Just another £1.2 Billion to fix the NHS?
Poll: Just another £1.2 Billion to fix the NHS?
Total Members Polled: 237
Discussion
Following on from the "Bye By Mr Miliband" thread in which we read about Mr Milibands mauling at the hands of Myleene Klass ("you can't just point to things and tax them" ) this thread is about how to fix the NHS.
Mr Miliband told Ms Klass that Labour would impose a "Mansion Tax" that would raise the £1.2billion that he claims is needed to "fix" the NHS. (Apparently it's going backwards under the coalition Government) In response, Ms Klass raised the valid question as to why the NHS is in such a mess, and asked whether money is the only answer?
Now, for as long as I can remember, (and I am in my 50s) the NHS, under Governments of all colours has always "needed more money". It seems that no matter how much we as a nation pour into the NHS it is never enough. Quite literally, a crisis is seemingly only ever a heartbeat away. In recent years, despite eye wateringly high levels of funding, the NHS just seems to stagger from one scandal to another, with filthy hospitals and uncaring staff leading to thousands of early deaths and unnecessary infections for patients.
And the variation in standards from one part of the country to another is staggering - Some of us have had appalling experiences at the hands of the 5th largest employer on the planet, whilst others cannot speak highly enough of the care they have received.
So, is the answer even more money? Or does something rather more fundamental need to be considered?
Mr Miliband told Ms Klass that Labour would impose a "Mansion Tax" that would raise the £1.2billion that he claims is needed to "fix" the NHS. (Apparently it's going backwards under the coalition Government) In response, Ms Klass raised the valid question as to why the NHS is in such a mess, and asked whether money is the only answer?
Now, for as long as I can remember, (and I am in my 50s) the NHS, under Governments of all colours has always "needed more money". It seems that no matter how much we as a nation pour into the NHS it is never enough. Quite literally, a crisis is seemingly only ever a heartbeat away. In recent years, despite eye wateringly high levels of funding, the NHS just seems to stagger from one scandal to another, with filthy hospitals and uncaring staff leading to thousands of early deaths and unnecessary infections for patients.
And the variation in standards from one part of the country to another is staggering - Some of us have had appalling experiences at the hands of the 5th largest employer on the planet, whilst others cannot speak highly enough of the care they have received.
So, is the answer even more money? Or does something rather more fundamental need to be considered?
Edited by andymadmak on Wednesday 19th November 09:09
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 NHS is a strange beast, the waste of money is monumental, no body cares, my wife works for them and tells me about it all the time, recently my wife had to go for some training,she was sent with some others, about six of them 50 miles away, all on travel allowance, when my wife asked could the trainer not come to them, she was told no they do not do it that way, on the coarse there was nothing that could not have been fitted in to a boot of a car, this is just a small example of a larger problem.
My father was a GP and up until the last few years of his career his 4 colleagues and him would share the on call work covering about 5 square miles and c.10k patients. It wasn't very pleasant being on call every 4th night and every 4th weekend and people did abuse the service calling out the docs for the most trivial of things however from a patients pov it was far better than the out of hours system we have now. It also meant less stress on the local A&E. I have a handful of friends who are medics working in A&E and the amount of people they see who really should have been dealt with at primary care level takes up a huge chunk of their work.
Perhaps it is time to renegotiate the GP's contracts (similar to what they did with the dentists recently) and make them take on a greater workload in order to ease the stress on A&E. That would save a lot of money.
Perhaps it is time to renegotiate the GP's contracts (similar to what they did with the dentists recently) and make them take on a greater workload in order to ease the stress on A&E. That would save a lot of money.
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.
Fully agree with this bit. 
Gargamel said:
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.
Not too sure. i think the "main" issue is that the NHS is trying to provide too much. Healthcare Innovation is ongoing, new treatments are constantly being devised, and all this increases cost. Painful and draconian as it may seem, there will need to be healthcare rationing.By my quick maths, £1.2b is the equivalent of 4.5 days of funding.
Hardly earth shattering is it?
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
Hardly earth shattering is it?
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
So why is it people think the NHS is broken?
