Dispatches - NHS in Crisis
Discussion
740EVTORQUES said:
Megaflow said:
740EVTORQUES said:
Megaflow said:
Lotusgone said:
There are several factors contributing to the current state of the NHS. What is clear though, is that the only method tried so far - more money - is not the answer. If your car keeps using more fuel (or electric), do you refuel more often or take it to the garage?
I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
I have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
Then there is also the problem of funding an above inflation increase for the long term:
FWIW, I believe the NHS, in certain circumstances, is the best in the world. There is no other country in the world I would want to be rushed into hospital in an ambulance or helicopter. But for the day to day stuff it is shocking.
ETA: I don't agree with the title of this, but it covers the subject very well I think: https://snowdon.substack.com/p/how-to-argue-with-a...
Edited by Megaflow on Friday 28th June 14:48
Megaflow said:
740EVTORQUES said:
Megaflow said:
740EVTORQUES said:
Megaflow said:
Lotusgone said:
There are several factors contributing to the current state of the NHS. What is clear though, is that the only method tried so far - more money - is not the answer. If your car keeps using more fuel (or electric), do you refuel more often or take it to the garage?
I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
I have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
Then there is also the problem of funding an above inflation increase for the long term:
FWIW, I believe the NHS, in certain circumstances, is the best in the world. There is no other country in the world I would want to be rushed into hospital in an ambulance or helicopter. But for the day to day stuff it is shocking.
ETA: I don't agree with the title of this, but it covers the subject very well I think: https://snowdon.substack.com/p/how-to-argue-with-a...
Edited by Megaflow on Friday 28th June 14:48
Why do you doubt that the examples I gave of where more funding would help are real? Or the concrete examples of why the cost of care has increased so that an increased per capita amount of funding might still mean that the service is underfunded? How would you deal with that? Ration expensive procedure? That woudl be possible although politically very difficult.
What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution? The usual political way of finding efficiencies involve things like the aforementioned replacement of GP appointments with non medically qualified PA's that in the long run often result in poorer and more expensive care.
More funding is not the easy answer, it's just the realistic but unpalatable one. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely that easy.
Edited by 740EVTORQUES on Friday 28th June 15:07
740EVTORQUES said:
Why do you doubt that the examples I gave of where more funding would help are real?
What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
Surely the unpalatable truth is that the NHS was designed pre WW2 and its implementation was stalled because of that minor disagreement, with it being introduced just after … almost 80 years ago What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
The world has changed massively since then, in population, expectations, medical advances etc etc
But fundementaly the NHS hasn’t changed, it’s just got bigger and bigger
Never in the last 80 years has anyone sat down and really looked at what is needed now and in the future .. it’s all sticking plasters
The answer always seems to be “we’ve 24hrs to save the NHS” and to do that we need to throw £ x X at it
Sometimes the people, no matter how senior, within an organisation, especially a huge one where perhaps their entire working life has been within it, are the last people that should be looking at an alternative way rather than “throw more money at something that is faiiing”
740EVTORQUES said:
Megaflow said:
740EVTORQUES said:
Megaflow said:
740EVTORQUES said:
Megaflow said:
Lotusgone said:
There are several factors contributing to the current state of the NHS. What is clear though, is that the only method tried so far - more money - is not the answer. If your car keeps using more fuel (or electric), do you refuel more often or take it to the garage?
I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
I have said in the past, and worth saying again, that more money is not the answer. I firmly believe you could double the NHS budget over night and it would make zero difference. Sort of proven by the comment that follows trying to prove that it is a population issue.I spent a couple of years in the NHS in the 1990s. The regard of staff to taxpayers' money was a lot closer to contempt than respect. Also, the insistence of hospitals (or providers, as they preferred then) of recruiting people with provider experience, just perpetuates and worsens the old mistakes and attitudes. (I'm not still bitter about not getting a job, by the way).
The waste is incredible. The agency staff situation is ludicrous. Whoever negotiated the PFI contracts on behalf of HMG should be sent to prison and their pensions forfeit.
