Discussion
968 said:
The Dangerous Elk said:
Not atall, from the Full Facts site.
Yes and of course you know that compared with inflation this increase is not significant particularly as pay was frozen for a number of years.You also know that an increase in full time equivalent doctors does not equate to fully staffed rotas or even barely adequate numbers of staff.
Will you withdraw you accusation of me trying to post incorrect facts from CHq to mislead the thread now then ?
968 said:
andymadmak said:
I am mystified by the point in bold. Leaving aside questions of what is the right level of funding for the NHS, whether too much is wasted, how things could be done better, etc, what is the relevance of expressing the amount as a percentage of GDP? Forgive me, but it seems like just another dubious and frankly dishonest way of trying to say funding is being cut, at a time when funding is actually rising. (OK, it might not be rising as fast as many would like it to be, but it is still rising)
No, it's dishonest to state the the funding levels are ok, because they appear to be rising, albeit extremely slightly. Dishonesty is the key attribute that the SoS posses. The level of demand is far outstripping the level of funding. If you don't like the way that is expressed then take it up with various think tanks such as the King's fund, who know a thing or two about health economics. Our spend in comparison to our GDP is falling and has been for sometime, and not keeping up with our european and international neighbours. Consequently reduced levels of spending are not able to meet rising demand and we see the result with the current crisis in beds (which are falling in number every year) and lack of a social care network.The dishonesty of the SoS has resulted in the crisis in nursing that we read above and the destruction of the morale of that sector of health care workers, amongst others.
I am not sure whether it is disingenuous or not to link NHS spending to GDP. It seems a widely used metric but stating that it has been cut (due to being a lower %age of GDP) is certainly disingenuous in my opinion. Spending simply has NOT been cut in real terms. We have seen massive rises in spending over the last 20 years or so to the point whereby the physical appearance, machines and facilities do seem to have been dragged into the modern world.
I do however agree with the various points (mainly by medics and medical staff it seems) that Hunt should spend a day in the life (several in my opinion) of a Junior Hospital Dr or even an A&E senior staffer. Trotting around for stage managed photo ops must seriously pi55 off the people working their fingers raw in wards and hospitals - regardless of the extra lick of paint and smiles on show. This I wholeheartedly agree with. I am sure that there would be a marked change in viewpoint here.
Does anybody REALLY believe that it is a Tory aim (especially the much maligned SoS) to privatise the NHS and that they don't give a damn? Does anybody have any idea why Hunt has refused to be moved - he seems to want to maintain ownership despite appearing to be Political and Social suicide? He may also be wrong and flawed but I am not sure personal vendettas are only one way on this forum?
Until the DoH and Social Responsibility are genuinely entwined which is a generational thing (and appears to have finally dawned on the powers that be) then there is no solution that can be suggested or implemented. Regardless of a stupid amount of money being thrown at things?
In an effort to bring this thread back onto a sensible discussion rather than the personal attacks, I think that we are clearly reaching a point with the NHS where a number of things need to happen, and clear choices will have to be made.
I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
Let me be clear, I am not advocating privatisation. Even if,(and that's a big if) with initial goodwill from all parties, agencies and employees, the NHS could be made to work that way, the political climate is just too toxic to ever think about rolling it out. Every failure (and there still will be failures, no matter who was in charge) would be blamed on "profiteering" or some such nonsense. If nothing else, the Unions would set out to ensure that a privatised NHS would fail, because it's just too big an opportunity for them to ignore.
The NHS probably needs to be a state owned industry, although I shudder as I write that when I think back to example after example of state owned enterprises that we used to suffer. - Part of the problem here is that many people under the age of 40 will have no real knowledge of just how crap the UK state owned enterprises were, and how much better they are today in private hands. Nevertheless, if privatisation is ruled out (and I believe it must be) then we must find a way to make the structure work as a Government owned enterprise, but with no Government interference.
We need to start changing the view of the general public that the NHS (in particular their local A&E Dept) is a catch all for everything. Last time I was in A&E, amongst those clearly in considerable need , there were a number of people who, frankly should have just gone to their GP. I know that because after they had been assessed they were told exactly that, and they didn't like it! Going to A&E with a head cold or a little splinter in your finger or an ingrowing toenail should be discouraged. It's not an accident and it's not an emergency. It's basic care that their GP could undertake. Of course, to do this, we need adequate numbers of properly organised GP surgeries. I don't know what has gone wrong with the GP service, but again my experience is that there are wild variations in the scope and quality of GP care, plus the availability of appointments.
I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
The next issue is to recognise the practical issues facing the NHS. For example...does it have enough beds? Well under most circumstances, it probably does, provided that beds are not filled with patients (mostly elderly) waiting to be discharged into social care. The new NHS has to join the dots up in this regard. Resources need to be targeted at building social care centres - places where people can recuperate whilst being medically cared for, but which do not require the full paraphernalia of (and costs associated with) a large hospital.
