Discussion
JagLover said:
...and ensure that all foreign residents are paying the full cost of their treatment. Other countries require health insurance as part of travel insurance before you can enter the country, why don't we?
There's nothing to stop the NHS re-charging residents of other EU countries via EHIC, of course, or requiring payment from non-EU residents. They simply choose not to.So why don't they? Perhaps it'd cost more to administer than it'd bring in?
968 said:
Of course, going back to Kings, it’s fascinating how the usual PH finance/private sector moguls have pronounced judgement without the slightest understanding why they’re in trouble.
They’re in trouble because Jeremy
, practically forced them to take over another failing trust in 2013, crippled by a hugely expensive PFI, that being Princess Royal University Hospital. This, in addition to the ongoing closure/downgrading of south east London hospitals like Lewisham, Sidcup and others means that demand has spiralled out of all proportion to resources available, all against the backdrop of supporting a failing trust financially.
Kings used to be one of the few trusts that was in the black, consistently, now it’s collapsing under the strain put on it with no additional resources, all due to the SoS being an incompetent tt.
All of which is fair enough (genuinely), but...They’re in trouble because Jeremy
, practically forced them to take over another failing trust in 2013, crippled by a hugely expensive PFI, that being Princess Royal University Hospital. This, in addition to the ongoing closure/downgrading of south east London hospitals like Lewisham, Sidcup and others means that demand has spiralled out of all proportion to resources available, all against the backdrop of supporting a failing trust financially.Kings used to be one of the few trusts that was in the black, consistently, now it’s collapsing under the strain put on it with no additional resources, all due to the SoS being an incompetent t
t.It does make you wonder why Kerslake took the job on/didn't resign sooner if the job was impossible, rather than just before it gets dirty great black marks against it.
Also, who set up the PFI arrangement.
TooMany2cvs said:
There's nothing to stop the NHS re-charging residents of other EU countries via EHIC, of course, or requiring payment from non-EU residents. They simply choose not to.
So why don't they? Perhaps it'd cost more to administer than it'd bring in?
Has that reason been set out by anyone?So why don't they? Perhaps it'd cost more to administer than it'd bring in?
This doesn't make that sound conclusive either way:
https://www.gov.uk/government/uploads/system/uploa...
Look more like the data simply isn't available (reading between the lines) which is the first thing that needs to change. It also cites cultural challenges in certain parts of the NHS.
Health spending accounts for a similar share of GDP as it did in 2010 and has been growing at 1.3% in real terms since then.
https://fullfact.org/health/spending-english-nhs/
Spending in virtually every other significant area of government expenditure has fallen, or remained the same, over the same time frame.
European comparisons have been distorted by the fact that a lot of "social" spending has been excluded. On a comparable basis the UK devotes 9.8% of GDP to Healthcare
http://www.bmj.com/content/358/bmj.j3568/rr
Given that there isn't infinite money we need to look at how the NHS is structured and what it does.
https://fullfact.org/health/spending-english-nhs/
Spending in virtually every other significant area of government expenditure has fallen, or remained the same, over the same time frame.
European comparisons have been distorted by the fact that a lot of "social" spending has been excluded. On a comparable basis the UK devotes 9.8% of GDP to Healthcare
http://www.bmj.com/content/358/bmj.j3568/rr
Given that there isn't infinite money we need to look at how the NHS is structured and what it does.
Edited by JagLover on Monday 11th December 11:16
JagLover said:
...
European comparisons have been distorted by the fact that allot of "social" spending has been excluded. On a comparable basis the UK devotes 9.8% of GDP to Healthcare
http://www.bmj.com/content/358/bmj.j3568/rr
Given that there isn't infinite money we need to look at how the NHS is structured and what it does.
I agree with your closing point, but the link shows how "useful" stats are...I'm not sure we want to be benchmarking ourselves agains the likes of Slovenia rather than Germany, do we?European comparisons have been distorted by the fact that allot of "social" spending has been excluded. On a comparable basis the UK devotes 9.8% of GDP to Healthcare
http://www.bmj.com/content/358/bmj.j3568/rr
Given that there isn't infinite money we need to look at how the NHS is structured and what it does.
