Discussion
EddieSteadyGo said:
If you have ever been involved in managing any organisation of any size, you would know nothing is perfectly efficient. So by that definition every organisation has waste. The extent to which you can improve such a complicated system is the question.
It isn't nice to say it. Any everyone wants to minimise it. But wishing it to be better doesn't make it better. So in my opinion the NHS needs to be given more money.
Uh? Businesses cannot be 100% efficient, so it's pointless trying to improve a business' efficiency?It isn't nice to say it. Any everyone wants to minimise it. But wishing it to be better doesn't make it better. So in my opinion the NHS needs to be given more money.
Unfortunately both the NHS and teaching have been untouchable for the last few decades, and are where the unions took the British car industry in the 70's - rampant inefficiency and self-protection, combined with some dangerous levels of incompetence. That's not to say the people at the coal face aren't on the whole dedicated to the job and able to make a genuine difference, but the organisation as a whole is a mess. Anyone with friends or relatives in the organisation can tell you the horror stories and ridiculous extremes.
The problem is, any negative comments about the organisation is seen as an attack on every last staff member and the principle of the organisation itself. So you can't say 'this is a bit s
t' without being accused of trying to destroy the whole edifice and put every last staff member out on the streets.The documentary from the 90's (https://www.youtube.com/watch?v=YIl0b7dWHHY - Can Gerry Robinson save the NHS) highlights the sort of problems encountered, and the absolute resistance to change from within. Much of what he encountered appears to still hold true.
Tuna said:
EddieSteadyGo said:
If you have ever been involved in managing any organisation of any size, you would know nothing is perfectly efficient. So by that definition every organisation has waste. The extent to which you can improve such a complicated system is the question.
It isn't nice to say it. Any everyone wants to minimise it. But wishing it to be better doesn't make it better. So in my opinion the NHS needs to be given more money.
Uh? Businesses cannot be 100% efficient, so it's pointless trying to improve a business' efficiency?It isn't nice to say it. Any everyone wants to minimise it. But wishing it to be better doesn't make it better. So in my opinion the NHS needs to be given more money.
Unfortunately both the NHS and teaching have been untouchable for the last few decades, and are where the unions took the British car industry in the 70's - rampant inefficiency and self-protection, combined with some dangerous levels of incompetence. That's not to say the people at the coal face aren't on the whole dedicated to the job and able to make a genuine difference, but the organisation as a whole is a mess. Anyone with friends or relatives in the organisation can tell you the horror stories and ridiculous extremes.
The problem is, any negative comments about the organisation is seen as an attack on every last staff member and the principle of the organisation itself. So you can't say 'this is a bit s
t' without being accused of trying to destroy the whole edifice and put every last staff member out on the streets.The documentary from the 90's (https://www.youtube.com/watch?v=YIl0b7dWHHY - Can Gerry Robinson save the NHS) highlights the sort of problems encountered, and the absolute resistance to change from within. Much of what he encountered appears to still hold true.
But you have to make a judgement whether firstly you think the NHS needs more resources. And if so, whether all of those resources can be gained from efficiency savings. Kccv23highliftcam thinks all of it can. I take a different view.
For someone earning £50k it will be about £1500 a year.
Now, to put that into perspective, the average price for private medical care in the UK is around £1400 a month.
Many so called socialists who earn good money could do their bit and take out private health care, taking the burden off the NHS. When it costs £8 to change a light bulb and £100 to change a printer toner because it is contracted out we all need to do our bit.
Plus with a population increase the size of Cambridge or Oxford every 6 months more money will only stop it getting worse.
Now, to put that into perspective, the average price for private medical care in the UK is around £1400 a month.
Many so called socialists who earn good money could do their bit and take out private health care, taking the burden off the NHS. When it costs £8 to change a light bulb and £100 to change a printer toner because it is contracted out we all need to do our bit.
Plus with a population increase the size of Cambridge or Oxford every 6 months more money will only stop it getting worse.
EddieSteadyGo said:
Maybe I didn't explain myself clearly. Efforts to improve efficiency are necessary, desirable and laudable. Efforts have been on-going for a long time, and there is no doubt there is still a lot more to do.
But you have to make a judgement whether firstly you think the NHS needs more resources. And if so, whether all of those resources can be gained from efficiency savings. Kccv23highliftcam thinks all of it can. I take a different view.
Fair enough. My view is that the NHS (and teaching) have deeply embedded cultural problems, and that until they are addressed, every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).But you have to make a judgement whether firstly you think the NHS needs more resources. And if so, whether all of those resources can be gained from efficiency savings. Kccv23highliftcam thinks all of it can. I take a different view.
The fact that the ministers for health and education are demonised the moment they begin to make any changes makes it impossible to address. It isn't until we have a complete failure (with serious consequences for the people involved) that problems are spoken about. That's not acceptable when people's lives are at stake.