My experience is quite the opposite. It seems to work effectively. Yes I hear of problems in some hospitals, but any large organisation (and it doesn;t get much larger than the NHS) has some duff bits. The ocassions I or my family have had to use it in my lifetime I could not find fault.
So what is broken? Or are we just fed a load of spin, to give an excuse to keep feeding vested interests (not patients) & the sacred cow.
My experience is quite the opposite. It seems to work effectively. Yes I hear of problems in some hospitals, but any large organisation (and it doesn;t get much larger than the NHS) has some duff bits. The ocassions I or my family have had to use it in my lifetime I could not find fault.
So what is broken? Or are we just fed a load of spin, to give an excuse to keep feeding vested interests (not patients) & the sacred cow.
The NHS will spend it's budget (possibly a little more) whatever level that budget is set at. As a nation we need to decide what level of service we want to be publicly funded. There would be difficult choices - how long do people with cancer get treatment that extends their life with no possibility of a cure? There will be choices that should be easy - who should pay for cosmetic surgery that has no medical justification?
Increasing life expectancy will increase the demand for NHS services regardless of any other factor. We have to decide what services we want and how far we are willing or able to fund those services.
Increasing life expectancy will increase the demand for NHS services regardless of any other factor. We have to decide what services we want and how far we are willing or able to fund those services.
PRTVR said:
The NHS is a strange beast, the waste of money is monumental, no body cares, my wife works for them and tells me about it all the time, recently my wife had to go for some training,she was sent with some others, about six of them 50 miles away, all on travel allowance, when my wife asked could the trainer not come to them, she was told no they do not do it that way, on the coarse there was nothing that could not have been fitted in to a boot of a car, this is just a small example of a larger problem.
But this would happen (and does) with any private organisation! For example, I recently had to go (primarily as a PR thing) to the very south of Germany to speak with a customer. I was flown to Zurich, where I rented a car, and went for a drive through beautiful southern Germany to a small alpine village. Of course, all of this was paid for by the company I work for.I know you weren't suggesting that a private NHS would be any different, but I think it's important to note how the private sector "wastes" their money in very similar ways. I don't think anyone would bat an eyelid if I went for a 50 mile jaunt.. I could probably go for one this afternoon if I wanted to.
The NHS doesn't need more money. It needs to stop wasting the money it already gets.
The big of the NHS that I work in throws money around like it's going out of fashion. If they spent what they have sensibly then we wouldn't be in the situation we're in at the moment where we're failing in almost every aspect of what we do.
The big of the NHS that I work in throws money around like it's going out of fashion. If they spent what they have sensibly then we wouldn't be in the situation we're in at the moment where we're failing in almost every aspect of what we do.
CamMoreRon said:
PRTVR said:
The NHS is a strange beast, the waste of money is monumental, no body cares, my wife works for them and tells me about it all the time, recently my wife had to go for some training,she was sent with some others, about six of them 50 miles away, all on travel allowance, when my wife asked could the trainer not come to them, she was told no they do not do it that way, on the coarse there was nothing that could not have been fitted in to a boot of a car, this is just a small example of a larger problem.
But this would happen (and does) with any private organisation! The private sector tends to be careful, with experience of both this would be obvious. Not that everything is hyper-efficient but then it's private money. Spot the differences: public / private, often / sometimes.
CoolC said:
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
Maybe I haven't been paying enough attention, but has anybody actually determined how much "bureaucracy" can be cut without suffering a complete management breakdown? I assume management structures have been fattened up over the years to cope with the vast torrents of paperwork and stock / equipment / records management that is required to keep everything running from behind the scenes? How much of that fat could actually be trimmed out, before people become overwhelmed with workloads and start half-jobbing everything to stay afloat?Gargamel said:
NHS - Full of clever people doing amazing things.....
....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.
That's a very significant point - even under this govt we've seen Tory MP's (even ministers I think) joining protests against the closure of their "local" services as too many votes depend on it. Wherever you go there is always a personal story about how that particular unit "saved my child's life so you can't close it". I think it's going to need a hard headed health secretary & a government with a big majority to deal with that one......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.
