The NHS

[Rascal]

I don't know except the waste that has been reported on this thread and my knowledge of private sector business where waste is aggressively controlled and hounded out.
Integrated computer systems would highlight this for you and as far as your posts are concerned allow investment to go in the areas that would benefit.
Incidentally, are you totally happy that all current investment is targeted correctly in all areas of nhs?
If so then producing a business plan for each area should be no problem at all.to their individual managers. Let them compete for money and show how they can improve rather than just say they are underfunded.
A budget should be something to save from rather than a target to spend.
Just an opinion from someone who knows nothing about the public sector but knows what happens when big organisations get out of control.

A lot of waste is anecdotal rather evidential. This is because currently there is little left you could waste and some of the reforms actually cause more waste and cost more money as they are examples of short termism. In my view short termism is the worst possible outcome for the NHS that's why a few pages back I advocated taking the NHS under direct democratic control away from Government ideological control. With all due respect to Health secretaries of all parties, they meddle in things with ideology in mind rather than understanding of structural issues. I know I bang on about Lansleys reforms but they were a disaster and they fragmented services rather than solve issues in supplying services.

I am not a great believer that it is underfunded, although the social care element is definitely underfunded. I would look to separate those components. The dermatology review I am involved in is producing a business plan, it has to so that it can prove it is viable. I cant speak for other areas because I don't know, but I would assume that any reform follows a similar plan, its not just an ad hoc plan that expects money to be delivered without recourse. As for competing for funding I am not sure exactly what you mean here, are you saying for instance Neurology should compete with Immunology for money? Or you saying Neurology at say Salford should compete with Bury for money?

 

[Rascal]

To be perfectly honest mate, I made my opening post based on how I feel about the whole thing. I think the NHS is dysfunctional as it stands, arguably unfit for purpose and we need a thorough and total review of how we wish to provide excellent health care for our 65m citizens for the next 50 years.

And yet any such debate is stiffled by disgruntled NHS workers banging on on the one hand about how bloody wonderful it is and that we mustn't mess with it, and in the same breath, how terrible it is and what awful conditions they have to put up with. And half the population chiming in with how marvellous it is on the basis that their sister/aunt/uncle/mother/neighbour works there and how hard done by they are. On page 2, I had Karen's first response - the very constructive, "Oh do one".

What's pretty clear is that half the employees (figuratively - it's probably more) are pretty pisssed off and something needs changing. And yet for most of them, the answer seems to be "don't change anything", with the added caveat, "just give us a shed load more funding".

That's about all I have to say on the matter really. I'm no expert on healthcare reform, but even from my lay position, I can see something needs to be changed and we cannot carry on with it as it is. It's not up to me to get into a point by point, blow by blow, line by line debate on how excellent or not NHS gynaecological services are in Bolton. My position is looking at it somewhat more strategically than that.

This is the problem, you think its dysfunctional based on feelings without knowledge of what is happening to solve the dysfunction. The NHS is not perfect, its far from it and I would argue it can never be perfect because of the simple fact that medical advancements always leave it behind the curve somewhat. This is probably true for any health system world wide because of the disconnect between research and outcomes. Because of this the NHS is continually evolving and needs to find new ways to work on a continual basis. It can never be in my view a perfect system and not only because of that but because of the human elements involved. The staff want continuity and a decent wage, like staff in any company regardless of industry, austerity has slowed wages and made working conditions harder and that is also true across all sectors of industry not just the NHS. It does not help when you have health secretaries who simply do not understand basic themes of care. The junior doctors dispute is a case in a point. The idea that the NHS was not a 24/7 service was a nonsense, brought about for ideological reasons. Hence I reiterate the NHS should be taken out of Government control and I my view run democratically.


Of course passions for the NHS will run high, it saves lives, it is noble and a jewel in the UK crown so people will get over defensive about it because they will have personal experience or involvement with it or through it. I would argue its the best thing this country has and from an economics point of view it keeps the workforce healthy at no direct cost to employers which increases profitability and therefore should increase investment. This is often overlooked in the NHS debate, it is not a net cost, it is a net benefit. A heathy workforce is vital for increasing productivity.

 

[Chippy_boy]

This is the problem, you think its dysfunctional based on feelings without knowledge of what is happening to solve the dysfunction.

I think it's dysfunctional based on my own experiences of it over the past 30 years or so and the countless hospital visits to friends and family members over that period. And also from what I've read about clinical outcomes for certain diseases and the survival rates, compared to other countries.

