Just another £1.2 Billion to fix the NHS?

[Slartifartfast]

The NHS is very good at coping. Unfortunately the mechanisms used to cope with unexpected emergencies has become the new standard modus operandi. It has stopped the NHS falling apart so far, but it is unsustainable for very much longer.

[V8 Fettler]

captainzep said:

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.

From the above link, refers to "stay" , although still as clear as mud. Does "admission" mean admitted to hospital overnight? Or does it mean admitted to hospital for a day only? Exec summary needed. With a nice pie chart.

[Du1point8]

Hope the fines that going to come out about bed blocking are not a one off £100, but are £100 per day.

I have been reading that some families have been keeping their elderly relatives in hospital as its a inconvenience for them to sort out other accommodation at the time, also means they don't have to pay anyone to take on an elderly patient that is physically fine, might just be missing a few marbles.

I experienced bed blocking when I couldn't get onto the ward I was supposed to be on, all thanks to a family deciding not to pick up their relative as they were going away for the weekend and it was already 'booked' so she could stay in the ward and they would be back after their break on monday, apparently she was already a week over her stay and they had been fobbed off for a week by this family... So instead of being on the correct ward awaiting my operation, I had to stay on a ward with 2 methadone addicts that were threatening everyone and screaming the place down until they go their hit.

Lovely 2 days with security there 24/7 until one of the addicts decided to make a break for it and another was moved.

[LucreLout]

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness isn't everyone's jobs frankly bizarre.
Only in the public sector could such attitudes be tolerable.
The NHS needs to get to grips with basic sanitation and healthcare. If you work in the NHS then patient care, and by extension, ward cleanliness is YOUR responsibility. If you have to stick in 30 mins unpaid overtime at the end of your shift, then roll up your bloody sleeves and get the floor mopped. Doesn't matter if you're a doctor, nurse, porter, or paper shuffler - cleaning is not a speciality.

[spaximus]

Most of the bed blocking is not caused by families going on holidays, it is council not getting care packages for people go home.

My mum had a stroke, the authorities came out to asses what she needed, walking frame, shower seat and handle, toilet handles to lift her off the pan.

She was due out four days later if it all went to plan, but 6 days later she was still there as she still had no equipment. I had offered to buy this but as I live in Bristol and parents like in Yorkshire was told no need it will be there before she comes out.

What they meant was as long as she was in hospital, they did not have to have two careers come every day twice a day to see to her so drag it out as that comes of the NHS budget not the council care one.

What would have been more effective would have been her in a convalescence home with others like her getting pysio instead of back and forwards with carers coming at odd times.

In many EU countries that is exactly what they have and it works.

[g3org3y]

V8 Fettler said:

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?

This.

And that's coming from an ex hospital doctor who has helped nurses/HCAs on multiple occasions cleaning or transferring patients, fetching commodes etc. A well run ward has good camaraderie and everyone chips in (if possible). However, one needs to be realistic regarding expectations.

If someone is paid to clean and it hasn't been done - why not? If the cleaner is sick, why are there no contingency plans? Where is the organisation? There has been a significant failing. To be honest taking shop floor staff away from their duties to cover up the failings of others isn't the way to do it imvho.

While I take the time to clean patients and mop floors, who would come to review my patients that are lining up in A&E? Who is going to see the sick patient I've been bleeped about? The cleaner? The manager responsible for organising the cleaners? The hospital CEO? LucreLout? Jeremy Hunt?

As noble a cause as it is, a doctor's time isn't infinite especially during a busy on call. Between seeing patients and the associated paperwork there's little time for much else. That's even before considering that a significant proportion stay way well beyond their timetabled hours anyway just trying to complete all the required work.

A proper, well run ward should not have such issues. I agree, as health care professionals we all have a duty of care and cleanliness. However, if a ward is filthy the are major failings that need to be addressed and a doctor with a mop isn't the answer.