NICE was a good start - clear and dispassionate policy about drugs, and a good attempt to fight back against the pharma companies. (subverted by the cancer drugs fund, which is now struggling)
I'd suggest that some of the answer is to get managers who can actually manage, not just administer. There's a big difference. Did you watch the Gerry Robinson programmes a few years back? they showed how useless some managers were, and actually how doctors wanted to do less managing, and have more time to do the jobs they were actually trained to do.. There are vast numbers of talented and committed people working for the NHS - the potential is there.
http://www.telegraph.co.uk/health/healthnews/98761...
Couple that with much more integrated social & community care - help people before they need to go to hospital, and support them when they leave, so they can get home quickly. Preventive & community medicine has got to be cheaper.
Money pressures will always be there I think - we know that our healthcare funding is lower as a % of GDP than Germany, France, US etc.. Better management of their estate would help - one off cash from redundant sites & reductions in running costs, but I don't see that as a major factor. There are some short term money issues that need addressing, but I've stayed away from party political points so I won't go there now..(edit - just noticed my dig at the cancer drugs fund..
)Edited by edh on Wednesday 19th November 09:59
CamMoreRon said:
CoolC said:
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
Maybe I haven't been paying enough attention, but has anybody actually determined how much "bureaucracy" can be cut without suffering a complete management breakdown? I assume management structures have been fattened up over the years to cope with the vast torrents of paperwork and stock / equipment / records management that is required to keep everything running from behind the scenes? How much of that fat could actually be trimmed out, before people become overwhelmed with workloads and start half-jobbing everything to stay afloat?This was described as an excoriating attach on NHS managers by a consultant surgeon who said:
A few weeks ago, I had lunch with four old friends. We have all worked in the NHS for more than 25 years. All of us are consultant surgeons and all trained together at the same London teaching hospital.
We learnt the art of surgery from masters of their craft and all undertook post-graduate research degrees in the same field. We left full of enthusiasm having been appointed as consultants to major hospitals. Each of us has led large clinical teams performing major cancer surgery as well as elective and emergency general surgery. We are all, sadly, about 50 years old. We meet a couple of times each year and as always, it was wonderful to see each other. As the wine flowed and the steaks arrived, the gossip got better. But before long the discussion took a distinctly melancholy turn.
We started talking about the NHS, our plans for the future and, specifically, retirement. Every one of us confessed that we were considering leaving the NHS early. My friends are disillusioned, not with being doctors, or the practice of surgery, not with our colleagues or patients, but with an overwhelming sense that we have lost all power over our day-to-day professional lives. They talked of feeling lost in a sea of bureaucracy over which they have little influence. Our ability to direct and control our own clinical teams has diminished. Those of us with managerial roles find we shoulder an enormous burden of responsibility — but little authority.
My friends are all frustrated to the point of throwing in the towel. These people were the brightest in their year. They passed gruelling exams and spent years training to perform hugely complex tasks combining intellectual and technical skills. Between us we have accrued more than 150 years of combined clinical experience. We ought all to be moving on to senior leadership roles. Indeed in any other professional services organisation, such as law or accountancy, that would be our ambition.
But my friends, like so many front-line staff, both doctors and nurses, are in despair. Yesterday, the Royal College of Nursing called on politicians to say how they plan to pay for an NHS that faces a £30 billion funding black hole by the end of the decade. One in three hospitals is now in the red. To address this deficit, some nurses are calling for patients to be charged a £10 fee to see their GP. This would raise £1.2 billion a year. But I have a more radical solution: put doctors and nurses back in charge of our health service. There are volumes of empirical and academic evidence that without the leadership of these two groups of front-line staff, hospitals fail. At best they become inefficient; at worse they become enormously dangerous.
The best performing hospitals in the world have cultures where clinicians move between operating theatre and ward and the boardroom, drawing on their expertise to inform management decisions. In the USA for example, a third of doctors at Kaiser Permanente, a high-performing healthcare organisation, spend a significant part of their careers taking responsibility for the management of the hospitals in which they practise.