A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
We also need to be brave and ask ourselves whether we want every treatment of every kind for every ailment or condition under all circumstances, and whether this should always be provided absolutely for free? I'll kick off by saying we cannot afford it. We never could have and we never will. Moreover, it was not the role originally envisaged for the NHS. This is the hardest part because there are going to be losers in deciding not to fund certain activities. Again, it can't be done easily right now because the emotive language of "rationing of care" and "NHS post code lottery" gets bandied about. But maybe, just maybe we do have to be candid and say we can do "this much" for your condition, but we cannot do more.
Once we have decided what the structure should look like and what it's scope of supply should be, then we can begin understand what the right level of funding is.... and I do not think that that should be based on giving the service everything it asks for financially, instead the NHS needs to get used to planning and budgeting under scrutiny, and to working within its means. (national disasters excluded) It's a cake mix (many ingredients) but we do still have waste in the system and it's simply not acceptable to leave it there.
For example, people say "oh, it's only XXX million on (for example) NHS Tourism" and in one sense they are right, especially when the number is compared to the overall NHS budget.. BUT, that way of thinking betrays an attitude that encourages abuse of the NHS, waste and inefficiency.
Instead, everyone in the country and every worker in the NHS needs to understand that every penny is as precious as if it lived in their own bank accounts. Every wasted consultation or abuse of service costs precious pennies, when every penny must be spent wisely. Every resource must be used economically. Every bit of procurement needs to be as fiercely negotiated as any successful private enterprise would do. Maybe this happens already in some places. I know for sure that it does not happen everywhere.
Sorry for the brain dump.. But hopefully there is some stuff there to (constructively) pick apart?
I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
Let me be clear, I am not advocating privatisation. Even if,(and that's a big if) with initial goodwill from all parties, agencies and employees, the NHS could be made to work that way, the political climate is just too toxic to ever think about rolling it out. Every failure (and there still will be failures, no matter who was in charge) would be blamed on "profiteering" or some such nonsense. If nothing else, the Unions would set out to ensure that a privatised NHS would fail, because it's just too big an opportunity for them to ignore.
The NHS probably needs to be a state owned industry, although I shudder as I write that when I think back to example after example of state owned enterprises that we used to suffer. - Part of the problem here is that many people under the age of 40 will have no real knowledge of just how crap the UK state owned enterprises were, and how much better they are today in private hands. Nevertheless, if privatisation is ruled out (and I believe it must be) then we must find a way to make the structure work as a Government owned enterprise, but with no Government interference.
We need to start changing the view of the general public that the NHS (in particular their local A&E Dept) is a catch all for everything. Last time I was in A&E, amongst those clearly in considerable need , there were a number of people who, frankly should have just gone to their GP. I know that because after they had been assessed they were told exactly that, and they didn't like it! Going to A&E with a head cold or a little splinter in your finger or an ingrowing toenail should be discouraged. It's not an accident and it's not an emergency. It's basic care that their GP could undertake. Of course, to do this, we need adequate numbers of properly organised GP surgeries. I don't know what has gone wrong with the GP service, but again my experience is that there are wild variations in the scope and quality of GP care, plus the availability of appointments.
I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
The next issue is to recognise the practical issues facing the NHS. For example...does it have enough beds? Well under most circumstances, it probably does, provided that beds are not filled with patients (mostly elderly) waiting to be discharged into social care. The new NHS has to join the dots up in this regard. Resources need to be targeted at building social care centres - places where people can recuperate whilst being medically cared for, but which do not require the full paraphernalia of (and costs associated with) a large hospital.
A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
We also need to be brave and ask ourselves whether we want every treatment of every kind for every ailment or condition under all circumstances, and whether this should always be provided absolutely for free? I'll kick off by saying we cannot afford it. We never could have and we never will. Moreover, it was not the role originally envisaged for the NHS. This is the hardest part because there are going to be losers in deciding not to fund certain activities. Again, it can't be done easily right now because the emotive language of "rationing of care" and "NHS post code lottery" gets bandied about. But maybe, just maybe we do have to be candid and say we can do "this much" for your condition, but we cannot do more.
Once we have decided what the structure should look like and what it's scope of supply should be, then we can begin understand what the right level of funding is.... and I do not think that that should be based on giving the service everything it asks for financially, instead the NHS needs to get used to planning and budgeting under scrutiny, and to working within its means. (national disasters excluded) It's a cake mix (many ingredients) but we do still have waste in the system and it's simply not acceptable to leave it there.
For example, people say "oh, it's only XXX million on (for example) NHS Tourism" and in one sense they are right, especially when the number is compared to the overall NHS budget.. BUT, that way of thinking betrays an attitude that encourages abuse of the NHS, waste and inefficiency.
Instead, everyone in the country and every worker in the NHS needs to understand that every penny is as precious as if it lived in their own bank accounts. Every wasted consultation or abuse of service costs precious pennies, when every penny must be spent wisely. Every resource must be used economically. Every bit of procurement needs to be as fiercely negotiated as any successful private enterprise would do. Maybe this happens already in some places. I know for sure that it does not happen everywhere.
Sorry for the brain dump.. But hopefully there is some stuff there to (constructively) pick apart?
andymadmak said:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time.
But how to organise the NHS if it's not a Government controlled department?