There is also far less accountability than there should be. Not just with money but with provision of services; there are plenty of instances where errors are covered up, with no-one carrying the can.
tele_lover said:
Hants PHer said:
The common denominator isn't the politicians, it's the NHS itself.
That's not the common denominator.1997 population 58 million
Today population 70 million
12 million
The population of London today is ~9 million
This is the reason ALL public services are affected.
NHS budget in 2024 230.5m, or £3.3m per head.
So inflation corrected and population corrected the NHS budget has literally doubled in 27 years.
Budget source: https://www.statista.com/statistics/317877/public-...
Inflation correction: https://www.statista.com/statistics/317877/public-...
In addition the complexity of care and associated costs have risen ahead of inflation. For example present with a stroke 30 years ago and the treatment would have been supportive care while today it’s a minimum of an immediate CT scans and then possibly endovascular surgery to remove a clot. Same for heart attack, instead of aspirin or theombolytic drugs, today you’ll get an emergency angiogram and coronary stenting or surgery. All with better outcomes but hugely more expensive
So you have the toxic situation where spend per head may have doubled and yet still be inadequate to meet the needs.
Add to that a shrinking proportion of working adults and you have the seeds of the problem.
‘More efficiency’ is an easy knee jerk answer but it’s far too simplistic.
We have some tough choices to make, which need to reflect the need for a proper cross generational solution better than simply cut taxes and send the lazy youth on national service.
Edited by 740EVTORQUES on Friday 28th June 12:35
The real solutions?
Well, fund it properly so that rebuilding, maintenance etc can be done rather than shelved for short term savings.
Fund social care to unblock hospitals (ie pay carers enough to recruit them).
Pay staff properly to stop the recruitment and (more importantly retention) issues. This can't be over-emphasised, staff turnover and especially loss of trained staff to emigration, going part time (or private) or early retirement is catastrophically wasteful.
Stop devaluing GP's and other staff by using PA's as (not even that) cheap substitutes in order to meet short term promises on consultations delivered, while storing up expensive problems through excessive use of tests (which is what junior and less qualified staff tend to do) and missed diagnoses.
Where there are efficiencies to be gained, it's more from reducing the multiple layers of management, and faux internal markets that achieve very little other than increase costs, more than the oft raised meme that the woes of teh NHS are entirely down to feckless nurses standing around eating quality street on the wards.
I might be 100% wrong, but 30+ years on the frontline mean I probably have a fair idea of how it works.
Then there is also the problem of funding an above inflation increase for the long term:
FWIW, I believe the NHS, in certain circumstances, is the best in the world. There is no other country in the world I would want to be rushed into hospital in an ambulance or helicopter. But for the day to day stuff it is shocking.
ETA: I don't agree with the title of this, but it covers the subject very well I think: https://snowdon.substack.com/p/how-to-argue-with-a...
Edited by Megaflow on Friday 28th June 14:48
What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
A new GM came on board and started a program called 'Turnaround' it was a brutal 2 years, every single expenditure was analysed and its value to the business calculated. We consolidated office space, everyone gave up their desks for ones half the size, to enable that to happen.
It worked, we went from boom and bust to steady continual growth and a few years after that when we had proved it worked, the parent company allowed us to invest a 9 figure sum in two new products that have enabled that growth to continue.
Savings through efficiencies happen every day in the private sector (I feel at this point I should remind people I have *never* said we need the private sector in the NHS, because that will end up with a US system) because that is how business works. The NHS needs to think more like the private sector. As an example a box of paracetamol costs literally pence in the supermarkets, you can bet the NHS is paying more, even though it is a bigger organisation and should in theory have even more buying power than the supermarkets.
For example, as I type this, lets assume the NHS has a budget of £250bn but with a bonus system in it, every thing under that £250bn that is not spent, gets split between the employees as a bonus. I bet they become a lot more interest in efficiencies and waste then, because that is how the private sector works.
PS: I spent 25 years as a cost engineer, and I'd love to get started on eifficieny savings in the NHS, I reckon I'd have a field day!