Mid Staffs, on the other hand, is an example of a hospital where there was a systematic failure of leadership with terrible consequences for its patients. There are currently 15 hospitals in this country under ‘special measures’ because of very serious concerns that patients are receiving such poor care that many are dying unnecessarily as a result. And it’s worth remembering that this deterioration in the quality of care provided by many hospitals has happened despite all the targets imposed upon hospitals which were supposed to improve performance, as well as a significant rise not only in the number of doctors employed by the NHS but also of managers.
Today, according to official statistics, there are 274,000 managers supporting doctors and nurses. They outnumber consultants nearly seven to one. The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK.
We learnt the art of surgery from masters of their craft and all undertook post-graduate research degrees in the same field. We left full of enthusiasm having been appointed as consultants to major hospitals. Each of us has led large clinical teams performing major cancer surgery as well as elective and emergency general surgery. We are all, sadly, about 50 years old. We meet a couple of times each year and as always, it was wonderful to see each other. As the wine flowed and the steaks arrived, the gossip got better. But before long the discussion took a distinctly melancholy turn.
We started talking about the NHS, our plans for the future and, specifically, retirement. Every one of us confessed that we were considering leaving the NHS early. My friends are disillusioned, not with being doctors, or the practice of surgery, not with our colleagues or patients, but with an overwhelming sense that we have lost all power over our day-to-day professional lives. They talked of feeling lost in a sea of bureaucracy over which they have little influence. Our ability to direct and control our own clinical teams has diminished. Those of us with managerial roles find we shoulder an enormous burden of responsibility — but little authority.
My friends are all frustrated to the point of throwing in the towel. These people were the brightest in their year. They passed gruelling exams and spent years training to perform hugely complex tasks combining intellectual and technical skills. Between us we have accrued more than 150 years of combined clinical experience. We ought all to be moving on to senior leadership roles. Indeed in any other professional services organisation, such as law or accountancy, that would be our ambition.
But my friends, like so many front-line staff, both doctors and nurses, are in despair. Yesterday, the Royal College of Nursing called on politicians to say how they plan to pay for an NHS that faces a £30 billion funding black hole by the end of the decade. One in three hospitals is now in the red. To address this deficit, some nurses are calling for patients to be charged a £10 fee to see their GP. This would raise £1.2 billion a year. But I have a more radical solution: put doctors and nurses back in charge of our health service. There are volumes of empirical and academic evidence that without the leadership of these two groups of front-line staff, hospitals fail. At best they become inefficient; at worse they become enormously dangerous.
The best performing hospitals in the world have cultures where clinicians move between operating theatre and ward and the boardroom, drawing on their expertise to inform management decisions. In the USA for example, a third of doctors at Kaiser Permanente, a high-performing healthcare organisation, spend a significant part of their careers taking responsibility for the management of the hospitals in which they practise.
Mid Staffs, on the other hand, is an example of a hospital where there was a systematic failure of leadership with terrible consequences for its patients. There are currently 15 hospitals in this country under ‘special measures’ because of very serious concerns that patients are receiving such poor care that many are dying unnecessarily as a result. And it’s worth remembering that this deterioration in the quality of care provided by many hospitals has happened despite all the targets imposed upon hospitals which were supposed to improve performance, as well as a significant rise not only in the number of doctors employed by the NHS but also of managers.
Today, according to official statistics, there are 274,000 managers supporting doctors and nurses. They outnumber consultants nearly seven to one. The causes of poor quality care are complex, but there is no doubt that a lack of clinical leadership literally costs lives. The disillusion that I and my friends feel is widespread, if not endemic, in the UK.
GT03ROB said:
So why is it people think the NHS is broken?
My experience is quite the opposite. It seems to work effectively. Yes I hear of problems in some hospitals, but any large organisation (and it doesn;t get much larger than the NHS) has some duff bits. The ocassions I or my family have had to use it in my lifetime I could not find fault.
So what is broken? Or are we just fed a load of spin, to give an excuse to keep feeding vested interests (not patients) & the sacred cow.
I have to say, there is a large degree of truth in this idea.My experience is quite the opposite. It seems to work effectively. Yes I hear of problems in some hospitals, but any large organisation (and it doesn;t get much larger than the NHS) has some duff bits. The ocassions I or my family have had to use it in my lifetime I could not find fault.
