Discussion
jjlynn27 said:
My experience is based on living and working (and using health systems) in quite a few countries around the world. My experience is also based on social circle that includes a disproportionate number of medics. My experience is based on talking to a schoolmate of mine who is now professor at leading medical school in States, who used to be an adviser to Govt on health, and who couldn't believe how much NHS manages to achieve with so little money. (In his words he didn't think that it's sustainable as it depended on good-will of too many clinical staff working overtime basically for free).
This is what experts think (leading think-tank in the field);
These are facts and my experiences.
I don't think that NHS is perfect, but I think given the circumstances, it's exceptional, even allowing for its failings.
Interesting how they get to the "Overall Ranking" there with the "outcomes" as they are.This is what experts think (leading think-tank in the field);
These are facts and my experiences.
I don't think that NHS is perfect, but I think given the circumstances, it's exceptional, even allowing for its failings.
On the basis of that table alone, I'd be taking a serious look at quite a few of those systems wrt emulating them.
Murph7355 said:
Interesting how they get to the "Overall Ranking" there with the "outcomes" as they are.
On the basis of that table alone, I'd be taking a serious look at quite a few of those systems wrt emulating them.
It is interesting. Maybe read the report, try to understand it, try to understand that obesity levels and teenage pregnancy, as well as early detection of cancers, play a significant role in outcomes as defined for the purpose of the table. On the basis of that table alone, I'd be taking a serious look at quite a few of those systems wrt emulating them.
As for emulating them, would you be prepared to pay more money?
Murph7355 said:
Without an identical system elsewhere working more optimally, how do we know the NHS isn't working as well as it can ever be expected to in its current format?
I suspect it's way too large. Diseconomies of scale are at play and its client base and science is actively working against it - living longer, able to fix more so people live longer. Recipe for disaster.
It needs scaling right back to the basics and leave everything else to private provision if people want it, but that will never sell to the electorate.
Nor to you, when it’s your turn to need it. Undoubtedly you’ll be outraged to find you have to pay for x operation or that your grandparents may have to.I suspect it's way too large. Diseconomies of scale are at play and its client base and science is actively working against it - living longer, able to fix more so people live longer. Recipe for disaster.
It needs scaling right back to the basics and leave everything else to private provision if people want it, but that will never sell to the electorate.
It could certainly work more efficiently without more DoH meddling, reorganisation and ridiculous pfi “investments”. It needs to be depoliticised but also copayment and charging needs to be considered in certain areas.
It does, however, need an SoS who is able to listen and understand the issues and recognise that current funding levels are not enabling the service to function within the parameters they set. Either increase resources, particularly staffing, or just be honest to the public and tell them to expect >4 hour waits in casualty and long waiting lists for clinics and theatres.
The sarcastic comment about skilled immigration is more than slightly ironic given the amount that support the service and have done for 60 years +
jjlynn27 said:
langtounlad said:
My personal system preference, for what that is worth, is to have a properly functioning NHS. My issue with the NHS is that there are too many vested interests and very few of them are aligned with the long term best interests of the patients. I have insight to the NHS via my wife who practices in the community but also has many years hospital working experience.
My critical comments are based on my own senior level management experience in well run organisations. I suspect that the other commentators of which you are critical are also referencing their private sector experience.
Many comments are perhaps stated simply as this is just an internet forum, however in my experience even the most complex problem can be distilled down to a few core issues. Fix them and things start to turn round.
A lot of the frustration of outsiders is that many of the problems are obvious and many would be quickly solved in industry using well proven management techniques. In industry however there is no direct political interference and the staff isn't allowed to complain to the local press if they feel disaffected. There is also, generally speaking, a well defined business strategy and 3 or 5 year plan. Management agrees its budget and then works the plan in line with the budget.
There are many areas of the NHS where this happens also but far too many instances where it doesn't.
That doesn't answer my question, and comparison with orders of magnitude smaller private sector organizations are inherently flawed. I asked, to repeat once again, is there a health system anywhere in the world, that you'd have here instead of NHS?My critical comments are based on my own senior level management experience in well run organisations. I suspect that the other commentators of which you are critical are also referencing their private sector experience.
Many comments are perhaps stated simply as this is just an internet forum, however in my experience even the most complex problem can be distilled down to a few core issues. Fix them and things start to turn round.
A lot of the frustration of outsiders is that many of the problems are obvious and many would be quickly solved in industry using well proven management techniques. In industry however there is no direct political interference and the staff isn't allowed to complain to the local press if they feel disaffected. There is also, generally speaking, a well defined business strategy and 3 or 5 year plan. Management agrees its budget and then works the plan in line with the budget.