Material to this is of course *why* it is not performing as well as I would like (and as well as many millions would also like, IMO), but when we dig into that, all we get is "it's under funded", "the government doesn't understand it". As if all it needs is more money and jobs a good 'un. I don't accept that.

Personally I see a stark difference in attitude to timeliness, cost control, waste and customer service, between the private sector vs public (and incidentally private sector monopolies). I struggle to think of a public sector institution which provides the same level of service to the public, and at the same cost and quality as is routinely available from the private sector. Whether that be having to ring HMRC 27 times to get through, not being able to speak to anyone on the council after 5pm or on a Saturday, the off-hand rudeness of reception staff at many public sector front desks (compared to any hotel, for example), the routine lateness of projects, cancellation of projects, gross budget overrun of projects. Because no-one REALLY cares about the "service" to you and me, when you and me have nowhere else to go. And no-one really cares about the money, when it's not their money.

That's my view and based on that, idealogically, I am in favour of trying to introduce a more competitive system. One with proper competition and proper patient choice. Outsourcing contracts with some bite to them - not long term cushy contracts where the contractor is allowed to milk the NHS in return for a piss poor service, which is what I see in the case of e.g. cleaning services! Why is the private sector seems to be able to outsource anything it likes with pretty much ease, and yet the NHS is so fucking crap at it? Why is it the government cannot run a successful on budget IT project to save its life? I'm back to paragraph 2 above.

But I may well be entirely wrong and this might not be the best option. And any such debate is shouted down by people - often with vested interests - who want to preserve it in aspic.

But what I do know is, it cannot carry on as it is.

 

[Chippy_boy]

A lot of waste is anecdotal rather evidential. This is because currently there is little left you could waste and some of the reforms actually cause more waste and cost more money as they are examples of short termism. In my view short termism is the worst possible outcome for the NHS that's why a few pages back I advocated taking the NHS under direct democratic control away from Government ideological control. With all due respect to Health secretaries of all parties, they meddle in things with ideology in mind rather than understanding of structural issues. I know I bang on about Lansleys reforms but they were a disaster and they fragmented services rather than solve issues in supplying services.

I'd definitely agree with you about taking it out of government control. I'd agree about taking anything out of government control.

 

[KS55]

Here's what the Kings Fund says.

"Following the Health and Social Care Act 2012, the number of contracts awarded to private providers increased, though there is little evidence of a significant increase in spending on private providers or widespread privatisation of NHS services. In many cases the use of private providers to treat NHS patients reflects operational challenges within NHS providers and is a continuation of longstanding practices. Provided that patients receive care that it is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver. More positively, the NHS can benefit from partnerships and joint ventures with the private sector to deliver some clinical and non-clinical services."

About 10% of health care spending by NHS commissioners is with private contractors.
As they say, evidence of widespread privatisation is thin to say the least.
I had surgery for a cancer a few years ago. The particular operation I needed was not available on the NHS in my area. The NHS paid a private clinic to do it. No cost to me and, given the rarity of the surgery, a saving for the NHS compared to the cost of providing it themselves.

 

[SilverFox2]

A lot of waste is anecdotal rather evidential. This is because currently there is little left you could waste and some of the reforms actually cause more waste and cost more money as they are examples of short termism. In my view short termism is the worst possible outcome for the NHS that's why a few pages back I advocated taking the NHS under direct democratic control away from Government ideological control. With all due respect to Health secretaries of all parties, they meddle in things with ideology in mind rather than understanding of structural issues. I know I bang on about Lansleys reforms but they were a disaster and they fragmented services rather than solve issues in supplying services.

I am not a great believer that it is underfunded, although the social care element is definitely underfunded. I would look to separate those components. The dermatology review I am involved in is producing a business plan, it has to so that it can prove it is viable. I cant speak for other areas because I don't know, but I would assume that any reform follows a similar plan, its not just an ad hoc plan that expects money to be delivered without recourse. As for competing for funding I am not sure exactly what you mean here, are you saying for instance Neurology should compete with Immunology for money? Or you saying Neurology at say Salford should compete with Bury for money?

Thanks for reply.
Regarding compete for money I meant that those who develop a business plan for their area of expertise should be favoured rather than those who simply spend on non developing areas and expect extra cash simply because they have spent theirs.
In car manufacture for instance a new model does not necessarily go to the same factory without competition.
Regarding short termism, if a business plan is approved for whatever period measuring its progress should be assessed regularly. To simply spend only within a.n allocated fund may lead to say pain control only before a possible other cause of the pain is investigated. In other words delaying spend to a later time even though screening and finding and curing in the same spend period may save money overall.
I am sure that state of the art progress is made by many areas within the nhs but the impression I get is that whilst some rightfully challenge existing practices and drugs, others refuse to accept that anything that involves any change is to be avoided.
I do agree though to allow bean counters to rule will stifle progress, let accountants check the spend but once a budget is signed off to be aware of ones spend is vital so that looking at the 5 year plan in the light of changes every 3 months will allow small changes that enhance the BP and its objectives.
Hope that makes sense.

