Waste in the NHS
Discussion
meehaja said:
MRI is a structural nightmare... quench pipes, location tightly controlled, often stand alone power function. Certainly for smaller hospitals mobile units are much more accessible.
I worked on the refurb of a MRI unit once and the M&E chappie didn't use non-ferrous products. Luckily someone noticed before the magnet was switched on 
TX.
Bertrum said:
You know an MRI scanner has to be in a appropriately shielded room. Which isn't that simple.... and is a bit more than a glorified porter cabin.
Yeah, I get that, I work in MRI 
The floors also need to be reinforced as the machines weigh a few tonnes a piece. It's just the way the quote doubled in such a short space of time for no reason. The requirements never changed - two scanners with the plant room for both on the second floor. It just reeks of someone taking the piss.Edited by Brainpox on Wednesday 18th April 21:16
Lets be clear this is not just an NHS issue. I work as a private contractor into all almost all civil service divisions and the waste is incredible and as another person alluded to its not just poor contract agreements.
It also comes down to base inefficiencies within the system/paperwork.
You cannot just order something. You have to go on an approved list and order from that list but before you can place the order you have to send in a request to place the order to a budget approver to whom you have to justify the purchase using a nice long form who in turn has to log in and check the system to make sure the costings are right and then they have to assess whether your request and justification is right and whther the funds are avialable within the allocated budget.
The financial approver also depending on service, division, request etc has to get approval from other site/line managers. Then once approved it will get sent back to originator and the originator can place the request.
Now where the fun comes into all of it is... Sometimes approval can take so long that by the time everything is in place ie cost approval access etc the requirement for the work is non existant anymore but due to processes it gets done anyway.
I recall our company being called in to do an installation at a government site a few years ago. A day or two after the request came through the government advised the site was being shut down. We queried this with the site as we assumed we would no longer be needed to do the installation. We were told yes still do the install as the budget has been approved for it and the government may end up changing their mind about shutting the site anyway.
About two or three weeks post completion of our work the site was permanently closed ie no staff on site anymore. The infrastructure we installed I dont believe was ever used as they were removing equipment from site at the same time we were completing the install.
Couple of grand washed down a hole although that said the couple of grand spent on us was nothing compared to the tens of millions they had spent on refurbishing some areas of the site and building new buildings over the prior 5 years.
It also comes down to base inefficiencies within the system/paperwork.
You cannot just order something. You have to go on an approved list and order from that list but before you can place the order you have to send in a request to place the order to a budget approver to whom you have to justify the purchase using a nice long form who in turn has to log in and check the system to make sure the costings are right and then they have to assess whether your request and justification is right and whther the funds are avialable within the allocated budget.
The financial approver also depending on service, division, request etc has to get approval from other site/line managers. Then once approved it will get sent back to originator and the originator can place the request.
Now where the fun comes into all of it is... Sometimes approval can take so long that by the time everything is in place ie cost approval access etc the requirement for the work is non existant anymore but due to processes it gets done anyway.
I recall our company being called in to do an installation at a government site a few years ago. A day or two after the request came through the government advised the site was being shut down. We queried this with the site as we assumed we would no longer be needed to do the installation. We were told yes still do the install as the budget has been approved for it and the government may end up changing their mind about shutting the site anyway.
About two or three weeks post completion of our work the site was permanently closed ie no staff on site anymore. The infrastructure we installed I dont believe was ever used as they were removing equipment from site at the same time we were completing the install.
Couple of grand washed down a hole although that said the couple of grand spent on us was nothing compared to the tens of millions they had spent on refurbishing some areas of the site and building new buildings over the prior 5 years.
BMWBen said:
Europa1 said:
Bertrum said:
You know an MRI scanner has to be in a appropriately shielded room. Which isn't that simple.... and is a bit more than a glorified porter cabin.
Would be cheaper to build an actual building, but I suspect your Trust has boxed itself into a corner on timing, hence the more expensive modular build.
An MRI Arctic trailer would be cheaper.
I think patients might be reluctant to strip down to a hospital gown in your trailer... Would be cheaper to build an actual building, but I suspect your Trust has boxed itself into a corner on timing, hence the more expensive modular build.
An MRI Arctic trailer would be cheaper.
Joe Public is also partly responsible for waste within the NHS too....
I took my daughter for an ultra sound earlier this week.
I saw this notice on the wall in the department reception area.....over £200k a year in wasted appointments where patients simply don’t turn up and can’t be bothered to let the hospital know, so they can be offered to others....