The key thing to me is how the German's do what they do, and does it lead to better outcomes? How much do they leverage private healthcare? Do they have similar demographic issues? Are they not spending on some things (defence
) that we do? And is that balance one we would prefer?There are no easy answers. However sticking our heads in the sand collectively (govt, employees of the NHS, users of its services) will get us nowhere...we've proven that over decades.
The true cost of providing health care to non-British nationals
https://www.spectator.co.uk/2017/01/if-the-nhs-nee...
This is not just the so called "Health tourism" the article claims that
https://www.spectator.co.uk/2017/01/if-the-nhs-nee...
This is not just the so called "Health tourism" the article claims that
Spectator said:
The second problem is the European Health Insurance Card (Ehic) system. Despite being a migration magnet, the UK pays five times as much to other EU countries as it receives. This is because most European migrants have no ‘home’ Ehic card, being unemployed and not contributing to their domestic health system. On arrival in UK, they are ‘ordinarily resident’ and entitled to any healthcare they need.
gooner1 said:
jjlynn27 said:
gooner1 said:
jjlynn27 said:
gooner1 said:
jjlynn27 said:
nikaiyo2 said:
Hmmm is this the same Bob Kerslake who was employed by the Labour Party?
O
Btw, fashioned anything useful from your notorious length of timber yet?
I didn't know that my 'length of timber' is notorious!
gooner1 said:
A crutch
for your lame humour perhaps.
The fantastically delicious irony. for your lame humour perhaps.
Not sure if laughing at one's own comments makes them any more funny, but don't
let me put you off. You carry on Rolfing at yourself. I may even join in.
JagLover said:
The true cost of providing health care to non-British nationals...
I've snipped it down to the only bit you need to know. Health entitlement goes by country of residence, not nationality.Spectator said:
On arrival in UK, they are ‘ordinarily resident’ and entitled to any healthcare they need.
A British "ex-pat" living on the Costa del Fishnchips would need to bring their Spanish EHIC card when they come to visit the grandkids... Can you imagine the Daily Wail headlines the first time Mrs Doris Leatheryskin is refused NHS treatment because she hasn't got it with her? Yet the Polish plumber (who bought her house from her five years ago) gets treated...?
langtounlad said:
In the private sector each year there is a budgeting process which eventually produces the AGREED business forecast for the following year and is detailed at various line items from revenue through all the various itemised business costs through to the expected business profit.
The NHS management perform a similar process and must surely arrive at an AGREED budget.
I consistently fail to understand why the NHS appears to run out of money every year and has a crisis as winter approaches.
These events occur every year and therefore should be accommodated within the budget setting process.
Companies of course may fail to achieve their budget and when that happens serious questions get asked.
Deviation to budget through the year results in actions to get back on track to achieve budget.
Consistent failure to achieve results in management changes and even dismissals.
I don't understand why when the NHS claims yet again to have run out of money that the media immediately blames the government and demands that more be spent. In my mind the media should be asking the NHS chiefs why they can't budget and if they will be resigning due their failure to produce an accurate budget. What are the demands on the service that they failed to forecast and plan for that results in £ billions of overspend?
Why has action not been taken to get departments or services back on budget?
Cold weather, Saturday night A&E admissions and all the other headline issues occur every year and should be budgeted accordingly.
This is separate to any discussion on how much the country should spend on health as that is a more strategic question.
How can you predict the pressure on a health service. How do you know what will come through the door to plan with 100% accuracy?The NHS management perform a similar process and must surely arrive at an AGREED budget.
I consistently fail to understand why the NHS appears to run out of money every year and has a crisis as winter approaches.
These events occur every year and therefore should be accommodated within the budget setting process.
Companies of course may fail to achieve their budget and when that happens serious questions get asked.
Deviation to budget through the year results in actions to get back on track to achieve budget.
Consistent failure to achieve results in management changes and even dismissals.
I don't understand why when the NHS claims yet again to have run out of money that the media immediately blames the government and demands that more be spent. In my mind the media should be asking the NHS chiefs why they can't budget and if they will be resigning due their failure to produce an accurate budget. What are the demands on the service that they failed to forecast and plan for that results in £ billions of overspend?
Why has action not been taken to get departments or services back on budget?
Cold weather, Saturday night A&E admissions and all the other headline issues occur every year and should be budgeted accordingly.