There are many areas of the NHS where this happens also but far too many instances where it doesn't.
jjlynn27 said:
Murph7355 said:
Interesting how they get to the "Overall Ranking" there with the "outcomes" as they are.
On the basis of that table alone, I'd be taking a serious look at quite a few of those systems wrt emulating them.
It is interesting. Maybe read the report, try to understand it, try to understand that obesity levels and teenage pregnancy, as well as early detection of cancers, play a significant role in outcomes as defined for the purpose of the table. On the basis of that table alone, I'd be taking a serious look at quite a few of those systems wrt emulating them.
As for emulating them, would you be prepared to pay more money?
Why include external factors within "outcomes" if the intention is to demonstrate the wonderfulness of the NHS? Are not the authors of the report supposed to be expert think-tankers? Are they not capable of filtering the data?
968 said:
Nor to you, when it’s your turn to need it. Undoubtedly you’ll be outraged to find you have to pay for x operation or that your grandparents may have to.
It could certainly work more efficiently without more DoH meddling, reorganisation and ridiculous pfi “investments”. It needs to be depoliticised but also copayment and charging needs to be considered in certain areas.
It does, however, need an SoS who is able to listen and understand the issues and recognise that current funding levels are not enabling the service to function within the parameters they set. Either increase resources, particularly staffing, or just be honest to the public and tell them to expect >4 hour waits in casualty and long waiting lists for clinics and theatres.
The sarcastic comment about skilled immigration is more than slightly ironic given the amount that support the service and have done for 60 years +
I'm pragmatic enough to realise that if there isn't a fundamental shift in the way it's operated, the NHS won't be able to function properly/"fairly" for even the basics. It could certainly work more efficiently without more DoH meddling, reorganisation and ridiculous pfi “investments”. It needs to be depoliticised but also copayment and charging needs to be considered in certain areas.
It does, however, need an SoS who is able to listen and understand the issues and recognise that current funding levels are not enabling the service to function within the parameters they set. Either increase resources, particularly staffing, or just be honest to the public and tell them to expect >4 hour waits in casualty and long waiting lists for clinics and theatres.
The sarcastic comment about skilled immigration is more than slightly ironic given the amount that support the service and have done for 60 years +
I only get even remotely "outraged" about the NHS when I hear that treatment often depends on where you live or that nonsense items are being covered by it. I have slightly less outrage when the service continually ups the amount it needs to keep it out of crisis.
Totally agree on the meddling, depoliticising etc. My sister's a nurse and the stuff I've listened to from her for the last 20yrs is not good - as noted, I think the organisation is way too big and diseconomies of scale are at play.
Not sure which sarcastic comment you're referring to...but I don't believe it was me.
V8 Fettler said:
Good box ticking skills
Why include external factors within "outcomes" if the intention is to demonstrate the wonderfulness of the NHS? Are not the authors of the report supposed to be expert think-tankers? Are they not capable of filtering the data?
Yes, them yanks, their only intention is to demonstrate 'wonderfulness of the NHS'. How would you filter outcome of the operation given that the outcome of the same operation is heavily influenced by obesity levels? Do you not understand how stupid your post is? (rhetorical question)Why include external factors within "outcomes" if the intention is to demonstrate the wonderfulness of the NHS? Are not the authors of the report supposed to be expert think-tankers? Are they not capable of filtering the data?
jjlynn27 said:
V8 Fettler said:
Good box ticking skills
Why include external factors within "outcomes" if the intention is to demonstrate the wonderfulness of the NHS? Are not the authors of the report supposed to be expert think-tankers? Are they not capable of filtering the data?
Yes, them yanks, their only intention is to demonstrate 'wonderfulness of the NHS'. How would you filter outcome of the operation given that the outcome of the same operation is heavily influenced by obesity levels? Do you not understand how stupid your post is? (rhetorical question)Why include external factors within "outcomes" if the intention is to demonstrate the wonderfulness of the NHS? Are not the authors of the report supposed to be expert think-tankers? Are they not capable of filtering the data?
jjlynn27 said:
...How would you filter outcome of the operation given that the outcome of the same operation is heavily influenced by obesity levels? ...
How "external" are things like obesity considered to be? It's a general health issue (isn't it?), so if nothing is done about it and it impacts the outcomes of the "whole" (which I'm assuming is what "outcomes" is measuring) then isn't it fair to include it?I can see other external factors being trickier to accommodate (social demographics, standards of living etc), which is why I've never been a fan of cherry picking comparisons of public services across nations without understanding the other trade offs they're making.