Perhaps the BBC is a decent model?But how to organise the NHS if it's not a Government controlled department?
You're always going to have the funding battle, though, one way or another. Ultimately, the NHS could absorb as much money as you could possibly throw at it, spending millions on keeping a pound of mince "alive".
Slaav said:
A disjointed (sorry) series of short ramblings:
I am not sure whether it is disingenuous or not to link NHS spending to GDP. It seems a widely used metric but stating that it has been cut (due to being a lower %age of GDP) is certainly disingenuous in my opinion. Spending simply has NOT been cut in real terms. We have seen massive rises in spending over the last 20 years or so to the point whereby the physical appearance, machines and facilities do seem to have been dragged into the modern world.
Those are figures from The Kings Fund. It’s not disingenuous. It’s attesting to the fact that funding has not increased at the same rate as demand and at the rate capacity has declined. For the last 10 years the secondary and tertiary care nhs has been reducing capacity in order to reduce costs, however, this has not worked. Beds have fallen sharply as the idea was more patients and conditions were to be managed in the community. That has clearly failed for a variety of reasons not least a staffing crisis throughout.I am not sure whether it is disingenuous or not to link NHS spending to GDP. It seems a widely used metric but stating that it has been cut (due to being a lower %age of GDP) is certainly disingenuous in my opinion. Spending simply has NOT been cut in real terms. We have seen massive rises in spending over the last 20 years or so to the point whereby the physical appearance, machines and facilities do seem to have been dragged into the modern world.
Slaav said:
Does anybody REALLY believe that it is a Tory aim (especially the much maligned SoS) to privatise the NHS and that they don't give a damn? Does anybody have any idea why Hunt has refused to be moved - he seems to want to maintain ownership despite appearing to be Political and Social suicide? He may also be wrong and flawed but I am not sure personal vendettas are only one way on this forum?
It certainly appears they want to. The situation at present would resemble ‘managed decline’. At the same time more and more nhs contracts for care are outsourced to the private sector who compete on an uneven playing field as AQP (any qualified provider) who can even offer lower tariffs than the NHS who are fixed. Hunt has picked fights with every sector of staff within the NHS and has created mendacious statements about them which are frankly insulting. As stated previously the row last year about the 7 day nhs was based on a lie which had been disproven and has resulted in harm to patients as predicted.He refused to be moved as it was a demotion. May is so weak and devoid of support that not only could she not denote this incompetent, she had to grant his request to take over social care, which on the face of it could be the most sensible thing he’s ever done, but based on his record, he’ll f
k it up.andymadmak said:
In an effort to bring this thread back onto a sensible discussion rather than the personal attacks, I think that we are clearly reaching a point with the NHS where a number of things need to happen, and clear choices will have to be made.
I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
Yes to depoliticising the NHS, no to Hunt. He is utterly incompetent and has single handedly destroyed the limited relationship between the DoH and NHS frontline staff with his selective use of statistics and outright lies. Each statement from the DoH sounds more like a North Korean announcement stating all is fine and record levels of investment and staffing exist when the contrary is the case. I’ve worked in the nhs for 20+ years and there has never been such a poor SoS. Yes he has difficult decisions but they all did and yet they did not make such a mess. When you’ve got limited resources you want to motivate your work force not destroy their morale.I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
andymadmak said:
Let me be clear, I am not advocating privatisation. Even if,(and that's a big if) with initial goodwill from all parties, agencies and employees, the NHS could be made to work that way, the political climate is just too toxic to ever think about rolling it out. Every failure (and there still will be failures, no matter who was in charge) would be blamed on "profiteering" or some such nonsense. If nothing else, the Unions would set out to ensure that a privatised NHS would fail, because it's just too big an opportunity for them to ignore.
It’s already happening.andymadmak said:
The NHS probably needs to be a state owned industry, although I shudder as I write that when I think back to example after example of state owned enterprises that we used to suffer. - Part of the problem here is that many people under the age of 40 will have no real knowledge of just how crap the UK state owned enterprises were, and how much better they are today in private hands. Nevertheless, if privatisation is ruled out (and I believe it must be) then we must find a way to make the structure work as a Government owned enterprise, but with no Government interference.
Partly agree. However as Carillion has shown the mantra that private is best isn’t always true, particularly when they are allowed to become bigger than the market. Healthcare is more complex as America shows, profit making on healthcare is dangerous for the public and ultimately leads to a vastly more expensive and inefficient service.andymadmak said:
We need to start changing the view of the general public that the NHS (in particular their local A&E Dept) is a catch all for everything. Last time I was in A&E, amongst those clearly in considerable need , there were a number of people who, frankly should have just gone to their GP. I know that because after they had been assessed they were told exactly that, and they didn't like it! Going to A&E with a head cold or a little splinter in your finger or an ingrowing toenail should be discouraged. It's not an accident and it's not an emergency. It's basic care that their GP could undertake. Of course, to do this, we need adequate numbers of properly organised GP surgeries. I don't know what has gone wrong with the GP service, but again my experience is that there are wild variations in the scope and quality of GP care, plus the availability of appointments.