Edited by Megaflow on Friday 28th June 15:18
Megaflow said:
As an example a box of paracetamol costs literally pence in the supermarkets, you can bet the NHS is paying more, even though it is a bigger organisation and should in theory have even more buying power than the supermarkets.
Would you like to know the current price for paracetamol in the NHS (hospitals)?Paracetamol 500mg caplets (100 caplets) - £0.60 (£0.006 per tablet). That is a national contract price (effective June 1st 24). That price needs VAT adding on for NHS Trusts as they are not VAT exempt but that allows for comparison to supermarkets who wont be paying VAT on drugs.
Edit: That is down from £0.75 in May
For comparison Tesco have paracetamol 500mg tablets (16) at £0.37 (which obviously has a mark up included)
Edited by pavarotti1980 on Friday 28th June 16:15
pavarotti1980 said:
Megaflow said:
As an example a box of paracetamol costs literally pence in the supermarkets, you can bet the NHS is paying more, even though it is a bigger organisation and should in theory have even more buying power than the supermarkets.
Would you like to know the current price for paracetamol in the NHS (hospitals)?Paracetamol 500mg caplets (100 caplets) - £0.60 (£0.006 per tablet). That is a national contract price (effective June 1st 24). That price needs VAT adding on for NHS Trusts as they are not VAT exempt but that allows for comparison to supermarkets who wont be paying VAT on drugs.
Edit: That is down from £0.75 in May
For comparison Tesco have paracetamol 500mg tablets (16) at £0.37 (which obviously has a mark up included)
Edited by pavarotti1980 on Friday 28th June 16:15
Megaflow said:
In which case, for that example, I was wrong.
For the most part NHS achieves huge discounts on drugs because as you say they have huge buying power. It will be very very rare that the list price of the drug is paid and the all the high volume low cost stuff is through regional or national contract frameworks. High cost ones are negotiated nationally.For my sins this is my every day at the moment as we have our annual drug cost improvement programme. Only this year the target is £4m savings instead of £3m (for one albeit larger NHS trust).
pavarotti1980 said:
Megaflow said:
In which case, for that example, I was wrong.
For the most part NHS achieves huge discounts on drugs because as you say they have huge buying power. It will be very very rare that the list price of the drug is paid and the all the high volume low cost stuff is through regional or national contract frameworks. High cost ones are negotiated nationally.For my sins this is my every day at the moment as we have our annual drug cost improvement programme. Only this year the target is £4m savings instead of £3m (for one albeit larger NHS trust).
Earthdweller said:
740EVTORQUES said:
Why do you doubt that the examples I gave of where more funding would help are real?
What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
Surely the unpalatable truth is that the NHS was designed pre WW2 and its implementation was stalled because of that minor disagreement, with it being introduced just after … almost 80 years ago What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
The world has changed massively since then, in population, expectations, medical advances etc etc
But fundementaly the NHS hasn’t changed, it’s just got bigger and bigger
Never in the last 80 years has anyone sat down and really looked at what is needed now and in the future .. it’s all sticking plasters
The answer always seems to be “we’ve 24hrs to save the NHS” and to do that we need to throw £ x X at it
Sometimes the people, no matter how senior, within an organisation, especially a huge one where perhaps their entire working life has been within it, are the last people that should be looking at an alternative way rather than “throw more money at something that is faiiing”
I'm not pretending there are easy solutions, but you absolutely have to involve the staff otherwise you are on a hiding to nothing.
Megaflow said:
The answers to all of those has been proven time and time again the private sector. I worked for a company that was on this continual boom and bust cycle. We made money for a couple of years, everybody would get carried away spunk a load of money up the wall, then we'd start to lose again.
A new GM came on board and started a program called 'Turnaround' it was a brutal 2 years, every single expenditure was analysed and its value to the business calculated. We consolidated office space, everyone gave up their desks for ones half the size, to enable that to happen.
It worked, we went from boom and bust to steady continual growth and a few years after that when we had proved it worked, the parent company allowed us to invest a 9 figure sum in two new products that have enabled that growth to continue.