This is separate to any discussion on how much the country should spend on health as that is a more strategic question.
Do we turn patients away once the money has run out?
pavarotti1980 said:
How can you predict the pressure on a health service. How do you know what will come through the door to plan with 100% accuracy?
Do we turn patients away once the money has run out?
The demand on the Health Service actually doesn't change dramatically from year to year.Do we turn patients away once the money has run out?
The pressure on A&E for instance should be quite easy to forecast, factoring in the trend for people to bypass their GP service (or lack of).
The first failure is at the highest level between Gov & NHS leaders to negotiate and agree a budget.
The second failure is at local trust and lower management levels where change is resisted and the demand is always for 'more money' or 'more resource'.
I'm not blind to the many excellent efficiency improvements that have been implemented but they are too few in relation to other depts that refuse to change and embrace 'working smarter'.
Of course we don't turn patients away - they should be better directed to the correct resource at point of entry.
In addition the NHS shouldn't be carrying the costs of Social Care which is the main cause of bed blocking.
But that is another failure to plan and budget correctly.
As I mentioned earlier I'm mystified why the media has not highlighted these issues rather than just be a mouthpiece for local budget holders demanding 'more'. But then again it's easy to see which is the easiest story to write.
pavarotti1980 said:
How can you predict the pressure on a health service. How do you know what will come through the door to plan with 100% accuracy?
Obviously you can't. However, you can predict with great accuracy that there will be 12 months in the year and if more than 8% is being spent each month then there will be issues towards the end of the year and preventative measures need to be taken.pavarotti1980 said:
Do we turn patients away once the money has run out?
We deal with it before the money runs out. Explain to the NHS staff that the unentitled need to be billed, Austria has a great system where emergency treatment is given, after which insurance of a credit card is needed for ongoing care- we could copy that with minor adjustments to suit our circumstances. Before anyone points out that some of the staff won't like doing it I'll point out that many jobs involve people doing stuff they'd rather not do.
Stop the free inessential stuff such as viagra, boob jobs & IVF; if people want them then they can pay for them. The NHS was created for basic medical needs not lifestyle choices.
There's plenty of inefficiency & waste to deal with- let's remove a little of it by running the show better than is currently the case.
In summary, shut the stable door BEFORE the horse has bolted.
Edited by Rovinghawk on Monday 11th December 17:20
langtounlad said:
The demand on the Health Service actually doesn't change dramatically from year to year.
The pressure on A&E for instance should be quite easy to forecast, factoring in the trend for people to bypass their GP service (or lack of).
The first failure is at the highest level between Gov & NHS leaders to negotiate and agree a budget.
The second failure is at local trust and lower management levels where change is resisted and the demand is always for 'more money' or 'more resource'.
I'm not blind to the many excellent efficiency improvements that have been implemented but they are too few in relation to other depts that refuse to change and embrace 'working smarter'.
Of course we don't turn patients away - they should be better directed to the correct resource at point of entry.
In addition the NHS shouldn't be carrying the costs of Social Care which is the main cause of bed blocking.
But that is another failure to plan and budget correctly.
As I mentioned earlier I'm mystified why the media has not highlighted these issues rather than just be a mouthpiece for local budget holders demanding 'more'. But then again it's easy to see which is the easiest story to write.
Better get yourself down to the the Department of Health and tell them whereabouts they are all going wrong thenThe pressure on A&E for instance should be quite easy to forecast, factoring in the trend for people to bypass their GP service (or lack of).
The first failure is at the highest level between Gov & NHS leaders to negotiate and agree a budget.
The second failure is at local trust and lower management levels where change is resisted and the demand is always for 'more money' or 'more resource'.
I'm not blind to the many excellent efficiency improvements that have been implemented but they are too few in relation to other depts that refuse to change and embrace 'working smarter'.
Of course we don't turn patients away - they should be better directed to the correct resource at point of entry.
In addition the NHS shouldn't be carrying the costs of Social Care which is the main cause of bed blocking.
But that is another failure to plan and budget correctly.
As I mentioned earlier I'm mystified why the media has not highlighted these issues rather than just be a mouthpiece for local budget holders demanding 'more'. But then again it's easy to see which is the easiest story to write.
pavarotti1980 said:
Better get yourself down to the the Department of Health and tell them whereabouts they are all going wrong then
I assume that you don't agree with my observations.I have some indirect experience of the day to day health service issues as my wife works in the NHS (delivering a specialist health service not management)
She sees the waste and cock-ups and suffers the inefficiencies and frustrations borne of poor IT implementation every day.