I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
I agree. Controversially I think patients should be charged for GP services (certain groups exempted) and A&E services if they are not treated or admitted.I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
andymadmak said:
The next issue is to recognise the practical issues facing the NHS. For example...does it have enough beds? Well under most circumstances, it probably does, provided that beds are not filled with patients (mostly elderly) waiting to be discharged into social care. The new NHS has to join the dots up in this regard. Resources need to be targeted at building social care centres - places where people can recuperate whilst being medically cared for, but which do not require the full paraphernalia of (and costs associated with) a large hospital.
A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
There are not enough beds in hospital or the community setting hence the problems we face right now and there isn’t adequate staffing to provide safe care.A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
andymadmak said:
We also need to be brave and ask ourselves whether we want every treatment of every kind for every ailment or condition under all circumstances, and whether this should always be provided absolutely for free? I'll kick off by saying we cannot afford it. We never could have and we never will. Moreover, it was not the role originally envisaged for the NHS. This is the hardest part because there are going to be losers in deciding not to fund certain activities. Again, it can't be done easily right now because the emotive language of "rationing of care" and "NHS post code lottery" gets bandied about. But maybe, just maybe we do have to be candid and say we can do "this much" for your condition, but we cannot do more.
It’s not emotive language, it’s the truth. The £20bn reorganisation enables each ccg to make up rules about what it felt it’s priority was and arbitrarily ration interventions which would hitherto be available to those in need. My area has thresholds for cataract surgery that I provide. It’s quite a task to explain to a patient who can no longer drive, living in a rural area with poor public transport, that they don’t meet the threshold for surgery set by someone in the ccgs. Who do you think the patient gets angry with? Me, or the faceless ccg who are unaccountable for their own decisions? andymadmak said:
For example, people say "oh, it's only XXX million on (for example) NHS Tourism" and in one sense they are right, especially when the number is compared to the overall NHS budget.. BUT, that way of thinking betrays an attitude that encourages abuse of the NHS, waste and inefficiency.
It really doesn’t. The focus on health tourism ignores the elephant in the room whilst focusing on the foreign ant. In the meantime we try to make savings every day in how we deliver care, the drugs we use, the visits we can reduce, the tests we don’t order.968 said:
chemistry said:
A small thing, but why don’t we simply deduct unpaid bills for NHS treatment given to foreign patients from the foreign aid budget each year?
I would be cost neutral for UK plc and would at least make a small contribution to NHS coffers.
Firstly it would not make a contribution to the NHS unless the government decided to increase the funding to the NHS, which they won't. Secondly the foreign aid budget (should) be used to be providing relief and help to the many humanitarian crises around the world. Reducing the budget simply punishes those people in refugee camps in Bangladesh (for instance) or in Jordan for something they've had nothing to do with. I would be cost neutral for UK plc and would at least make a small contribution to NHS coffers.
I also agree that, notwithstanding any arguments about how well/badly foreign aid is spent, diverting money away from 'overseas foreign aid' into 'foreign aid paid to compensate the NHS for health tourism' would indeed have a negative impact for innocent people in say Bangladesh or Jordan. Unfortunately though, with a finite amount of money, choices have to be made, so either some people in the UK suffer/die as a result of an NHS that is struggling to cope, or some people in Bangladesh or Jordan do, because we make a choice to view paying for health tourism as part of foreign aid (or not). It's a horrible unfair world, but in my view, my proposal would be a small* way of reconciling our need to support the NHS to the benefit of UK citizens whilst meeting our commitments to foreigners (an unintentionally emotive word in this context perhaps, but I can't think of a better alternative!) who need our help.
By the same argument, the UK's arbitrary decision to spend 0.7% of GDP on foreign aid rather than 0.8%, 0.9% or whatever 'punishes' innocent and needy people too. We could put more into foreign aid if we wanted to, but we've chosen not to and at the end of the day, there's only so much money.
Consequently, I remain of the view that, as a 'least worst option' for an imperfect world, redirecting £200m from foreign aid into the NHS to cover the costs of health tourism would be a good thing for the UK to do. It won't solve the NHS funding crisis, but it would pay for several thousand nurses (or whatever) and is a step in the right direction.
chemistry
- At least £200m p.a.: https://www.theguardian.com/commentisfree/2016/nov... (I picked the Guardian as I and not seeking to be inflammatory and I suspect it cites a lower figure than say the Daily Mail would do
)
chemistry said:
By the same argument, the UK's arbitrary decision to spend 0.7% of GDP on foreign aid rather than 0.8%, 0.9% or whatever 'punishes' innocent and needy people too.
Hardly "the UK's arbitrary decision". It was a UN resolution in 1970, and has been restated many times since, not least by the EU in 2004.http://www.oecd.org/dac/stats/the07odagnitarget-ah...
TooMany2cvs said:
chemistry said:
By the same argument, the UK's arbitrary decision to spend 0.7% of GDP on foreign aid rather than 0.8%, 0.9% or whatever 'punishes' innocent and needy people too.