 

[Rascal]

Here's what the Kings Fund says.

"Following the Health and Social Care Act 2012, the number of contracts awarded to private providers increased, though there is little evidence of a significant increase in spending on private providers or widespread privatisation of NHS services. In many cases the use of private providers to treat NHS patients reflects operational challenges within NHS providers and is a continuation of longstanding practices. Provided that patients receive care that it is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver. More positively, the NHS can benefit from partnerships and joint ventures with the private sector to deliver some clinical and non-clinical services."

About 10% of health care spending by NHS commissioners is with private contractors.
As they say, evidence of widespread privatisation is thin to say the least.
I had surgery for a cancer a few years ago. The particular operation I needed was not available on the NHS in my area. The NHS paid a private clinic to do it. No cost to me and, given the rarity of the surgery, a saving for the NHS compared to the cost of providing it themselves.

The Kings fund do some good work, although I am a sceptic of some of their motives. Their corporate partners make me slightly suspicious and their description of being a charity disguises that they are a lobby group of some sorts. That's my own personal view of course and I don't dispute they have undertaken some really important work.

I am not particularly against private provision per se, as it can benefit the populace and some specialisations can be done more effectively this way. This point is anecdotal and I don't really like using anecdotal as evidence as it is not, but I look at the ward I am most familiar with and there is a disconnect between the outsourced cleaning staff and the nursing staff. As a patient I would prefer a full team approach with Matron being the leader, the cleaning staff who do a great job btw, come under different leadership and that can lead to communication issues. As I say this anecdotal not evidential but on one of my admissions to hospital I was informed a bed was available and I should be there by midday. I arrived just before and the bed wasn't ready. The bed I was taking was one where a patient had sadly passed away and under those circumstances mattresseses are changed and a deep clean is undertaken. In order for that to be done the Charge Nurse had to contact the outsourcers and arrange the clean rather than it being done in-house. This of course takes time because outsourcers run for profit and supply the minimum service required. I finally got to the bed at 7pm, now 7 hours does not seem a long time but when there is a general shortage of beds the knock on effect of that is similar to that of a delayed aeroplane, everybody further down the line waits a little longer. I know its a minor gripe and one I was fine with but if a patient was really ill and desperate for a bed those 7 hours seems a lifetime. That leads to stories of people lying on hospital trollies which are then exploited by the media for whatever agenda they follow. Like I say this is anecdotal and it has only happened once in my 29 stays in hospital and there could have been many reasons for it, but I still feel there is a disconnect between NHS and outsourced staff that results in issues arising.

 

[Rascal]

I think it's dysfunctional based on my own experiences of it over the past 30 years or so and the countless hospital visits to friends and family members over that period. And also from what I've read about clinical outcomes for certain diseases and the survival rates, compared to other countries.

Material to this is of course *why* it is not performing as well as I would like (and as well as many millions would also like, IMO), but when we dig into that, all we get is "it's under funded", "the government doesn't understand it". As if all it needs is more money and jobs a good 'un. I don't accept that.

Personally I see a stark difference in attitude to timeliness, cost control, waste and customer service, between the private sector vs public (and incidentally private sector monopolies). I struggle to think of a public sector institution which provides the same level of service to the public, and at the same cost and quality as is routinely available from the private sector. Whether that be having to ring HMRC 27 times to get through, not being able to speak to anyone on the council after 5pm or on a Saturday, the off-hand rudeness of reception staff at many public sector front desks (compared to any hotel, for example), the routine lateness of projects, cancellation of projects, gross budget overrun of projects. Because no-one REALLY cares about the "service" to you and me, when you and me have nowhere else to go. And no-one really cares about the money, when it's not their money.

That's my view and based on that, idealogically, I am in favour of trying to introduce a more competitive system. One with proper competition and proper patient choice. Outsourcing contracts with some bite to them - not long term cushy contracts where the contractor is allowed to milk the NHS in return for a piss poor service, which is what I see in the case of e.g. cleaning services! Why is the private sector seems to be able to outsource anything it likes with pretty much ease, and yet the NHS is so fucking crap at it? Why is it the government cannot run a successful on budget IT project to save its life? I'm back to paragraph 2 above.