It's clear to me that there is poor budgetary control, poor planning and poor management.
Not one of the many recent 'reorganisation' that have been introduced have gone to plan or budget, but the same management remains in post.
Strategically they are trying to move in the right direction of combining her area with Social Services but the implementation is awful.
Staff not willing to contemplate change and actively resisting the changes without being managed accordingly slows the process and adds to running costs.
These are the main reasons why the NHS cannot keep to agreed budgets.
I'm guessing that you explain all that as 'Tory cuts' whereas I see it from a different perspective.
langtounlad said:
I assume that you don't agree with my observations.
I have some indirect experience of the day to day health service issues as my wife works in the NHS (delivering a specialist health service not management)
She sees the waste and cock-ups and suffers the inefficiencies and frustrations borne of poor IT implementation every day.
It's clear to me that there is poor budgetary control, poor planning and poor management.
Not one of the many recent 'reorganisation' that have been introduced have gone to plan or budget, but the same management remains in post.
Strategically they are trying to move in the right direction of combining her area with Social Services but the implementation is awful.
Staff not willing to contemplate change and actively resisting the changes without being managed accordingly slows the process and adds to running costs.
These are the main reasons why the NHS cannot keep to agreed budgets.
I'm guessing that you explain all that as 'Tory cuts' whereas I see it from a different perspective.
Always the same with every NHS thread. The main reasons were explained to you, in short, too many demands with not enough funding. You can check for yourself comparison of costs per capita (with pp) for advanced economies and see where we fit.I have some indirect experience of the day to day health service issues as my wife works in the NHS (delivering a specialist health service not management)
She sees the waste and cock-ups and suffers the inefficiencies and frustrations borne of poor IT implementation every day.
It's clear to me that there is poor budgetary control, poor planning and poor management.
Not one of the many recent 'reorganisation' that have been introduced have gone to plan or budget, but the same management remains in post.
Strategically they are trying to move in the right direction of combining her area with Social Services but the implementation is awful.
Staff not willing to contemplate change and actively resisting the changes without being managed accordingly slows the process and adds to running costs.
These are the main reasons why the NHS cannot keep to agreed budgets.
I'm guessing that you explain all that as 'Tory cuts' whereas I see it from a different perspective.
There will be another thread with the same 'conclusions' any day now.
langtounlad said:
I assume that you don't agree with my observations.
I have some indirect experience of the day to day health service issues as my wife works in the NHS (delivering a specialist health service not management)
She sees the waste and cock-ups and suffers the inefficiencies and frustrations borne of poor IT implementation every day.
It's clear to me that there is poor budgetary control, poor planning and poor management.
Not one of the many recent 'reorganisation' that have been introduced have gone to plan or budget, but the same management remains in post.
Strategically they are trying to move in the right direction of combining her area with Social Services but the implementation is awful.
Staff not willing to contemplate change and actively resisting the changes without being managed accordingly slows the process and adds to running costs.
These are the main reasons why the NHS cannot keep to agreed budgets.
I'm guessing that you explain all that as 'Tory cuts' whereas I see it from a different perspective.
Cuts have never been a part because allegedly the NHS has not suffered cuts. I have direct experience of it both from the commissioner and provider perspective. A little fact for you. At the end of 2017/18 financial year every single NHS Trust will be in deficit or be using their capital reserves to keep their heads above water. This includes trusts who historically were always in surplus due to very good governance. Now if there hasnt been a cut to funding in real terms why are all of these trusts suddenly scrabbling around for money? I have some indirect experience of the day to day health service issues as my wife works in the NHS (delivering a specialist health service not management)
She sees the waste and cock-ups and suffers the inefficiencies and frustrations borne of poor IT implementation every day.
It's clear to me that there is poor budgetary control, poor planning and poor management.
Not one of the many recent 'reorganisation' that have been introduced have gone to plan or budget, but the same management remains in post.
Strategically they are trying to move in the right direction of combining her area with Social Services but the implementation is awful.