Hardly "the UK's arbitrary decision". It was a UN resolution in 1970, and has been restated many times since, not least by the EU in 2004.http://www.oecd.org/dac/stats/the07odagnitarget-ah...
andymadmak said:
In an effort to bring this thread back onto a sensible discussion rather than the personal attacks, I think that we are clearly reaching a point with the NHS where a number of things need to happen, and clear choices will have to be made.
I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
Let me be clear, I am not advocating privatisation. Even if,(and that's a big if) with initial goodwill from all parties, agencies and employees, the NHS could be made to work that way, the political climate is just too toxic to ever think about rolling it out. Every failure (and there still will be failures, no matter who was in charge) would be blamed on "profiteering" or some such nonsense. If nothing else, the Unions would set out to ensure that a privatised NHS would fail, because it's just too big an opportunity for them to ignore.
The NHS probably needs to be a state owned industry, although I shudder as I write that when I think back to example after example of state owned enterprises that we used to suffer. - Part of the problem here is that many people under the age of 40 will have no real knowledge of just how crap the UK state owned enterprises were, and how much better they are today in private hands. Nevertheless, if privatisation is ruled out (and I believe it must be) then we must find a way to make the structure work as a Government owned enterprise, but with no Government interference.
We need to start changing the view of the general public that the NHS (in particular their local A&E Dept) is a catch all for everything. Last time I was in A&E, amongst those clearly in considerable need , there were a number of people who, frankly should have just gone to their GP. I know that because after they had been assessed they were told exactly that, and they didn't like it! Going to A&E with a head cold or a little splinter in your finger or an ingrowing toenail should be discouraged. It's not an accident and it's not an emergency. It's basic care that their GP could undertake. Of course, to do this, we need adequate numbers of properly organised GP surgeries. I don't know what has gone wrong with the GP service, but again my experience is that there are wild variations in the scope and quality of GP care, plus the availability of appointments.
I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
The next issue is to recognise the practical issues facing the NHS. For example...does it have enough beds? Well under most circumstances, it probably does, provided that beds are not filled with patients (mostly elderly) waiting to be discharged into social care. The new NHS has to join the dots up in this regard. Resources need to be targeted at building social care centres - places where people can recuperate whilst being medically cared for, but which do not require the full paraphernalia of (and costs associated with) a large hospital.
A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
We also need to be brave and ask ourselves whether we want every treatment of every kind for every ailment or condition under all circumstances, and whether this should always be provided absolutely for free? I'll kick off by saying we cannot afford it. We never could have and we never will. Moreover, it was not the role originally envisaged for the NHS. This is the hardest part because there are going to be losers in deciding not to fund certain activities. Again, it can't be done easily right now because the emotive language of "rationing of care" and "NHS post code lottery" gets bandied about. But maybe, just maybe we do have to be candid and say we can do "this much" for your condition, but we cannot do more.
Once we have decided what the structure should look like and what it's scope of supply should be, then we can begin understand what the right level of funding is.... and I do not think that that should be based on giving the service everything it asks for financially, instead the NHS needs to get used to planning and budgeting under scrutiny, and to working within its means. (national disasters excluded) It's a cake mix (many ingredients) but we do still have waste in the system and it's simply not acceptable to leave it there.
For example, people say "oh, it's only XXX million on (for example) NHS Tourism" and in one sense they are right, especially when the number is compared to the overall NHS budget.. BUT, that way of thinking betrays an attitude that encourages abuse of the NHS, waste and inefficiency.
Instead, everyone in the country and every worker in the NHS needs to understand that every penny is as precious as if it lived in their own bank accounts. Every wasted consultation or abuse of service costs precious pennies, when every penny must be spent wisely. Every resource must be used economically. Every bit of procurement needs to be as fiercely negotiated as any successful private enterprise would do. Maybe this happens already in some places. I know for sure that it does not happen everywhere.
Sorry for the brain dump.. But hopefully there is some stuff there to (constructively) pick apart?
At last a sensible post, nothing to disagree with there.I am absolutely not an expert on the NHS, although I did have relatives who worked in it at a senior level (clinical, not managerial) and my own personal experiences of the service have been wildly varying, from the truly brilliant, to the utterly incompetent - the latter landing me in hospital for more than 3 months a few years back.
My suggestions for a long term NHS solution (or at least, some of them) would be as follows:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time. The race to see who will promise the most cash is nauseating at every election time. Unlike some, I don't think that Jeremy Hunt is the reincarnation of Beelzebub, but I do think that he (like every other Heath Secretary from whichever party that is not gifted a limitless cash pot) has to make some very difficult decisions..... and he has to do so in a political climate that is on the one hand unwilling to grant him an open cheque book, and on the other hand determined to hold him personally to account for every failure, perceived or real that besets the NHS. That is not a sensible position to place any person, let alone a politician with even half an eye on his future career. That kind of pressure leads to misjudgements and wrong decisions. But how to organise the NHS if it's not a Government controlled department?
Let me be clear, I am not advocating privatisation. Even if,(and that's a big if) with initial goodwill from all parties, agencies and employees, the NHS could be made to work that way, the political climate is just too toxic to ever think about rolling it out. Every failure (and there still will be failures, no matter who was in charge) would be blamed on "profiteering" or some such nonsense. If nothing else, the Unions would set out to ensure that a privatised NHS would fail, because it's just too big an opportunity for them to ignore.