Now multiply by all the other departments in every hospital accross the country....
I took my daughter for an ultra sound earlier this week.
I saw this notice on the wall in the department reception area.....over £200k a year in wasted appointments where patients simply don’t turn up and can’t be bothered to let the hospital know, so they can be offered to others....
Now multiply by all the other departments in every hospital accross the country....
Funnily enough my wife took he dad for a CT scan at the Countess of Chester hospital - just down the road from the one above - today.
She was surprised how low the DNA rate was - 27 (plus 1 on the day cancellation) - but the number of scans was massive at 2762. Looking at Wrexham's scan days lost, Chester must have a lot more scanners.
The thing is, there could be all sorts of valid reasons for non-attendance. Some people could have died.
She was surprised how low the DNA rate was - 27 (plus 1 on the day cancellation) - but the number of scans was massive at 2762. Looking at Wrexham's scan days lost, Chester must have a lot more scanners.
The thing is, there could be all sorts of valid reasons for non-attendance. Some people could have died.
Sheepshanks said:
Funnily enough my wife took he dad for a CT scan at the Countess of Chester hospital - just down the road from the one above - today.
She was surprised how low the DNA rate was - 27 (plus 1 on the day cancellation) - but the number of scans was massive at 2762. Looking at Wrexham's scan days lost, Chester must have a lot more scanners.
The thing is, there could be all sorts of valid reasons for non-attendance. Some people could have died.
Yep, could certainly be true. I did notice they didn’t list the number of scans planbed, so no induction of the percentage missed...She was surprised how low the DNA rate was - 27 (plus 1 on the day cancellation) - but the number of scans was massive at 2762. Looking at Wrexham's scan days lost, Chester must have a lot more scanners.
The thing is, there could be all sorts of valid reasons for non-attendance. Some people could have died.
The DNAs at my GP is equally shocking, esp when you consider that it is a three week wait for a “standard” non-urgent appointment....
Ah the joys of the NHS in labour-run Wales...
Sheepshanks said:
Some people could have died.
It doesn't happen that often. The most common reasons for DNAs in my experience is- appointment letters not arriving on time
- issues with patient transport/carer being available to bring them to hospital
- care homes that claim to know nothing about their residents appointments
- traffic/trains cancelled/car broken down
If someone dies we are often informed ahead of time so we can book someone else.
But there are some that plainly don't give a f
k. A number of times I've had patients turn up at midday for their 9.30am scan saying they "don't get out of bed that early". Brainpox said:
Sheepshanks said:
Some people could have died.
It doesn't happen that often. The most common reasons for DNAs in my experience is- appointment letters not arriving on time
- issues with patient transport/carer being available to bring them to hospital
- care homes that claim to know nothing about their residents appointments
- traffic/trains cancelled/car broken down
If someone dies we are often informed ahead of time so we can book someone else.
But there are some that plainly don't give a f
k. A number of times I've had patients turn up at midday for their 9.30am scan saying they "don't get out of bed that early". Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
frankenstein12 said:
Which is why personally i think there should be a financial penalty for missing an appointment. First time £10 second time £20 etc.
They'd exclude people on benefits (otherwise "it's a tax on the poor") which is probably 90% of the people using the NHS.frankenstein12 said:
Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Would the NHS also pay patients who were kept waiting more than 30 mins? Based on most interactions I've had with the NHS that could get pretty expensive.frankenstein12 said:
Which is why personally i think there should be a financial penalty for missing an appointment. First time £10 second time £20 etc.
Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
I’m afraid that would cost more to administer than the money it would take in. The type of people who don’t care about missing an appointment are also the type of people to ignore a charge for missed appointments...Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
Sheepshanks said:
frankenstein12 said:
Which is why personally i think there should be a financial penalty for missing an appointment. First time £10 second time £20 etc.
They'd exclude people on benefits (otherwise "it's a tax on the poor") which is probably 90% of the people using the NHS.frankenstein12 said:
Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Would the NHS also pay patients who were kept waiting more than 30 mins? Based on most interactions I've had with the NHS that could get pretty expensive.It would also help as people would be less inclined to miss or even book appointments they probably wouldnt have turned up for anyway.
In turn it would mean less people using the NHS and more space for those genuinely in need.
rossub said:
frankenstein12 said:
Which is why personally i think there should be a financial penalty for missing an appointment. First time £10 second time £20 etc.
Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
I’m afraid that would cost more to administer than the money it would take in. The type of people who don’t care about missing an appointment are also the type of people to ignore a charge for missed appointments...Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
PWeston said:
Waste follows socialised healthcare like night follows day. There's a distinct lack of accountability and complete perversion of incentives in a way which just doesn't exist in the private sector to anything like the same degree.