Staff not willing to contemplate change and actively resisting the changes without being managed accordingly slows the process and adds to running costs.
These are the main reasons why the NHS cannot keep to agreed budgets.
I'm guessing that you explain all that as 'Tory cuts' whereas I see it from a different perspective.
Which numerous reorganisations do you make reference to? The one handled by Andrew Landsley which created an extra layer of beurocracy in April 2013? Because apart from that there hasnt been major reform across the whole NHS in the years previous or since
The general incompetence from a very high ministerial level is the main reason.
Edited by pavarotti1980 on Monday 11th December 16:34
Edited by pavarotti1980 on Monday 11th December 16:35
The NHS is constantly reorganising itself at the lower levels although I suspect a lot of it is shuffling deckchairs.
Middle management initiatives that are prone to failure through inadequate planning, poor implementation and resistance from employees entrenched in current methods of working.
I shudder to think how much has been wasted on IT systems that still don't 'talk' to each other and just add time and complexity to day to day practice.
Plus the cost of manually inputting data from one record system into another.
If the trusts are in deficit was that financial position the agreed budget?
If not, then it is senior management that need to take the necessary steps to get back on track or be replaced by better managers.
I'm a fan of the NHS but not of the way its finances are managed and how the media is always happy to give it a platform to say that the answer is more money.
If we started asking the difficult questions more rigorously it might help to arrive at a workable solution.
Just giving more clearly hasn't worked and isn't sustainable.
Middle management initiatives that are prone to failure through inadequate planning, poor implementation and resistance from employees entrenched in current methods of working.
I shudder to think how much has been wasted on IT systems that still don't 'talk' to each other and just add time and complexity to day to day practice.
Plus the cost of manually inputting data from one record system into another.
If the trusts are in deficit was that financial position the agreed budget?
If not, then it is senior management that need to take the necessary steps to get back on track or be replaced by better managers.
I'm a fan of the NHS but not of the way its finances are managed and how the media is always happy to give it a platform to say that the answer is more money.
If we started asking the difficult questions more rigorously it might help to arrive at a workable solution.
Just giving more clearly hasn't worked and isn't sustainable.
langtounlad said:
The NHS is constantly reorganising itself at the lower levels although I suspect a lot of it is shuffling deckchairs.
Middle management initiatives that are prone to failure through inadequate planning, poor implementation and resistance from employees entrenched in current methods of working.
I shudder to think how much has been wasted on IT systems that still don't 'talk' to each other and just add time and complexity to day to day practice.
Plus the cost of manually inputting data from one record system into another.
If the trusts are in deficit was that financial position the agreed budget?
If not, then it is senior management that need to take the necessary steps to get back on track or be replaced by better managers.
I'm a fan of the NHS but not of the way its finances are managed and how the media is always happy to give it a platform to say that the answer is more money.
If we started asking the difficult questions more rigorously it might help to arrive at a workable solution.
Just giving more clearly hasn't worked and isn't sustainable.
The NHS is fundamentally reorganised every 5-10 years with differing govts the latest one reorganising the entire system at a cost of £20bn which has achieved fMiddle management initiatives that are prone to failure through inadequate planning, poor implementation and resistance from employees entrenched in current methods of working.
I shudder to think how much has been wasted on IT systems that still don't 'talk' to each other and just add time and complexity to day to day practice.
Plus the cost of manually inputting data from one record system into another.
If the trusts are in deficit was that financial position the agreed budget?
If not, then it is senior management that need to take the necessary steps to get back on track or be replaced by better managers.
I'm a fan of the NHS but not of the way its finances are managed and how the media is always happy to give it a platform to say that the answer is more money.
If we started asking the difficult questions more rigorously it might help to arrive at a workable solution.
Just giving more clearly hasn't worked and isn't sustainable.
k all apart from introducing worsening rationing and health inequality. It has always been thus, politicians and accountants seem to know the solutions but seem to fail every time.Interesting that the whole point of this recent spate of posts has brushed over the fact that the SoS forced King’s nhs trust to acquire PRUH and pushed its finances over the edge.once again Teflon, lying Jeremy seems to have escaped any criticism despite being the root of the problems.
It’s quite astonishing that someone so inept and so incapable of telling the truth remains in a job, but nothing surprises me with this government and the peanut brained cabinet.
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