Discussion
The Surveyor said:
jjlynn27 said:
....
Saying that NHS as a business, is rotten to the core', is, imho, particularly stupid.
I'm quite comfortable and relieved to hold a very different opinion to you on these topics, petty insults or not. Saying that NHS as a business, is rotten to the core', is, imho, particularly stupid.
JagLover said:
Personally I am quite happy for the government to fund a certain level of care that is free at the point of use, but I see no rational reason why it should be provided by a monolithic organization like the NHS.
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.
Perhaps you could call them things like "trusts" or "clinical commissioning groups"?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.
The Surveyor said:
jjlynn27 said:
....
Saying that NHS as a business, is rotten to the core', is, imho, particularly stupid.
I'm quite comfortable and relieved to hold a very different opinion to you on these topics, petty insults or not. Saying that NHS as a business, is rotten to the core', is, imho, particularly stupid.
TooMany2cvs said:
JagLover said:
Personally I am quite happy for the government to fund a certain level of care that is free at the point of use, but I see no rational reason why it should be provided by a monolithic organization like the NHS.
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.
Perhaps you could call them things like "trusts" or "clinical commissioning groups"?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.
A prime example this morning:
I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
WinstonWolf said:
A prime example this morning:
I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
But for the trust you get your spares from it makes perfect sense. They don’t get paid for the tubes they give you without an appointment so while they cost pennies they lose income. By having you make an appointment they will get reimbursed. I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
It’s how the system of payment works I’m afraid and unless you can bill for everything individually (you can’t) or fund services via a block grant then it’s the old way to get paid.
Lynx516 said:
WinstonWolf said:
A prime example this morning:
I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
But for the trust you get your spares from it makes perfect sense. They don’t get paid for the tubes they give you without an appointment so while they cost pennies they lose income. By having you make an appointment they will get reimbursed. I wear a hearing aid, the tubes get blocked/perish and need to be replaced. I can do it quite happily myself, I just need the tubes. Popped in to get some batteries this morning (still free issue thankfully) and asked for some spare tubes. "Sorry, you have to make an appointment now. It's so we can control costs".
The whole point of me having spares that cost pennies is so I don't have to take up an audiologist's time to service it. It'll probably cost three figures to achieve something that used to be achieved for pennies.
It’s how the system of payment works I’m afraid and unless you can bill for everything individually (you can’t) or fund services via a block grant then it’s the old way to get paid.
Batteries are still free issue (and more expensive) so it must be possible.
Situations such as this should make no sense whatsoever to the trust...
WinstonWolf said:
QED there's the problem. That's patently ridiculous, there must be a way of accounting for 'medical consumables' for want of a better description that doesn't cost a fortune.
Batteries are still free issue (and more expensive) so it must be possible.
Situations such as this should make no sense whatsoever to the trust...
If they cost pennies - can they not be bought privately of t’internet?Batteries are still free issue (and more expensive) so it must be possible.
Situations such as this should make no sense whatsoever to the trust...
Personally i’d be weighing the ‘pennies’ cost vs my time and the burden on the NHS - and if what you say is true - i’d probably source my own if possible.
Moonhawk said:
WinstonWolf said:
QED there's the problem. That's patently ridiculous, there must be a way of accounting for 'medical consumables' for want of a better description that doesn't cost a fortune.
Batteries are still free issue (and more expensive) so it must be possible.
Situations such as this should make no sense whatsoever to the trust...
If they cost pennies - can they not be bought privately of t’internet?Batteries are still free issue (and more expensive) so it must be possible.
Situations such as this should make no sense whatsoever to the trust...
Personally i’d be weighing the ‘pennies’ cost vs my time and the burden on the NHS - and if what you say is true - i’d probably source my own if possible.
I didn't post to get some free spares, I posted to point out how the NHS is spending hundreds to save probably 2p. It makes no sense...
WinstonWolf said:
Here we go, the NHS overspending is suddenly my fault. Only on PH
I didn't post to get some free spares, I posted to point out how the NHS is spending hundreds to save probably 2p. It makes no sense...
I didnt say it’s your fault - of course the situation you describe is patently ridiculous and shouldnt happen.I didn't post to get some free spares, I posted to point out how the NHS is spending hundreds to save probably 2p. It makes no sense...
I was merely pointing out that you appear to have identified a problem and it’s possibly within your power to help aleviate its impact.
TooMany2cvs said:
JagLover said:
Personally I am quite happy for the government to fund a certain level of care that is free at the point of use, but I see no rational reason why it should be provided by a monolithic organization like the NHS.
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.
Perhaps you could call them things like "trusts" or "clinical commissioning groups"?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.
I am saying to cut out all layers in the NHS other than those who provide the actual medical care and have these be stand alone, independent, entities.
Funding would come from being reimbursed for medical treatment, just as with private hospitals, but via a state backed insurance scheme that remains free at the point of use.
I am aware that there is a system in place that has elements of this, but, IMO it is just grafting on a quasi market rather than a true one.