The best ward I ever worked on was run by a traditional old school matron. She had been there decades, took no crap from anyone and was respected by everyone. No chat back from junior nurses, everyone knew their role and the ward was always perfectly clean. Was that because the staff on that ward were better or more numerous than other wards? No, it was because she ran it brilliantly.

[mph1977]

spaximus said:

Most of the bed blocking is not caused by families going on holidays, it is council not getting care packages for people go home.

My mum had a stroke, the authorities came out to asses what she needed, walking frame, shower seat and handle, toilet handles to lift her off the pan.

She was due out four days later if it all went to plan, but 6 days later she was still there as she still had no equipment. I had offered to buy this but as I live in Bristol and parents like in Yorkshire was told no need it will be there before she comes out.

What they meant was as long as she was in hospital, they did not have to have two careers come every day twice a day to see to her so drag it out as that comes of the NHS budget not the council care one.

What would have been more effective would have been her in a convalescence home with others like her getting pysio instead of back and forwards with carers coming at odd times.

In many EU countries that is exactly what they have and it works.

unfortunately when , in the NHS , we (doictors, Nurses, AHPs , social workers, try to place people in community rehab beds , all hell breaks out ...

including notably, an adult son or a perfectly mentally competent elderly lady ranting , raving and taking a swing at one of my colleagues because " You can't effing put my mother in a home without my consent you effing see u next tuesday, I pay my taxes she stays in hospital and if you do anything different i'll have you effing job " , while not so expletive filled this was a regular fixture of working on an acuite assessment unit in the urban UK.

despite , with regard to the above example, the facts

1. the lady was competent to make her own decision
2. she fully understood why, what and where the plan was
3. even if she lacked capacity, unless he was a Court appointed deputy or have a valid power of attorney he could not consent on her behalf " next of kin" has no meaning in law
4. there was no clinical reason for the lady to be in an acute hospital, her care needs where personal care related ( because of mobility) and rehab

If someone needs a longer term residental or nursing home placement delaying tactics are common even if there are beds in good homes able to meet the needs of the patient ... families hoping for miracles, thinking that the hospital will just keep them if they delay long enough ( prolonged stays without extremely good clinical reason are infinitessimally rare - and when they do exist it'sd for people with complex medical needs - where their stay is made up on months on intensive care, followed my months of 6 million dollar man style 'we will rebuild him' , followed by months of intense rehab in a tertiary specialist unit - meaning incident to hospital discharge can be as much as 18 months ... this isn't the 1950 and 60s with long stay hospitals any more ... and where long stay elderly care 'hospitals' persisted after this you really wouldn't want to send someone to this putrid warehouses especially when you look at the person centred care delivered in a decent Residential or Nursing Care Home these days.

Edited by mph1977 on Friday 21st November 19:55

[spaximus]

I understand that MPH. as I wrote before I get it from both directions with the wife being a senior person in NHS finance and daughter a Doctor.
The problem is that people do not understand anything other than what they think they know.
I was at a Care UK hospital for a scan. A woman in the waiting room said "nice to see a new NHS hospital here". So I explained that it was infact a private hospital we were in. There were 6 or 7 others who were there who could not see how it could be treating NHS. There was a sign saying NHS treatment centre so it was NHS.
After a while the penny dropped and they all agreed that it was a nice hospital, clean, with real people so it didn't matter so long as they got paid.
Now if the same was done to accomadate bed blockers in a clean safe environment then there would not be so much anger. What the public see is care home workers on minimum wage beating up and abusing people, if that was not true and it became the norm that if they were not able to go home they went to a suitable place people would accept it.
A&E is the thing that casues "normal" hospitals problems as you know. Having elective surgery elsewhere takes the pressure off but Labour keep spouting privatisation is bad and people beleive it, even though they did most of it.