The NHS probably needs to be a state owned industry, although I shudder as I write that when I think back to example after example of state owned enterprises that we used to suffer. - Part of the problem here is that many people under the age of 40 will have no real knowledge of just how crap the UK state owned enterprises were, and how much better they are today in private hands. Nevertheless, if privatisation is ruled out (and I believe it must be) then we must find a way to make the structure work as a Government owned enterprise, but with no Government interference.
We need to start changing the view of the general public that the NHS (in particular their local A&E Dept) is a catch all for everything. Last time I was in A&E, amongst those clearly in considerable need , there were a number of people who, frankly should have just gone to their GP. I know that because after they had been assessed they were told exactly that, and they didn't like it! Going to A&E with a head cold or a little splinter in your finger or an ingrowing toenail should be discouraged. It's not an accident and it's not an emergency. It's basic care that their GP could undertake. Of course, to do this, we need adequate numbers of properly organised GP surgeries. I don't know what has gone wrong with the GP service, but again my experience is that there are wild variations in the scope and quality of GP care, plus the availability of appointments.
I do understand that if your GP surgery says "can't see you till a week on friday" then you're going to trot down to the hospital A&E instead, but all that does is shift the problem from the largely hidden GP waiting time issue, to the Daily Mail spotlight of the A&E waiting time issue.
In very basic terms I think people should have the following tiered response in their heads:
1. Is it serious or am I just uncomfortable ? (like a head cold)
2. Can I help myself?
3. Do I really need to see my GP?
4. Is it so serious that I really need to go to A&E?
Some of what I have seen recently suggests that for too many people, the default for any ailment is stage 4, regardless. That has to stop.
The next issue is to recognise the practical issues facing the NHS. For example...does it have enough beds? Well under most circumstances, it probably does, provided that beds are not filled with patients (mostly elderly) waiting to be discharged into social care. The new NHS has to join the dots up in this regard. Resources need to be targeted at building social care centres - places where people can recuperate whilst being medically cared for, but which do not require the full paraphernalia of (and costs associated with) a large hospital.
A front-line care service based on lower cost dedicated facilities, strong GP support and which coordinates the other care agencies with a view to getting patients back to their homes in an appropriate timeframe would free up a considerable amount of hospital resource.
We also need to be brave and ask ourselves whether we want every treatment of every kind for every ailment or condition under all circumstances, and whether this should always be provided absolutely for free? I'll kick off by saying we cannot afford it. We never could have and we never will. Moreover, it was not the role originally envisaged for the NHS. This is the hardest part because there are going to be losers in deciding not to fund certain activities. Again, it can't be done easily right now because the emotive language of "rationing of care" and "NHS post code lottery" gets bandied about. But maybe, just maybe we do have to be candid and say we can do "this much" for your condition, but we cannot do more.
Once we have decided what the structure should look like and what it's scope of supply should be, then we can begin understand what the right level of funding is.... and I do not think that that should be based on giving the service everything it asks for financially, instead the NHS needs to get used to planning and budgeting under scrutiny, and to working within its means. (national disasters excluded) It's a cake mix (many ingredients) but we do still have waste in the system and it's simply not acceptable to leave it there.
For example, people say "oh, it's only XXX million on (for example) NHS Tourism" and in one sense they are right, especially when the number is compared to the overall NHS budget.. BUT, that way of thinking betrays an attitude that encourages abuse of the NHS, waste and inefficiency.
Instead, everyone in the country and every worker in the NHS needs to understand that every penny is as precious as if it lived in their own bank accounts. Every wasted consultation or abuse of service costs precious pennies, when every penny must be spent wisely. Every resource must be used economically. Every bit of procurement needs to be as fiercely negotiated as any successful private enterprise would do. Maybe this happens already in some places. I know for sure that it does not happen everywhere.
Sorry for the brain dump.. But hopefully there is some stuff there to (constructively) pick apart?
The Surveyor said:
968, please give it a rest about your hatred for Jeremy Hunt. We get it, you don't like him, not many people do but some people recognise the impossibility of the conflicts the SoS has to face without constantly derailing the discussion with a very personal vendetta.
Firstly it’s not a personal vendetta. I voice what the vast majority of NHS employees think. Secondly he has made this situation uniquely, by making personal insults about the integrity, motivation and work ethic of his staff and tried to dress up his actions with lies. Thirdly it’s not derailing the discussion, he is ultimately responsible as are all SoS but he has made the worst possible mess. Additionally his role and culpability has to be discussed in the context of the latest issue ie nursing numbers dropping since it was his decision to cut nursing bursaries.The Surveyor said:
968, please give it a rest about your hatred for Jeremy Hunt. We get it, you don't like him, not many people do but some people recognise the impossibility of the conflicts the SoS has to face without constantly derailing the discussion with a very personal vendetta.
If you think it's personal, you clearly don't know any clinical staff. He is the main reason for locums costing over £2.7b/y instead of budgeted £1b. What an odd post.