Savings through efficiencies happen every day in the private sector (I feel at this point I should remind people I have *never* said we need the private sector in the NHS, because that will end up with a US system) because that is how business works. The NHS needs to think more like the private sector. As an example a box of paracetamol costs literally pence in the supermarkets, you can bet the NHS is paying more, even though it is a bigger organisation and should in theory have even more buying power than the supermarkets.
For example, as I type this, lets assume the NHS has a budget of £250bn but with a bonus system in it, every thing under that £250bn that is not spent, gets split between the employees as a bonus. I bet they become a lot more interest in efficiencies and waste then, because that is how the private sector works.
PS: I spent 25 years as a cost engineer, and I'd love to get started on eifficieny savings in the NHS, I reckon I'd have a field day!
The trouble is that you fundamentally can't treat healthcare in the same way as industry or retail or whatever. The drivers, motivations and rewards are just not the same. A new GM came on board and started a program called 'Turnaround' it was a brutal 2 years, every single expenditure was analysed and its value to the business calculated. We consolidated office space, everyone gave up their desks for ones half the size, to enable that to happen.
It worked, we went from boom and bust to steady continual growth and a few years after that when we had proved it worked, the parent company allowed us to invest a 9 figure sum in two new products that have enabled that growth to continue.
Savings through efficiencies happen every day in the private sector (I feel at this point I should remind people I have *never* said we need the private sector in the NHS, because that will end up with a US system) because that is how business works. The NHS needs to think more like the private sector. As an example a box of paracetamol costs literally pence in the supermarkets, you can bet the NHS is paying more, even though it is a bigger organisation and should in theory have even more buying power than the supermarkets.
For example, as I type this, lets assume the NHS has a budget of £250bn but with a bonus system in it, every thing under that £250bn that is not spent, gets split between the employees as a bonus. I bet they become a lot more interest in efficiencies and waste then, because that is how the private sector works.
PS: I spent 25 years as a cost engineer, and I'd love to get started on eifficieny savings in the NHS, I reckon I'd have a field day!
Edited by Megaflow on Friday 28th June 15:18
The output in healthcare is limitation or better prevention of suffering and death, and while you can cost interventions, you can't, at least in our society, really limit them. At the same time, the needs and costs rise, and the impact of technology perversely makes more conditions survivable and thus more not less expensive. At the same time you have population that sees it as a right (rightly so IMO) not a privilege to access such care, and a workforce that is driven by outcomes not profit or efficiency.
How are you to drive efficiency when there is always a tension between doing the best for an individual patient, re-enforced by a personal, moral or medico-legal drive and the imperative to be efficient with resources?
What does efficiency even mean when in many cases the resource use is essentially open ended? I've seen many £100,000's of pounds spent on one patient in a way that while morally and ethically justifiable, makes no business sense.
I have no doubt that you would like to apply private sector style reforms to the NHS, but I also have no doubt, having witnessed many attempts at this from very bright people from the 'big four' and others, that you would not succeed if you do not accept that healthcare can never be a business in the way you are suggesting.
If healthcare followed more normal business practices, then we would insist on levels of resilience that would require additional layers of staff, backups of equipment etc that woudl be ruinously expensive, the NHS operates on a knife edge. You can see this by the effect of the recent cyber-attack in London, there's no spare capacity to deal with black swan events like this as the system is pushed to the limit all the time. Where is the efficiency to come from?
You describe a model where material costs reduce by 3% PA, how about one where costs increase by 10-15% PA as the work becomes harder and more complex?
The fact that all healthcare systems across the developed world are under various forms of stress irrespective of how they are organised tells you that NHS efficiency is very much not the bigger picture.
(Before you ask, private healthcare only works as a wort of business as it is a very selected profitable subset of the whole need and is not comparable.)
I do hope that Labour have learned the lessons of the past 15-20 years and do not try once again to impose private sector solutions as that will be doomed to failure, it's been tried so many times already.
Megaflow said:
Out of interest what is the NHS drugs budget, ball park. I ask because the manufacturing industry I come from works on 3% annual cost savings on material cost every year. It would be interesting to know how the £4m compares as a percentage.