968 said:
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.
(more stuff)
One shouldn't use arbitrary numbers and %ages/metrics unless to express that statistic in comparison to other countries who in turn use the same methodology to give a true comparison? But WHY GDP?
If the GDP of the UK starts to falter or even drop, with the inbuilt rises and protected spending on the NHS in REAL terms will start to rocket as a %age of GDP? With falling GDP numbers, by definition, people will start to feel worse off and most likely start to be ill more, undernourished etc etc. So that then gives a perfect storm for our over burdened NHS despite the NHS funding shooting up as a %age of GDP?
WHY link it to GDP and then claim that NHS funding is dropping against that metric? That's the bit I really don't get? Can anyone help??
jjlynn27 said:
There were no insults, petty or otherwise, it was a comment on your rather ridiculous generalization. To say that 3mil or whatever is the number of people working for NHS are sharing responsibilities, even with that handy little caveat that allows one to exclude his immediate family, is stupid. As stupid as claiming that 'business', which even allowing for wastage, is consistently voted as one of the top performings by people who actually do know what they are doing and what to look for.
Let me have another go at explaining why I think as a business, the NHS is rotten. The NHS is a Health Care Provider, and a bloody good one despite the ever increasing demand on its services. Health services that are delivered by the clinical staff and which is funded by the UK tax payer. That side of the NHS is not the 'business' side of things and not what I'm referring too.
The NHS has also evolved into a business which manages payments from one department to another, from one Trust to another, and which imposes fines for poor performance, and where it seams a £20 per hour manager concludes that to save money the best way to decide whether a patient can have a new £1 battery for a hearing aid is to have a £10 per hour secretary make an appointment and have a £15 per hour clinical member of staff sit with the patient to say 'here's your battery'. An NHS where the local Ambulance Services Trust takes payments from the Primary Care Trust for patient transfers from the local Mental Health Trust who are treated by the local Hospitals Trust, along with every permutation between all based around a hugely complex national tariff scheme. Regional stand-alone Trusts all multiplied over every region of the country, and every penny spent is managed and monitored despite it all coming from the same UK Taxpayer pot. These are the individual empires I mentioned yesterday, headed by a 6 figure salaried Chief Exec with a 7 figure pension pot and equally expensive support staff, in equally expensive office facilities, this is the 'business' side of the NHS who do nothing but manage the movement of money and that, as a principle is rotten to the core IMHO.
Yes, that may be an over simplification but when I worked in a Mental Health Trust Estates department (20 years ago) it was that simple. Departments got a budget, departments managed their budget, whether that was managed by the estates director or the senior clinician in the department, their brief was simply to deliver their services and deliver 'Best Value'.
For me (and whilst I'm sure you won't agree) the principle of one NHS division calculating then charging another NHS entity for services which are all funded from the same pot is a ridiculous waste of money.
^^^ Great post and another insight into the world of the NHS, thank you!
How this can be resolved given our weak political masters at the moment, is another question, but we will need to address this conondrum eventually to save the NHS long term, IMHO. Maybe it's too late and we are heading for a split system of publicly funded care and an insurance system of further treatment beyond the life preserving basic service?
How this can be resolved given our weak political masters at the moment, is another question, but we will need to address this conondrum eventually to save the NHS long term, IMHO. Maybe it's too late and we are heading for a split system of publicly funded care and an insurance system of further treatment beyond the life preserving basic service?
Very very good post. When the first foundation trusts were legalised vast armies of accountants and financial folk got jobs managing the money. Now you have 400 or so trusts all battling to manage the money to justify targets and incomes/ expenditure, as described, all to justify tariffs and cost per patient.
It's now led to vast armies of CQC inspectors being bussed into trusts for weeks on end to check and quantify and to rate.
The amount of money spent on financial management, supplies management and the like for 400 trusts must be appalling and with no economies of scale as everyone is competing to better the others with no thought for its the same NHS, the same pot and the same patients.
Maybe in future there could be a move back towards a more unified regional and national structure without purchasing wars and armies of people arguing about spending the cash, while burning through it themselves.
It's now led to vast armies of CQC inspectors being bussed into trusts for weeks on end to check and quantify and to rate.
The amount of money spent on financial management, supplies management and the like for 400 trusts must be appalling and with no economies of scale as everyone is competing to better the others with no thought for its the same NHS, the same pot and the same patients.
Maybe in future there could be a move back towards a more unified regional and national structure without purchasing wars and armies of people arguing about spending the cash, while burning through it themselves.
The Surveyor said:
For me (and whilst I'm sure you won't agree) the principle of one NHS division calculating then charging another NHS entity for services which are all funded from the same pot is a ridiculous waste of money.
Agree entirely. As someone who is working to try and improve matters this becomes a massive problem as you can't make very good improvements work because "financially it doesn't work" even though it actually saves money. It just doesn't save the right person money. 200Plus Club said:
Very very good post. When the first foundation trusts were legalised vast armies of accountants and financial folk got jobs managing the money. Now you have 400 or so trusts all battling to manage the money to justify targets and incomes/ expenditure, as described, all to justify tariffs and cost per patient.