[mph1977]

spaximus said:

A&E is the thing that casues "normal" hospitals problems as you know. Having elective surgery elsewhere takes the pressure off but Labour keep spouting privatisation is bad and people beleive it, even though they did most of it.

having the same people doing all the emergency and all the elective work is a zero sum game - people seem to forget this

Labour have to come up with the rhetoric about privatisation to keep the money pouting into their coffers Unison, Unite etc etc

the Blair- Brown era saw a hell of a lot of privatisation i nthe NHS , PFI, treatment centres etc etc etc

what's the difference between Ed Milliband and Wallace from Wallace and Gromit ?

one's a funny looking puppet who every movement and action is controlled by others behind the scenes and the other is made of plasticene

[V8 Fettler]

LucreLout said:

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness isn't everyone's jobs frankly bizarre.
Only in the public sector could such attitudes be tolerable.
The NHS needs to get to grips with basic sanitation and healthcare. If you work in the NHS then patient care, and by extension, ward cleanliness is YOUR responsibility. If you have to stick in 30 mins unpaid overtime at the end of your shift, then roll up your bloody sleeves and get the floor mopped. Doesn't matter if you're a doctor, nurse, porter, or paper shuffler - cleaning is not a speciality.

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness should be dealt with by using expensive doctors in a firefighting role is frankly bizarre and a waste of my tax money (that bit is important).

Planned cleaning to prevent the gradual build up of dirt over time, emergency cleaning team on a 15 minute attendance time. Just need to get the costs right and ensure that the contract has no wriggle room for the contractor.

[andymadmak]

V8 Fettler said:

LucreLout said:

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness isn't everyone's jobs frankly bizarre.
Only in the public sector could such attitudes be tolerable.
The NHS needs to get to grips with basic sanitation and healthcare. If you work in the NHS then patient care, and by extension, ward cleanliness is YOUR responsibility. If you have to stick in 30 mins unpaid overtime at the end of your shift, then roll up your bloody sleeves and get the floor mopped. Doesn't matter if you're a doctor, nurse, porter, or paper shuffler - cleaning is not a speciality.

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness should be dealt with by using expensive doctors in a firefighting role is frankly bizarre and a waste of my tax money (that bit is important).

Planned cleaning to prevent the gradual build up of dirt over time, emergency cleaning team on a 15 minute attendance time. Just need to get the costs right and ensure that the contract has no wriggle room for the contractor.

I think you are missing the point. Doctors and Nurses merrily turning a blind eye to filth, to the detriment of their patients, is indicative of a mindset that has no place in the NHS.
Doctors and Nurses should not be cleaning wards. Doctors and Nurses should not be firefighting ( as you put it) for the defficiencies of the cleaners. Doctors and Nurses should also not be failing to ensure that filth or spills are cleaned up.

I have first hand experience of nurses happily ignoring a large pool of blood, st and piss on the floor for several hours. No one called it in, no one volunteered to clean it up. They were " waiting for the next cleaner to come on shift" . I was in the bed next to the Nurse station, and I heard/ saw everything. I myself pointed out that the mess was not healthy, but was ignored.

During the time they were waiting for the next cleaner to arrive countless people, including nurses, patients and visitors, walked through the mess and, of course, proceeded to distribute it around the ward and ( I assume) the hospital. It eventually got cleaned up when my then girlfriend ( who had come to visit me) and who is an ex staff nurse and now senior NHS manager suggested that it should be sorted IMMEDIATELY! The nurses, who had spent the entire previous hour discussing their sex lives over a cuppa at the Nurses station, then organised an auxiliary to do the clean up ( but not without the nurses significant audible chuntering and complaining that it was not their job to organise the clean up)
A case of bad apples, or an indicator of a"not my job, mate'" attitude that can only spell danger for patients.

During that same stay in hospital I also noticed just how reluctant some nurses were to actually wash their hands between touching different patients. Given that this was only 3 years ago, is it any wonder that so many people die of hospital acquired infections?
The attitudes HAVE TO CHANGE!

[andymadmak]

More populist nonsense from New Labour.........

http://www.bbc.co.uk/news/uk-politics-30158810

[Countdown]

http://www.telegraph.co.uk/health/nhs/11244723/Hos...

[Zedboy1200]

The NHS is largely very good at doing what it does in terms of acute care, but it is very poor at stopping doing what it doesn't need to do anymore and using the savings to tackle the new challenges in a different way.

