Just another £1.2 Billion to fix the NHS?

[andymadmak]

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?

Edited by andymadmak on Wednesday 19th November 09:09

[andymadmak]

CamMoreRon said:

Regarding PFI.. what can we do about it? I mean.. if I were PM (and it's a bloody good job I'm not) I would cancel all PFI contracts and stick my fingers up at anybody who complains they're losing out. I wouldn't have a bad word to say about any politician who proposed the same.

It is one of the greatest scandals of the New Labour years that PFI was used on projects that it was never designed or intended for. PFI was (I think) originally an Australian idea that the Conservatives had imported for use on a few projects. Essentially it was designed for large scale infrastructure projects that generate revenue from their use, and that revenue is used to pay off the finance that was put up by the markets to build and maintain that infrastructure. So good examples of the correct use of PFI would be toll bridges, toll roads etc.

What PFI was NEVER designed for was to be used to pay for general government expenditure on things like schools, hospitals etc. This is because there is no user generated revenue, and payments are thus required to be funded entirely from taxation (local and national) . Guess what Mr Brown used PFI for?

Why did Mr Brown do this? Basically so he could keep the "borrowing" off the books. The legacy of this approach has been apocalyptic in many cases. - the more so because many PFI contracts were so badly negotiated by the Public sector.

Can we just tear them up? Sadly not - the impact on the markets would horrible. However I do think that the Government should be insisting on renegotiating the contracts in many cases.

[andymadmak]

mrpurple said:

spaximus said:

But when you have overseen a culture where all nurses have been made to be special as they are now degree educated, they do not like doing what they see as menial tasks. So when a spill of bodily fluids takes place they have to have a cleaner come instead of getting the appropriate mop and bucket. Cleaning is not their job so they accept sloppy standards.

Apparently it is now a care assistants job to change nappies on people not nurses in some hospitals.

Somehow I don't think nurses not using a mop and bucket is the cause of the NHS's woes in the scheme of things. Not a very well thought out post and bit of a cheap shot that's way off target IMO. But then I would say that as my OH has been a nurse for almost 40 yrs.

And yet the many senior nurses that I have spoken to have said that the issue highlighted by Spaximus is indeed at the heart of the problems facing the NHS today. The "too qualified to do the menial stuff" attitude that many young nurses have these days betrays a culture within the NHS that everything is always somebody else's fault or responsibility.
It was not always that way, and the senior nurses told me that they see stuff going on and attitudes to patients being tolerated from nurses in wards today that would have seen them hoiked up before Matron had they done the same things when they were younger.

What that culture ensures is that when the provision of basics like hygiene and cleaning and feeding and toilet duties etc breaks down then the whole edifice above it crashes too.
Basically, (for example) the st stays on the floor and become a problem for everyone if the cleaner fails in his/her duties for whatever reason. When the inevitable infection or accident then takes place the nurses see themselves as blameless despite having seen and ignored the (st) problem for hours/days. - And yes I have seen precisely this attitude first hand!

[andymadmak]

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.

[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.)

[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

[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

[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.

[andymadmak]

MartG said:

Croutons said:

Convenient pre-Autumn statement leak (or perhaps briefing) to the Telegraph says George will give em £2bn more next year. Nice Labour outflank, no info on which money tree is dropping it for him.

I wonder if that £2Bn was calculated in the same way that he 'halved' the recent EU bill ?

Aye.. Either way it's the wrong way to go about this imho. 1.2 Billion, 2 Billion, it's all nonsense unless the basic issues that ensure that the NHS is always in crisis are grasped and dealt with. Sadly our politicians (of all colours) are too cowardly to do what needs to be done, and too focussed on using the NHS as a political football instead. Osbourne just went down in my opinion.