So what is broken? Or are we just fed a load of spin, to give an excuse to keep feeding vested interests (not patients) & the sacred cow.
I do feel the ethos of the service, as much as anything is what might be broken - pride in the job and a real, vocational, care for the patient (and the state of the hospital you work in) - but in terms of who it serves and what it does, the NHS is still very good by any objective standard.
I would agree that more consideration about the types of care offered needs to be made. For example, I am skeptical about whether the gastric band type solutions to obesity are to be encouraged, over a more causal attack at the root of the problem in society, but I can see that over time, some treatments of the sort can be shown to save on overall costs.
I think local A&E provision is vital - the difference it can make to patient outcomes is vast.
....get out there and do something about it....I'm not a fan of this creeping privatisation of NHS services. Imho turn the taps off, give the money back to the taxpayer (ha, ha as if that will happen!) and let us all buy proper private healthcare. Those that can't afford it (the work-shy and feeble minded etc) still get it free of course.
TX.
TX.
CamMoreRon said:
But this would happen (and does) with any private organisation! For example, I recently had to go (primarily as a PR thing) to the very south of Germany to speak with a customer. I was flown to Zurich, where I rented a car, and went for a drive through beautiful southern Germany to a small alpine village. Of course, all of this was paid for by the company I work for.
I know you weren't suggesting that a private NHS would be any different, but I think it's important to note how the private sector "wastes" their money in very similar ways. I don't think anyone would bat an eyelid if I went for a 50 mile jaunt.. I could probably go for one this afternoon if I wanted to.
But presumably the company you work for isn't broke?I know you weren't suggesting that a private NHS would be any different, but I think it's important to note how the private sector "wastes" their money in very similar ways. I don't think anyone would bat an eyelid if I went for a 50 mile jaunt.. I could probably go for one this afternoon if I wanted to.
CamMoreRon said:
CoolC said:
To me the only way is to have a cull of middle management and start running to service in a controlled way. Story after story of waste within the NHS comes out, but nothing ever seems to change.
Maybe I haven't been paying enough attention, but has anybody actually determined how much "bureaucracy" can be cut without suffering a complete management breakdown? I assume management structures have been fattened up over the years to cope with the vast torrents of paperwork and stock / equipment / records management that is required to keep everything running from behind the scenes? How much of that fat could actually be trimmed out, before people become overwhelmed with workloads and start half-jobbing everything to stay afloat?I have ex colleagues that are very experienced, working for various NHS Trusts. Their experience is that given the ability to do so, they could reduce costs by half.
One of the largest problems is failure demand - pretty much every single person in the country will have an example where due to ineffective delivery at an early stage, the level of care and treatment required increases massively.
As an example of failure demand, I recently had both my washing machine and central heating boiler repaired. The boiler chap turned up, diagnosed the problem incorrectly, ordered the wrong part (even for his diagnosis). So the lead time to actually fix things increased to nearly three weeks, and four visits to my house.
My washing machine was very different. When arranging the repair visit, the call centre operative ran through a fairly simple diagnostic question flow. The engineer arrived two days later (same lead time as the boiler repair). He performed a couple of tests using kit I would be very unlikely to have, and pinpointed the fault. I asked him how long it would take to repair. His response was that 'he broadly knew the issue before leaving, had all the parts that could be causing that, and so it'd be fixed in about half an hour'. I assume that the other parts would either be returned to stock or returned to supplier, at minimal cost to the business (or supplier).
There's a few hundred quid difference in business costs to the different approaches, and the customer satisfaction much higher - so much so I've signed up to the warrantee scheme they run for all my appliances. So the first company has lost a customer, the second a regular guaranteed income. Remember, the chaps coming out to do the work onsite are considerably more expensive than the call centre operatives...
Not all of this applies to the NHS, but there are significant parallels that in principle can be applied all across the two differing approaches.
The problem is the ability to actually deliver them.
Secondly, the crippling factor for many NHS Trusts are the PFI costs - I'm sure there was a recent article that showed the average NHS Trust is spending a significant percentage of it's budget paying those loans off, when in many cases the need for the stuff paid for by those loans is very questionable...
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