TooMany2cvs said:
andymadmak said:
Firstly, remove the NHS from Government control. As it stands right now, it's a political football that means that any rational debate over the issues is clouded by political opportunism from whichever political party is not holding the baton at that time.
But how to organise the NHS if it's not a Government controlled department?
Perhaps the BBC is a decent model?But how to organise the NHS if it's not a Government controlled department?
You're always going to have the funding battle, though, one way or another. Ultimately, the NHS could absorb as much money as you could possibly throw at it, spending millions on keeping a pound of mince "alive".
Privatization would be politically unpalatable so I would make every part of the NHS (excluding GPs, Dentists etc which already have their own arrangements) independent not for profit organizations.
On the patient side issue everyone with an NHS "insurance policy", to those who can prove entitlement. This would set out a range of conditions and treatments that would be covered. Hospitals could provide treatment for those not entitled if they so choose, and also not reclaim costs from the patients concerned, but they would only be reimbursed by the NHS for the above, so they would bear the costs.
Funding would have to match the above and if costs were rising too high then it would present a clear choice about treatments included in the policy.
Anything else leaves the NHS as a political football and does not confront the real issues.
968 said:
He refused to be moved as it was a demotion. May is so weak and devoid of support that not only could she not denote this incompetent, she had to grant his request to take over social care, which on the face of it could be the most sensible thing he’s ever done, but based on his record, he’ll fk it up.
Don't really agree on that as it was effectively to become May's second in command and, based upon how weak May is, appeared to a powerful position within government.k it up.jjlynn27 said:
The Surveyor said:
968, please give it a rest about your hatred for Jeremy Hunt. We get it, you don't like him, not many people do but some people recognise the impossibility of the conflicts the SoS has to face without constantly derailing the discussion with a very personal vendetta.
If you think it's personal, you clearly don't know any clinical staff. He is the main reason for locums costing over £2.7b/y instead of budgeted £1b. What an odd post.
For reference, I'm married to a full time Senior Nurse, and I know very well many other NHS employees. They all have a very different view on why the NHS is in crisis and lack of available funding crops up as often as the flu and endemic poor management.
My (now retired) Mother was a Midwife Sister and sadly witnessed first hand the transition of the NHS from a compassionate Healthcare provider to a multifaceted business which happens to look after people. Its clear the NHS has lost its way in a bid to become a business, where multiple highly paid senior execs protect their competing business empires by building up a complex and expensive management structure housed in expensive offices to deliver a simple service, then when cuts are needed, they employ mangers to 'manage' a cut in services rather than consider a cut in pointless management.
Once you realise that there are management teams monitoring patient pathways and imposing fines for missed targets (that's right, NHS paid managers employed to fine a failing NHS department rather than giving it extra support), where District Nurses are encouraged not to home-visit patients by GP's, expecting patients to taken by ambulance back to the hospital trust for dressings to be replaced in out-patients, all to protect GP's profit margins (We can thank the last GP contract negotiation for that), and where admin and management support staff have better pay terms than clinical staff (managers and secretaries getting paid overtime, nurses don't etc), you know that its a business where the tail is wagging the dog, a situation arising from decades of poor leadership across all political parties.
The NHS needs to remember that every penny spent comes from the same limited tax-payer pot, it shouldn't need an admin, accounting and management teams to process payment of costs and fines from one trust to another, from one hospital department to a PCT to a GP Surgery etc. 968 said earlier in the tread that his department was profit making, FFS why should that even matter?
So no, I don't agree Jeremy Hunt is responsible for the state of the NHS, the problem is much more endemic than any individual you may line up as scape-goat. IMHO every single individual in the whole complex chain who's focus isn't on patient care needs to accept a part of that blame. As a business, it's rotten to the core.
The Surveyor said:
I know it's personal because 968 is incapable of discussing the NHS without taking it as an excuse to blame Jeremy Hunt. His response to my post earlier being case in point.
Nope. I just happen to have personal experience of working in the system and to an extent managing a department and liaising with the various ccg and DoH agencies designed to complicate delivery of care and destroy quality of care, rather than anecdotes from relatives.surveyor said:
My (now retired) Mother was a Midwife Sister and sadly witnessed first hand the transition of the NHS from a compassionate Healthcare provider to a multifaceted business which happens to look after people. Its clear the NHS has lost its way in a bid to become a business, where multiple highly paid senior execs protect their competing business empires by building up a complex and expensive management structure housed in expensive offices to deliver a simple service, then when cuts are needed, they employ mangers to 'manage' a cut in services rather than consider a cut in pointless management.
Sorry what business empires do you refer to? What simple service are you referring to?surveyor said:
Once you realise that there are management teams monitoring patient pathways and imposing fines for missed targets (that's right, NHS paid managers employed to fine a failing NHS department rather than giving it extra support)
Who do you think is responsible for this and these targets? Not the DoH surely?surveyor said:
, where District Nurses are encouraged not to home-visit patients by GP's, expecting patients to taken by ambulance back to the hospital trust for dressings to be replaced in out-patients, all to protect GP's profit margins (We can thank the last GP contract negotiation for that), and where admin and management support staff have better pay terms than clinical staff (managers and secretaries getting paid overtime, nurses don't etc), you know that its a business where the tail is wagging the dog, a situation arising from decades of poor leadership across all political parties.