The ministers should be demonised (especially if they're demons), the NHS should be removed out of the political sphere. THat seems to be the opinion of the great and the good who are removed from that sphere themselves. BUt those in power wish to keep control to use it a a football/stick.
Tuna said:
Halb said:
The ministers should be demonised (especially if they're demons), the NHS should be removed out of the political sphere.
That works both ways. The staff of the NHS turn any attempts at serious reform into a political issue when it should be handled dispassionately.Tuna said:
EddieSteadyGo said:
Maybe I didn't explain myself clearly. Efforts to improve efficiency are necessary, desirable and laudable. Efforts have been on-going for a long time, and there is no doubt there is still a lot more to do.
But you have to make a judgement whether firstly you think the NHS needs more resources. And if so, whether all of those resources can be gained from efficiency savings. Kccv23highliftcam thinks all of it can. I take a different view.
Fair enough. My view is that the NHS (and teaching) have deeply embedded cultural problems, and that until they are addressed, every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).But you have to make a judgement whether firstly you think the NHS needs more resources. And if so, whether all of those resources can be gained from efficiency savings. Kccv23highliftcam thinks all of it can. I take a different view.
The fact that the ministers for health and education are demonised the moment they begin to make any changes makes it impossible to address. It isn't until we have a complete failure (with serious consequences for the people involved) that problems are spoken about. That's not acceptable when people's lives are at stake.
Tuna said:
... every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).
...
Any source for the above?...
EddieSteadyGo said:
My sister-in-law is a GP and another relative is a consultant, so I tend to hear quite a few stories about what is happening in the NHS. And I do hear some things which are definitely wasteful and could be improved. But it is also a very complicated system and most of the clinicians are (rightly) far more focused on quality than on optimising costs. So I myself don't see lots of easy cost saving wins which would equate to the gap in resources.
Same here - friends and family in the service. The clinicians are working the best they can in the system. Issues seem often to be around the routing of patients through the system. Issues like appointments booked in three months time where all that is being done is booking the actual investigation three months later - so they meet target waiting times of three months when actual time to intervention is twice that. Or problems including multimorbidity, in-patient nutrition and multiply assigned nurses. Everyone is working flat out, but patients trickle through the system, often getting more ill before they can get better.All of these things are outside the purview of the clinician but have a direct effect on the outcome of the patient and a cost to the NHS as a whole. At times the 'its a complex system' defence hides the fact that the system itself is needlessly complex.
jjlynn27 said:
Tuna said:
... every extra pound in funding results in ten pence worth of improvements. Worse, the extra funding tends to have the side effect of yet more managers being employed - so efficiency drops even further (because the magic money tree keeps growing).
...
Any source for the above?...
Tuna said:
The fact that the ministers for health and education are demonised the moment they begin to make any changes makes it impossible to address.
I just wanted to make one other point to show how difficult and entangled it all is. Some time ago I was asking my sister-in-law what changes she would like to make in an ideal world which might make a dramatic improvement to her GP practice. She was explaining that she has done a lot of analysis to show in her practice a very significant portion of appointments were from the same people each month who did not need to see a doctor. So this included people who were hypochondriacs, paranoid, drug addicts to people who were just too stupid to make good decisions (yes, there are quite a few of them out there).My guess is there are similar situations in many GP practises across the country. Now they do take action to improve things using triage etc. But really, to make a big difference you needs a national approach as some of the changes might be politically unpopular and some might require other agencies to take more responsibility. For example, you could introduce a nominal charge to discourage frivolous appointments. Just look at the effect that has had on plastic bag usage. But that would likely be hugely unpopular and could have downsides yet to be quantified.
So I'm just making the point that is a complicated minefield trying to find large savings imho.
Tuna said:
All of these things are outside the purview of the clinician but have a direct effect on the outcome of the patient and a cost to the NHS as a whole. At times the 'its a complex system' defence hides the fact that the system itself is needlessly complex.
Yes, I pretty much agree. If I am sounding like I am advocating that we shouldn't bother managing costs as it is all too difficult, then it is my fault for not explaining myself properly. The starting point of this small sidebar was whether the NHS needed additional resources and if so, could that be achieved solely from improving efficiency. My gut feel is that on balance we ought to find more money for the NHS through additional taxation, painful/annoying as that will be.
If they want to raise taxes they should look at fixing the current system, we're a lopsided income family and the system is stacked against us, we pay more tax and get zero "extras" like child benefit,it's a stupid system when a family which earns more money pays less tax and gets more extras just because both partners earn equal salaries. Sick of being heavily taxed when our combined income is far lower than others :/
MDMetal said:
If they want to raise taxes they should look at fixing the current system, we're a lopsided income family and the system is stacked against us, we pay more tax and get zero "extras" like child benefit,it's a stupid system when a family which earns more money pays less tax and gets more extras just because both partners earn equal salaries. Sick of being heavily taxed when our combined income is far lower than others :/
Tax is personal, which is correct.I sympathise with the CB though. A typical crap piece of Government implementation, which then never gets increased or reviewed.
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