Not sure on entire budget but ours is £270m up from £262m last year. That includes new drugs, growth and savings. So approx 1.5%740EVTORQUES said:
Earthdweller said:
740EVTORQUES said:
Why do you doubt that the examples I gave of where more funding would help are real?
What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
Surely the unpalatable truth is that the NHS was designed pre WW2 and its implementation was stalled because of that minor disagreement, with it being introduced just after … almost 80 years ago What is your solution to crumbling infrastructure, high staff turnover, poor retention and recruitment, social care not being able to take patients out of hospital unblocking beds that don't involve more funding?
By contrast where are your supposed efficiencies going to come from and what evidence do you have for these being the solution?
More funding is not the easy answer, it's just unpalatable. The easy (simplistic) solution is to say 'find more efficiencies' but it's rarely the right one.
The world has changed massively since then, in population, expectations, medical advances etc etc
But fundementaly the NHS hasn’t changed, it’s just got bigger and bigger
Never in the last 80 years has anyone sat down and really looked at what is needed now and in the future .. it’s all sticking plasters
The answer always seems to be “we’ve 24hrs to save the NHS” and to do that we need to throw £ x X at it
Sometimes the people, no matter how senior, within an organisation, especially a huge one where perhaps their entire working life has been within it, are the last people that should be looking at an alternative way rather than “throw more money at something that is faiiing”
I'm not pretending there are easy solutions, but you absolutely have to involve the staff otherwise you are on a hiding to nothing.
Why not have a royal commission into what we need, want and how to provide it ?
Certainly input from people like yourself is invaluable but eyes from outside can do no harm surely?
And no I don’t mean 20 somethings in sharp suits with degrees in “management”
Trust me, like you I want the NHS to be the absolute best it can be but I sense it’s an inefficient monster at the moment and I don’t hold any hope that any politician of whatever colour rosette will make a difference
Rather sobering to have returned from a trip to see colleagues in a city that 30 years ago was in East Germany. As part of the re-unification they had a massive new hospital built, and as you might imagine it is a model of efficiency, so certainly worth examining lessons from around the world. But it's hard to escape the fact that the level of resources (infrastructure and staff) in relation to the remand is massively better than in the NHS as so you are starting from a very different place. If you are constantly fire-fighting then it's very difficult to develop. The fact that the NHS is a political football subject to repeated 5 yearly cycles doesn't help of course. At the very least it's so broken that it needs a reset before anything meaningful can be achieved.
740EVTORQUES said:
Rather sobering to have returned from a trip to see colleagues in a city that 30 years ago was in East Germany. As part of the re-unification they had a massive new hospital built, and as you might imagine it is a model of efficiency, so certainly worth examining lessons from around the world. But it's hard to escape the fact that the level of resources (infrastructure and staff) in relation to the remand is massively better than in the NHS as so you are starting from a very different place. If you are constantly fire-fighting then it's very difficult to develop. The fact that the NHS is a political football subject to repeated 5 yearly cycles doesn't help of course. At the very least it's so broken that it needs a reset before anything meaningful can be achieved.
Agree The phrase “work smarter not harder” comes to mind o
Salted_Peanut said:
tele_lover said:
This is the reason ALL public services are affected.
I’m afraid the answer is more nuanced and complex. On one hand, a larger population requires more NHS resources.On the other hand, immigration drives GDP. Plus, the NHS relies on people coming from overseas to do essential clinical and other roles.
The NHS’s issues are complex, including tackling a population that’s ageing, more obese and sedentary.
And do you honestly think life is happier? Population = congestion = stress = crime
Mass, low-skilled immigration (which was 80+% of immigration) was allowed only to line the pockets of landlords and businesses.
Correction: Labour started it to create more future voters. Tories continued it to line pockets.
Edited by tele_lover on Friday 28th June 20:06
A few random points about my encounters with A&E:
-A few years ago I walked in to A&E during summer. Behind the reception desk they had a Dyson air chiller, the type which cost £300+. It could have been a staff member's personal one, but I doubt it.
-Where I used to live, the local A&E deliberately hired multiple receptionists to work the twilight shift. Later I wrote a letter and was officially informed this was for security reasons (even though the receptionist was behind a screen and there's security officers around). So they spend £20k a year to chat with someone all night.