I'm assuming the "equity" row is about how much is spent on healthcare (had a quick look for the survey, found the site etc but couldn't see the descriptors when I looked late last night). Does it breakdown between what is provided publicly and what is private?
(You have some good insight on this topic. Your posts would be significantly improved without the unnecessary jibes/sniping).
anonymous said:
[redacted]
Um no, it's nothing to do with efficiency and everything to do with a lack of resources to be able to staff those beds and provide care to patients, and about cutting costs. So you can blame the SoS directly for that as that's down to him. It's also due to the CCGs requiring costs reduced and demanding more care be delivered in the community, which currently is incapable of dealing with the volumes required.Murph7355 said:
I'm pragmatic enough to realise that if there isn't a fundamental shift in the way it's operated, the NHS won't be able to function properly/"fairly" for even the basics.
I only get even remotely "outraged" about the NHS when I hear that treatment often depends on where you live or that nonsense items are being covered by it. I have slightly less outrage when the service continually ups the amount it needs to keep it out of crisis.
Totally agree on the meddling, depoliticising etc. My sister's a nurse and the stuff I've listened to from her for the last 20yrs is not good - as noted, I think the organisation is way too big and diseconomies of scale are at play.
Not sure which sarcastic comment you're referring to...but I don't believe it was me.
Well you should be very outraged that the reorganisation of the NHS which has resulted in the CCGs being given more control has resulted in more incidents of rationing and post code lottery. My CCG has instituted thresholding for cataract surgery, for instance, against our advice and against patients wishes. You can blame the DoH for this. I only get even remotely "outraged" about the NHS when I hear that treatment often depends on where you live or that nonsense items are being covered by it. I have slightly less outrage when the service continually ups the amount it needs to keep it out of crisis.
Totally agree on the meddling, depoliticising etc. My sister's a nurse and the stuff I've listened to from her for the last 20yrs is not good - as noted, I think the organisation is way too big and diseconomies of scale are at play.
Not sure which sarcastic comment you're referring to...but I don't believe it was me.
The service increases the amount required because the demand increases whilst resources/staffing are reduced.
The sarcastic comment was not you, it was another poster but sadly ignorant of the way the NHS is actually staffed. It's also very insulting to the immigrants who have come here to work within the NHS.
Well this seems an appropriate place to post this.
10% of Nurses leaving each year.
http://www.bbc.co.uk/news/health-42653542
There seems to be a clear problem with retention, particularly with younger nurses joining the profession. Is higher pay the answer?, particularly at the lower starting pay grades?
It seems a false economy to pay Nurses below a market rate and then have to replace 10% of them each year as a result.
10% of Nurses leaving each year.
http://www.bbc.co.uk/news/health-42653542
There seems to be a clear problem with retention, particularly with younger nurses joining the profession. Is higher pay the answer?, particularly at the lower starting pay grades?
It seems a false economy to pay Nurses below a market rate and then have to replace 10% of them each year as a result.
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.
That is far too easy and far too sensible to possibly work! No doubt the charities who suck up huge amounts in admin from Aid would objectI would be cost neutral for UK plc and would at least make a small contribution to NHS coffers.
JagLover said:
Well this seems an appropriate place to post this.
10% of Nurses leaving each year.
http://www.bbc.co.uk/news/health-42653542
There seems to be a clear problem with retention, particularly with younger nurses joining the profession. Is higher pay the answer?, particularly at the lower starting pay grades?
It seems a false economy to pay Nurses below a market rate and then have to replace 10% of them each year as a result.
Perhaps the NHS actually does need to be funded appropriately and not be subjected to the largest sustained reduction in spending as a percentage of GDP?10% of Nurses leaving each year.
http://www.bbc.co.uk/news/health-42653542
There seems to be a clear problem with retention, particularly with younger nurses joining the profession. Is higher pay the answer?, particularly at the lower starting pay grades?
It seems a false economy to pay Nurses below a market rate and then have to replace 10% of them each year as a result.
Also of those leaving, the majority are the younger nurses, and as the older nurses are nearing retirement, this will result in a big drop in numbers in a decade or so.
The sheer contempt that the SoS has treated nurses (and other health professionals) with, has resulted in this reduction. Pay is poor, working conditions deteriorating and the removal of nursing bursaries means that attracting new nurses has become more difficult.
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.
968 said:
Perhaps the NHS actually does need to be funded appropriately and not be subjected to the largest sustained reduction in spending as a percentage of GDP?
.
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) .
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