But I may well be entirely wrong and this might not be the best option. And any such debate is shouted down by people - often with vested interests - who want to preserve it in aspic.

But what I do know is, it cannot carry on as it is.

I have not said its underfunded, although more money would be welcome and more staff would be a bonus, I do disagree that the Government understands it though, governments use it as a vote winning tool and ideological prover.

The private sector good, public sector bad debate is in my view ideological, capitalists believe that the market solves all, Socialists believe capital only serves the owners of capital. The truth is somewhere in the middle, its finding the balance that is the key. Capital can be involved but only if it is not to the detriment of the common good, even Marx himself acknowledged that capital has its uses as he states in the Communist Manifesto.

The problem as I see it, which btw does not make it right, is that some services are simply not suited to being open to capitalist forces. Railway privatisation has proved that in some areas competition is not feasible. An example in the NHS I would give is an area I am familiar with, dermatology. The current model in Greater Manchester is a world leader in research and in teaching, if you opened that up to competition I struggle to see how a service that competes would increase better patient outcomes. The fact that Manchester is a world leader attracts staff from across the world and has lead to the creation of the global atlas of dermatology. A competing entity would dilute the researchers required in an area that is already short of sufficient staffing levels. Research would become fragmented rather than under an umbrella organisation which defines the areas that it is needed. The research areas were decided upon by patients through collaboration with the James Lind alliance and a thorough consultation across the sector. I don't believe this would be possible or profitable for a private company whose bottom line is more important than the requested outcomes.

I hope you see I have approached this debate in a reasonable manner, I have not shouted you down and my only vested interests have been stated in that I undertake work as a volunteer for Innovation Health Manchester in which I represent patient interests.

 

[Rascal]

Thanks for reply.
Regarding compete for money I meant that those who develop a business plan for their area of expertise should be favoured rather than those who simply spend on non developing areas and expect extra cash simply because they have spent theirs.
In car manufacture for instance a new model does not necessarily go to the same factory without competition.
Regarding short termism, if a business plan is approved for whatever period measuring its progress should be assessed regularly. To simply spend only within a.n allocated fund may lead to say pain control only before a possible other cause of the pain is investigated. In other words delaying spend to a later time even though screening and finding and curing in the same spend period may save money overall.
I am sure that state of the art progress is made by many areas within the nhs but the impression I get is that whilst some rightfully challenge existing practices and drugs, others refuse to accept that anything that involves any change is to be avoided.
I do agree though to allow bean counters to rule will stifle progress, let accountants check the spend but once a budget is signed off to be aware of ones spend is vital so that looking at the 5 year plan in the light of changes every 3 months will allow small changes that enhance the BP and its objectives.
Hope that makes sense.

It does make sense, and one area where there is improvement is in accountability. I often see and hear that the NHS is overstaffed with managers, but I deal with them and their expertise in health sectors and their expertise in business planning is vital if we are to make the most of what we have. In any organisation people are resistant to change, I studied it years ago and cant remember the name of the theory behind it, but I digress, I believe it is the job of the innovators to show those who are resistant to change why change will be good for them. I have attended meetings where people are very protective of their own particular part of the system, but when the change is explained I have seen them change their minds and accept that the proposal has merits. As Keynes said, if the facts change I change my mind and that is becoming more and more a normal way of thinking inside the NHS. It knows it has to evolve or it runs the risk of becoming an outdated dinosaur of an organisation.

 

[yerwot?]

out-sourcing cleaning and laundry gave us c-difficile and needless deaths. thatcher...
The all-out war on nurses and doctors gave us death by lack of staff. thatcher...
the naked propaganda by the daily hate mail and murdoch turned the victim of ideology into the culprit, lovingly adopted by the thatcher mafia and demonstrated so gleefully on this thread...follows the usual far-right pattern, everyone knows a tramp who lives in a mansion, everyone knows someone who died because some left-wing idle bastard didn't do what he was over-paid to do, all bosses are saints, all workers are thieves, no such thing as white-collar crime, just market forces blah blah fuckin' blah.
When the govnt is determined to sell-off/give away public-owned assets, energy, health, water, telecoms health depts, the service deteriorates the cost multiplies the pensions evaporate the t's and c's for employees are then reduced to the minimum wage that requires topping up, by the tax payer( not the share-holders of course, their pay-off is bullet-proof thanks to the "watch-dog" ) . Despite everything, the americans will make it worse, far worse, the british public are being lied to on a scale never seen before, despite the lies of the last 3 years, and they take some beating