It is also very very poor at saying no. For example, it just won't stop trying to deliver social care, even though it is not reimbursed for this hugely costly activity.

The challenge is not financial, demographic or anything else mentioned already, it is the culture. Change that and you'll change outcomes for patients and enable it to live within its means. The problem is you'll need to performance manage hundreds of thousands of people to treat this business as their own, plus put themselves out of their oh so comfortable zones... Can't see any clinical managers achieving this themselves, or any non-clinical managers persuading HCPs to change what they do consistently.

Hey ho, will keep me in work for the rest of my career?!...but depressing too. After all, it's our money they waste.

[mph1977]

Zedboy1200 said:

The NHS is largely very good at doing what it does in terms of acute care, but it is very poor at stopping doing what it doesn't need to do anymore and using the savings to tackle the new challenges in a different way.

It is also very very poor at saying no. For example, it just won't stop trying to deliver social care, even though it is not reimbursed for this hugely costly activity.

what exactly are you proposing there ?

USAmerican style wheel them out the doors of the hospital and tip them into the gutter ?

sending medically fit patients home to unadapted properties and without a package of care in place ?

you going to meet the difference in earnings between the top of band 5 and minimum wage working as a packer ? as any HCP doing that would be roasted by the NMC/HCPC/GMC

Zedboy1200 said:

The challenge is not financial, demographic or anything else mentioned already, it is the culture. Change that and you'll change outcomes for patients and enable it to live within its means. The problem is you'll need to performance manage hundreds of thousands of people to treat this business as their own, plus put themselves out of their oh so comfortable zones... Can't see any clinical managers achieving this themselves, or any non-clinical managers persuading HCPs to change what they do consistently.

Hey ho, will keep me in work for the rest of my career?!...but depressing too. After all, it's our money they waste.

Part of the problem is the 'un redundables' people i nthe 1995 p ension scheme who are basically too expensive to make redundant , becasue the trust employing them at that point has to pay the employee and employer contributions for pension until 60 years of age / 40 years service to the NHSBSA


The press and politicians like to attack Educated Nurses ( and dear of Clare Rayner was at the forefront of it , lauded by various people fro mthe fact she'd been a SRN and SCM - she practiced for less than 10 years including both sets of pre-reg training and hadn;t worked in a rtegisterable capacirty since something like 1960), the problem with this is I'm not aware of any Trust who has a Director of Nursing who did education based pre-reg rather than traditional training , not sure how many 'Educated' Nurses thereare at assistant director level, they are generally outnumbered by traditional trained at Matron and Ward Manager (Senior Sister/ Senior Charge Nurse) level.

[Snollygoster]

Personally, I'd much prefer not paying NI and just paying for insurance. The problem is, and it's with all public sector companies - not just the NHS, but the ridiculously polices they set which aren't cost effective. Privatisation means expenditure will be much more closely monitored, and they won't waste as much money.

My dad spent a year with the public sector coming from private all his life. He's had company cars, but in the public sector they wouldn't provide one as they make them use public transport due to being transparent etc. His rail bills for a year were something like £10,000. A company car would surely have been more cost effective?

And with obesity on the up, this is going to put a huge drain on the NHS over the years.

[speedy_thrills]

The UK has quite a confrontational form of politics. At times that has allowed the UK to perform well when short term agility was required. However long term commitments (Health, Defence, Infrastructure, Law and Order, Social Welfare) might be better served by seeking binding long term commitments between major parties.

Much of the difficulty government departments have is that there has been no collaboration or agreement between political parties. One government invests in building long term capability (updating facilities, training staff etc.), the next government benefits in the short term by mining those same capabilities (not maintaining facilities, cutting staff training programs etc.)

Obviously I don't live in the UK any more or care much about it's social services but I'd expect NHS costs to continue to grow at a rate above inflation given the population age demographics of the UK. Any NHS budget targets should take this and other factors (cost of treatment, supply of staff etc.) into account when allocating funding if it is to be successful. Once this is done the NHS can be held accountable on outcomes.