It's now led to vast armies of CQC inspectors being bussed into trusts for weeks on end to check and quantify and to rate.
The amount of money spent on financial management, supplies management and the like for 400 trusts must be appalling and with no economies of scale as everyone is competing to better the others with no thought for its the same NHS, the same pot and the same patients.
Maybe in future there could be a move back towards a more unified regional and national structure without purchasing wars and armies of people arguing about spending the cash, while burning through it themselves.
There are lots of problems with his post but essentially you are suggesting dismantling the internal market and certainly rewinding the £20bn reform undertaken by Lansley.It's now led to vast armies of CQC inspectors being bussed into trusts for weeks on end to check and quantify and to rate.
The amount of money spent on financial management, supplies management and the like for 400 trusts must be appalling and with no economies of scale as everyone is competing to better the others with no thought for its the same NHS, the same pot and the same patients.
Maybe in future there could be a move back towards a more unified regional and national structure without purchasing wars and armies of people arguing about spending the cash, while burning through it themselves.
Why should there be an internal market and a million managers and accountants policing it? I'd like to see if other ways of costing healthcare ops and "buying" them are feasible.
Do other healthcare systems work like this and if not, how do they do it? Can we learn from other systems that are not insurance cover based? 20 odd yearsor more have been spent so far playing with the NHS internal market system.
We had a raft of changes prior to him, and it's not improved things since local commissioning groups and GPs got in on the act from what I can see. If they'd spent as much time and money sorting nursing homes and social care the NHS wouldnt be bed blocked so much.
One thing I do see is practise GP surgeries have had a lot of money spent on them but there are no big increase in doctor numbers than before and it appears worse in terms of appointments and referrals. They are good at offering flu jabs for income generation, but not so quick on much else. Half the people in A+E are there purely because of the way their local GP surgery ration appointments and outof hours cover.
Do other healthcare systems work like this and if not, how do they do it? Can we learn from other systems that are not insurance cover based? 20 odd yearsor more have been spent so far playing with the NHS internal market system.
We had a raft of changes prior to him, and it's not improved things since local commissioning groups and GPs got in on the act from what I can see. If they'd spent as much time and money sorting nursing homes and social care the NHS wouldnt be bed blocked so much.
One thing I do see is practise GP surgeries have had a lot of money spent on them but there are no big increase in doctor numbers than before and it appears worse in terms of appointments and referrals. They are good at offering flu jabs for income generation, but not so quick on much else. Half the people in A+E are there purely because of the way their local GP surgery ration appointments and outof hours cover.
200Plus Club said:
Why should there be an internal market and a million managers and accountants policing it? I'd like to see if other ways of costing healthcare ops and "buying" them are feasible.
Do other healthcare systems work like this and if not, how do they do it? Can we learn from other systems that are not insurance cover based? 20 odd yearsor more have been spent so far playing with the NHS internal market system.
As far as i am aware no other developed country has the structure of the NHS and we were unfortunate that it was set up at a time when statism was at its height in this country.Do other healthcare systems work like this and if not, how do they do it? Can we learn from other systems that are not insurance cover based? 20 odd yearsor more have been spent so far playing with the NHS internal market system.
France
Is often regarded as having one of the world's best healthcare systems. The French model is very similar to a private health insurance model, but a state version. Every citizen is required to have health insurance, which is deducted directly from their pay, in accordance with their income. So it is both universal and progressive.
You are then billed by your GP, hospital etc when you go for treatment and a proportion is reimbursed. This could be 100% for long term treatments, or 80% for other conditions.
Spain
In Spain each person entitled to health care is issued with an individual health card (think a few people on here have been advocating something similar
)Funding is mostly controlled at a regional level. It is a bit complicated but as far as I can see hospitals recover their costs using an internal market.
Spain seems to have the model closest to ours but is usually regarded as being superior on healthcare outcomes and has a strong policy on ensuring entitlement to free healthcare.
Germany
As with France Germany also has state insurance scheme for healthcare.
downloaded some quick details
The premium is set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch – SGB), which limits those services to "economically viable, sufficient, necessary and meaningful services"
is not dependent on an individual's health condition, but a percentage (currently 15.5%, 7.3% of which is covered by the employer) of salaried income under € 52,200.01 per year.
includes family members of any family members, or "registered member" ( Familienversicherung – i.e., husband/wife and children are free)
is a "pay as you go" system – there is no saving for an individual's higher health costs with rising age or existing conditions.
according to some details I have seen Germans have lower waiting times than Americans despite paying considerably less for their healthcare.
I could go on. Only the UK thinks the best way to provide healthcare is a monolithic organisation controlled by one politician in government (who then gets roundly abused until removed to be replaced by the next one). Only the UK has no proper means of establishing entitlement to healthcare.
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