been doing it for 10 years and done tens of thousands of them or by some spotty youth fresh out of medical school ? - yes junior doctors have to learn but it is crazy that people consider Nurse practitioner Led and delivered services to be downgrade from Junior doctor delivered services with (still) absentee landlord consultants - or led by consultants stuck in Resus with genuinely life threateningly ill people )

They oppose the rationalisation of services which require large populations to support safe and effective practice and given an acceptable on call rota for the speciality ( vs the joys of junior dentists covering ENT on call as a SHO in the hospital as part of a joint 'head and neck ' on call rota - as MaxFax House officers/ SHOs are often single qualified dentists )


Then there are the blind ideolgues who oppose community based Care of the eldery and Rehab services because it's not hospital , they opposed dedicated 'cold' surgical units - despite the fact the seperation of elective and emergency and/or highly complex work means that both get delivered in a timely manner as eletcive and emergency in the same facility is a zero sum game

you also have to consider why the likes of Unison want to maintain the monolithic structures -
1. strikes can be spread easily ( as it's 'all the same employer' )
2. trusts have become used to paying for Unison's full time Officer cadre (and that is in reality what convenors are for Unison in the Health Service and LAs )
3. provides good shroud waving publicity opportunities.

Edited by mph1977 on Thursday 20th November 20:03

[mph1977]

turbobloke said:

The number of managers in the NHS rose at double the rate of doctors and nurses under Labour. Throwing other people's money around and generating taxpayer subsidised jobs is all they know.

and that's the problem , also they were nearly all pointless lay managers or claim-to-be-Nurses-but-don't-actually-practice Managers - they function as Political Commissars ensuring that tractor production will break all records comrade !

There is a requirement for a certain level of managerial presence in the NHS but these by and large (asside from line management of Health professionals by healoth professionals) they should be support professionals as managers e.g. HR people, accountants, engineers (HVAC, medical systems, building services) , 'facilities management ( catering, cleaning, laundry etc ) but the Blair- Brown era saw a ridiculous increase in lay managers who are far more of the problerm than the oft lampooned ' 5 -a- day advisor ' ( cheaper to pay band 4 for someone with a level 3 in health prmotion or a nutrition degree to do this than to pay band 6 for a District Nurse or Dietitian )
or 'carbon reduction manager' ( who using their business and/or building services background to reduce energy consumption and reduce waste , increase useful recycling by waste segregation etc)

Edited by mph1977 on Thursday 20th November 20:00

[rovermorris999]

mph1977 said:

Lots of good stuff....

I agree. I've seen it in my area with ambulance provision.