After all this problem of building future capability or mining an organization isn't even unique to government.

[V8 Fettler]

andymadmak said:

V8 Fettler said:

LucreLout said:

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness isn't everyone's jobs frankly bizarre.
Only in the public sector could such attitudes be tolerable.
The NHS needs to get to grips with basic sanitation and healthcare. If you work in the NHS then patient care, and by extension, ward cleanliness is YOUR responsibility. If you have to stick in 30 mins unpaid overtime at the end of your shift, then roll up your bloody sleeves and get the floor mopped. Doesn't matter if you're a doctor, nurse, porter, or paper shuffler - cleaning is not a speciality.

In a time where literally thousands of people are dying of hospital acquired infections, I find the attitude that ward cleanliness should be dealt with by using expensive doctors in a firefighting role is frankly bizarre and a waste of my tax money (that bit is important).

Planned cleaning to prevent the gradual build up of dirt over time, emergency cleaning team on a 15 minute attendance time. Just need to get the costs right and ensure that the contract has no wriggle room for the contractor.

I think you are missing the point. Doctors and Nurses merrily turning a blind eye to filth, to the detriment of their patients, is indicative of a mindset that has no place in the NHS.
Doctors and Nurses should not be cleaning wards. Doctors and Nurses should not be firefighting ( as you put it) for the defficiencies of the cleaners. Doctors and Nurses should also not be failing to ensure that filth or spills are cleaned up.

I have first hand experience of nurses happily ignoring a large pool of blood, st and piss on the floor for several hours. No one called it in, no one volunteered to clean it up. They were " waiting for the next cleaner to come on shift" . I was in the bed next to the Nurse station, and I heard/ saw everything. I myself pointed out that the mess was not healthy, but was ignored.

During the time they were waiting for the next cleaner to arrive countless people, including nurses, patients and visitors, walked through the mess and, of course, proceeded to distribute it around the ward and ( I assume) the hospital. It eventually got cleaned up when my then girlfriend ( who had come to visit me) and who is an ex staff nurse and now senior NHS manager suggested that it should be sorted IMMEDIATELY! The nurses, who had spent the entire previous hour discussing their sex lives over a cuppa at the Nurses station, then organised an auxiliary to do the clean up ( but not without the nurses significant audible chuntering and complaining that it was not their job to organise the clean up)
A case of bad apples, or an indicator of a"not my job, mate'" attitude that can only spell danger for patients.

During that same stay in hospital I also noticed just how reluctant some nurses were to actually wash their hands between touching different patients. Given that this was only 3 years ago, is it any wonder that so many people die of hospital acquired infections?
The attitudes HAVE TO CHANGE!

Management issues. I'm sure you complained about the pool of mixed ingredients (with photographs as evidence), what was the outcome?

[andymadmak]

V8 Fettler said:

Management issues. I'm sure you complained about the pool of mixed ingredients (with photographs as evidence), what was the outcome?

Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.

[LucreLout]

andymadmak said:

Not management issues alone. Attitudinal issues from care staff too.

Did you read what I wrote? I complained to the nurses but was ignored. My ex gf got the mess cleaned up by getting the nurses to call a cleaner. The nurses complained about having to make the call. If you honestly cannot see that there is an attitudinal problem here then i dont know what else to say to you.

I never thought I'd say this as long as I lived, but the disgusting attitudes shown by NHS staff on this thread have finally convinced me. The only answer is to shut it down. All of it.
Start again with a clean sheet of paper, no standing army of paper pushers or jobsworths (for that is the attitude being shown however well camouflaged), and design a new organisation focussed around patient care. That may or may not need some privatised elements, but what it so definitely doesn't need is any unionisation.
Set a fixed percentage of gdp beyond which spending on health cannot rise, and create legally binding contracts to drive the best outcomes based on that money. It'd force the new nhs to stay modern and look to efficiency in all it does. And yes, if a bunch of nurses have an hour to chat about shagging during their shift, then they have time to mop the ps off the floor while chatting. Better for the patient you see.