Except private healthcare provision tends to be even more wasteful because it also suffers from a complete perversion of incentives compared to an ideal free market activity.Government contracts needs a thread all of its own as I have no doubt, the stuff that goes in with NHS goes on in many more public sector departments.
E.g. a few years ago in my public sector department, I wanted a USB stick. We had to order from the approved list. It cost £30. I complained and said I could go to Tesco down the road and buy the same thing for £5. The answer.... Ah but you're paying for ongoing support, maintenance, disposal etc. What, for a memory stick?!
E.g. a few years ago in my public sector department, I wanted a USB stick. We had to order from the approved list. It cost £30. I complained and said I could go to Tesco down the road and buy the same thing for £5. The answer.... Ah but you're paying for ongoing support, maintenance, disposal etc. What, for a memory stick?!
frankenstein12 said:
In turn it would mean less people using the NHS and more space for those genuinely in need.
I know 'every little helps' but I'm not convinced it's a big deal in the great scheme of things.On the picture above it looks like there's a lot of ultrasound appts missed - but they're probably doing thousands per month. Sure, there's going to be a few feckless people who just can't be bothered but many DNAs will have genuine reasons, as Brainpox detailed.
frankenstein12 said:
Brainpox said:
Sheepshanks said:
Some people could have died.
It doesn't happen that often. The most common reasons for DNAs in my experience is- appointment letters not arriving on time
- issues with patient transport/carer being available to bring them to hospital
- care homes that claim to know nothing about their residents appointments
- traffic/trains cancelled/car broken down
If someone dies we are often informed ahead of time so we can book someone else.
But there are some that plainly don't give a f
k. A number of times I've had patients turn up at midday for their 9.30am scan saying they "don't get out of bed that early". Set a rule that if you are more than 30 minutes late without good reason you miss the appointment and get fined etc.
Those with mobility, disabilities obviously would get a great deal more leeway.
I had a CT scan booked for a Monday morning at 10am. But I was admitted into A&E on the Friday night, had a blood transfusion, told the nurses and the doctors about my CT scan appointment and even showed then the letter. No problem they said. Reminded them all through the weekend. No problem they said. Come Monday morning, nobody came to take me down.
It was on Tuesday morning that I was eventually taken down for the scan and they said they didn't know I was in the building over the weekend. Got home and the very next day, I got a rather harsh letter threatening to stop my treatment due to me 'missing' the Monday appointment.
mp3manager said:
It's not just patients who miss appointments.
I had a CT scan booked for a Monday morning at 10am. But I was admitted into A&E on the Friday night, had a blood transfusion, told the nurses and the doctors about my CT scan appointment and even showed then the letter. No problem they said. Reminded them all through the weekend. No problem they said. Come Monday morning, nobody came to take me down.
It was on Tuesday morning that I was eventually taken down for the scan and they said they didn't know I was in the building over the weekend. Got home and the very next day, I got a rather harsh letter threatening to stop my treatment due to me 'missing' the Monday appointment.
Really Hope you kicked up a fuss and named names?!? I've had similar before when I cancelled a Doctors appointment due to being so full of Flu, I honestly couldn't make the appointment for an un related issue. Thankfully, I made notes of time / date/ and the name of the receptionist who 'recorded' my call and cancellation! Got an apology, but they wouldn't put it in writing! Still get the 'daggers' stare when I see the receptionist in question! I do wonder how many times she's done it though?!I had a CT scan booked for a Monday morning at 10am. But I was admitted into A&E on the Friday night, had a blood transfusion, told the nurses and the doctors about my CT scan appointment and even showed then the letter. No problem they said. Reminded them all through the weekend. No problem they said. Come Monday morning, nobody came to take me down.
It was on Tuesday morning that I was eventually taken down for the scan and they said they didn't know I was in the building over the weekend. Got home and the very next day, I got a rather harsh letter threatening to stop my treatment due to me 'missing' the Monday appointment.
10 years ago I used to provide training to the NHS for Cognos, they used this to provide statistical information on blood tests. I worked for a company that was contracted to provide this to the NHS via a much larger company. My company charged me out at £750 a day. I was in training one day talking to a guy I'd met several times and spoken to lots, He said they were charged £1500 a day by the main company. They had no involvement with the training other than to send the invoice, training and setup was a week work, so they were doubling our money for sending the invoice. Barmy!
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