Daily Mail soundbyte quota reached but completely without evidence regarding GP profit margins.surveyor said:
The NHS needs to remember that every penny spent comes from the same limited tax-payer pot, it shouldn't need an admin, accounting and management teams to process payment of costs and fines from one trust to another, from one hospital department to a PCT to a GP Surgery etc. 968 said earlier in the tread that his department was profit making, FFS why should that even matter?
Far be it from me to explain economics to you but it matters because the nhs is funded from a limited tax pot, as a result we are expected to run as a business that exercises some restraint on spending the money the commissioners give us, that we tendered for. It also matters because my profit making department can support those that don’t make profits, unfashionable ones like paediatric oncology for example. You want it both ways, the nhs to be accountable for every penny but not to be a business?surveyor said:
So no, I don't agree Jeremy Hunt is responsible for the state of the NHS, the problem is much more endemic than any individual you may line up as scape-goat. IMHO every single individual in the whole complex chain who's focus isn't on patient care needs to accept a part of that blame. As a business, it's rotten to the core.
Who’s decision was it to cut nursing bursaries? Who’s decision was it to pick a fight with the junior doctors and lie to the public misusing statistics that have been thoroughly disproven? Has he apologised? How do you think the junior docs and seniors for that matter feel about him now? What about the nurses and midwives?The Surveyor said:
I know it's personal because 968 is incapable of discussing the NHS without taking it as an excuse to blame Jeremy Hunt. His response to my post earlier being case in point.
...
You can't know that. From what I hear 968's opinion of JC is almost universal amongst clinical staff, to the point that some people, coming from generations of doctors, are leaving profession as a direct result of JC's incompetence. ...
The Surveyor said:
For reference, I'm married to a full time Senior Nurse, and I know very well many other NHS employees. They all have a very different view on why the NHS is in crisis and lack of available funding crops up as often as the flu and endemic poor management.
What's your wife's opinion on JC?The Surveyor said:
My (now retired) Mother was a Midwife Sister and sadly witnessed first hand the transition of the NHS from a compassionate Healthcare provider to a multifaceted business which happens to look after people. Its clear the NHS has lost its way in a bid to become a business, where multiple highly paid senior execs protect their competing business empires by building up a complex and expensive management structure housed in expensive offices to deliver a simple service, then when cuts are needed, they employ mangers to 'manage' a cut in services rather than consider a cut in pointless management.
Once you realise that there are management teams monitoring patient pathways and imposing fines for missed targets (that's right, NHS paid managers employed to fine a failing NHS department rather than giving it extra support), where District Nurses are encouraged not to home-visit patients by GP's, expecting patients to taken by ambulance back to the hospital trust for dressings to be replaced in out-patients, all to protect GP's profit margins (We can thank the last GP contract negotiation for that), and where admin and management support staff have better pay terms than clinical staff (managers and secretaries getting paid overtime, nurses don't etc), you know that its a business where the tail is wagging the dog, a situation arising from decades of poor leadership across all political parties.
The NHS needs to remember that every penny spent comes from the same limited tax-payer pot, it shouldn't need an admin, accounting and management teams to process payment of costs and fines from one trust to another, from one hospital department to a PCT to a GP Surgery etc. 968 said earlier in the tread that his department was profit making, FFS why should that even matter?
So no, I don't agree Jeremy Hunt is responsible for the state of the NHS, the problem is much more endemic than any individual you may line up as scape-goat. IMHO every single individual in the whole complex chain who's focus isn't on patient care needs to accept a part of that blame. As a business, it's rotten to the core.
Is JC hunt solely responsible for state of NHS? No, I don't think he is. Is he hugely contributing factor? I believe, after looking at the evidence and talking to people that yes, yes he is. Once you realise that there are management teams monitoring patient pathways and imposing fines for missed targets (that's right, NHS paid managers employed to fine a failing NHS department rather than giving it extra support), where District Nurses are encouraged not to home-visit patients by GP's, expecting patients to taken by ambulance back to the hospital trust for dressings to be replaced in out-patients, all to protect GP's profit margins (We can thank the last GP contract negotiation for that), and where admin and management support staff have better pay terms than clinical staff (managers and secretaries getting paid overtime, nurses don't etc), you know that its a business where the tail is wagging the dog, a situation arising from decades of poor leadership across all political parties.
The NHS needs to remember that every penny spent comes from the same limited tax-payer pot, it shouldn't need an admin, accounting and management teams to process payment of costs and fines from one trust to another, from one hospital department to a PCT to a GP Surgery etc. 968 said earlier in the tread that his department was profit making, FFS why should that even matter?
So no, I don't agree Jeremy Hunt is responsible for the state of the NHS, the problem is much more endemic than any individual you may line up as scape-goat. IMHO every single individual in the whole complex chain who's focus isn't on patient care needs to accept a part of that blame. As a business, it's rotten to the core.
Saying that NHS as a business, is rotten to the core', is, imho, particularly stupid.
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