-I was at A&E with a relative during the time of the junior doctor strikes (but this shouldn't be related). We waited for 3 hours just to see the initial triage nurse. During those 3 hours, I think I counted 7 people were seen. Initial triage usually takes 5 mins. Most of the time the initial triage nurse was wandering around. During the same night I saw one nurse keep popping outside every 30-45 mins for a cigarette and another nurse was carrying chairs around the department. They were acting like there weren't patients waiting.
I can only wonder what happens across the rest of the NHS.
I love what the NHS stands for but it's so badly managed.
-A few years ago I walked in to A&E during summer. Behind the reception desk they had a Dyson air chiller, the type which cost £300+. It could have been a staff member's personal one, but I doubt it.
-Where I used to live, the local A&E deliberately hired multiple receptionists to work the twilight shift. Later I wrote a letter and was officially informed this was for security reasons (even though the receptionist was behind a screen and there's security officers around). So they spend £20k a year to chat with someone all night.
-I was at A&E with a relative during the time of the junior doctor strikes (but this shouldn't be related). We waited for 3 hours just to see the initial triage nurse. During those 3 hours, I think I counted 7 people were seen. Initial triage usually takes 5 mins. Most of the time the initial triage nurse was wandering around. During the same night I saw one nurse keep popping outside every 30-45 mins for a cigarette and another nurse was carrying chairs around the department. They were acting like there weren't patients waiting.
I can only wonder what happens across the rest of the NHS.
I love what the NHS stands for but it's so badly managed.
WestyCarl said:
However it's not a vote winner for any Party to tell people the NHS will never recover due to people being too fat, alcoholics, druggies or just abusing the system.
For the first time in the history of the country, the poorer people have higher levels of obesity.It also seems that life expectancy is stalling. Due in part to covid and also to unhealthy lifestyles.
One other issue is that the services provided by the NHS has expanded.
As a kid, if you wanted cosmetic surgery on sticking out ears, the only option was private. Now the mental health box gets ticked and you join the list.
https://www.nhs.uk/conditions/cosmetic-procedures/...
Friends daughter has been going through IVF. I think they are on their third round. Fifty years ago your only option was adoption. I think in some ways it was easier to deal with. IVF seems to put tremendous strain on a relationship.
I think a difficult discussion needs to be had about what the NHS provides.
As a kid, if you wanted cosmetic surgery on sticking out ears, the only option was private. Now the mental health box gets ticked and you join the list.
https://www.nhs.uk/conditions/cosmetic-procedures/...
Friends daughter has been going through IVF. I think they are on their third round. Fifty years ago your only option was adoption. I think in some ways it was easier to deal with. IVF seems to put tremendous strain on a relationship.
I think a difficult discussion needs to be had about what the NHS provides.
Slow.Patrol said:
One other issue is that the services provided by the NHS has expanded.
As a kid, if you wanted cosmetic surgery on sticking out ears, the only option was private. Now the mental health box gets ticked and you join the list.
https://www.nhs.uk/conditions/cosmetic-procedures/...
Friends daughter has been going through IVF. I think they are on their third round. Fifty years ago your only option was adoption. I think in some ways it was easier to deal with. IVF seems to put tremendous strain on a relationship.
I think a difficult discussion needs to be had about what the NHS provides.
I see your point but it doesnt seem like lack of money is the issue. So these services shouldnt affect the core ones.As a kid, if you wanted cosmetic surgery on sticking out ears, the only option was private. Now the mental health box gets ticked and you join the list.
https://www.nhs.uk/conditions/cosmetic-procedures/...
Friends daughter has been going through IVF. I think they are on their third round. Fifty years ago your only option was adoption. I think in some ways it was easier to deal with. IVF seems to put tremendous strain on a relationship.
I think a difficult discussion needs to be had about what the NHS provides.
Edited by tele_lover on Friday 28th June 21:52
Gassing Station | TV, Film, Video Streaming & Radio | Top of Page | What's New | My Stuff