Dispatches - NHS in Crisis
Discussion
740EVTORQUES said:
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.
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.
You say you can't treat healthcare the same as industry or retail or whatever, but why? There is a technic in manufacturing called 5 why's?, somebody presents a problem and you ask why. 9/10 people will believe the first answer is the problem, carry on asking why, and you soon find out the real problem. So, why can't you run the NHS as industry, retail or whatever?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.
The work we do gets harder and more complex every year. 30 years ago we were build mechanical engines with nothing in the exhaust system to treat exhaust gases. We now have fully electronic engines with massively complicated aftertreatment in the exhaust to deal with the emissions 1 engine from 30 years ago now puts out the same emissions as 25 modern engines.
50 years ago the company built 150,000 engines with 10,000 people. we now build 400,000 with 5,000. And if you normalise for the increased complexity of the engine, they are cheaper than 30 years ago.
In the private sector there is no such thing as more money, it is a business case. Sadly the public sector seems to believe in the magic money tree and more money can fix everything.
pavarotti1980 said:
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%So your 1.5% is pretty much what I hope for. Thank you.
Megaflow said:
pavarotti1980 said:
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%So your 1.5% is pretty much what I hope for. Thank you.
Megaflow said:
740EVTORQUES said:
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.
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.
You say you can't treat healthcare the same as industry or retail or whatever, but why? There is a technic in manufacturing called 5 why's?, somebody presents a problem and you ask why. 9/10 people will believe the first answer is the problem, carry on asking why, and you soon find out the real problem. So, why can't you run the NHS as industry, retail or whatever?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.
The work we do gets harder and more complex every year. 30 years ago we were build mechanical engines with nothing in the exhaust system to treat exhaust gases. We now have fully electronic engines with massively complicated aftertreatment in the exhaust to deal with the emissions 1 engine from 30 years ago now puts out the same emissions as 25 modern engines.
50 years ago the company built 150,000 engines with 10,000 people. we now build 400,000 with 5,000. And if you normalise for the increased complexity of the engine, they are cheaper than 30 years ago.
In the private sector there is no such thing as more money, it is a business case. Sadly the public sector seems to believe in the magic money tree and more money can fix everything.
In healthcare, improvements often mean being able to deliver care and prolong life for more people, which is great but increases costs .
Basically life is expensive and improvements in healthcare deliver more life, which is good, but also more expense.
Sort of like Logan’s run backwards if you like.
It really is different to making stuff.
An example I thought of in the gym last night of efficiency improvements, based directly off the back of the program.
One of the biggest concerns raised was the lack of observations done on time. I am not a doctor, but I believe obs are blood pressure, pulse, O2 saturation and temperature.
In this day and age do we really need that data to be collected recorded manual, why does each patient not have a small data logger to capture this information, freeing up nurses and staff for more important work?
One of the biggest concerns raised was the lack of observations done on time. I am not a doctor, but I believe obs are blood pressure, pulse, O2 saturation and temperature.
In this day and age do we really need that data to be collected recorded manual, why does each patient not have a small data logger to capture this information, freeing up nurses and staff for more important work?
Megaflow said:
An example I thought of in the gym last night of efficiency improvements, based directly off the back of the program.
One of the biggest concerns raised was the lack of observations done on time. I am not a doctor, but I believe obs are blood pressure, pulse, O2 saturation and temperature.
In this day and age do we really need that data to be collected recorded manual, why does each patient not have a small data logger to capture this information, freeing up nurses and staff for more important work?
Well they do on ITU and ward patients have telemetry if needed. There’s also increasing use of home data collection devices such as reveal for Afib as well as Apple Watches etc.One of the biggest concerns raised was the lack of observations done on time. I am not a doctor, but I believe obs are blood pressure, pulse, O2 saturation and temperature.
In this day and age do we really need that data to be collected recorded manual, why does each patient not have a small data logger to capture this information, freeing up nurses and staff for more important work?
One potential is for AR devices for medical staff so that as you wander round the ward the devices will recognise patients from rfid name tags and give the docs a HUD with the latest lab results.
There’s a lot of innovation on the (near) horizon.
740EVTORQUES said:
No, but the target was no 18 week waiters. It always creates an issue when the real solution is more capacity.
Another example, to avoid ambulances queuing outside A&E, patients are moved to ‘board’ on a ward as extras, one per ward, to free up space in A&E,
They’re not being treated and are ‘extra’ so there aren’t staff to look after them but it superficially addresses the A&E queue which is the political priority.
Its really, really hard not to incentivise these sorts of things when you set narrow targets which is why medics are so distrustful if any kind of management performance monitoring, prefering the traditional imperative of clinical priorities.
There do need to be incentives, but I’ve no idea how to structure them to avoid these issues, it’s hard.
(You can view this all as just bad management, setting the wrong targets, and I don’t disagree with that by the way, but it’s a common theme in healthcare when politicians try to manage clinicians.)
Question for you:Another example, to avoid ambulances queuing outside A&E, patients are moved to ‘board’ on a ward as extras, one per ward, to free up space in A&E,
They’re not being treated and are ‘extra’ so there aren’t staff to look after them but it superficially addresses the A&E queue which is the political priority.
Its really, really hard not to incentivise these sorts of things when you set narrow targets which is why medics are so distrustful if any kind of management performance monitoring, prefering the traditional imperative of clinical priorities.
There do need to be incentives, but I’ve no idea how to structure them to avoid these issues, it’s hard.
(You can view this all as just bad management, setting the wrong targets, and I don’t disagree with that by the way, but it’s a common theme in healthcare when politicians try to manage clinicians.)
Edited by 740EVTORQUES on Saturday 29th June 08:51
Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
tele_lover said:
Question for you:
Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
What do you mean they remain in hospital?Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
740EVTORQUES said:
tele_lover said:
Question for you:
Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
What do you mean they remain in hospital?Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
740EVTORQUES said:
tele_lover said:
Question for you:
Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
What do you mean they remain in hospital?Paramedics. Spend a lot time inside hospitals.
Why? Surely someone must realise this is utterly stupid? Their job should end once they deliver the patient. Under no circumstances should they remain.
Someone could be having a heart attack and there's no ambulance because paramedics are playing babysitter.
In the meantime someone's dialing 999 and being told to wait 25 mins.
Perhaps it's just my local trust??
wisbech said:
Or just be brutal in rationing care. The ‘State’ has no real interest in keeping old people alive, so have a cut off for access to NHS that is the same as the retirement age. As much of the cost is in the last few months of people’s lives, reallocate this to ongoing health care for working age people (annual medicals, incentives to get fit etc)
Of course, voters have to accept that their mum might get killed from a flu, or not their broken hip fixed unless they go private but them’s the breaks.
Where there is talk of taxing pensions etc maybe this is the way they will go, but in response to this people have already been taxed on everything so they will be taxed again.Of course, voters have to accept that their mum might get killed from a flu, or not their broken hip fixed unless they go private but them’s the breaks.
The over arching problem is the big state. Health and welfare are massive addictions in this country, hence treated like religions. We make it bigger and bigger, providing ever more "free stuff" to ever more people with few new contributors. In the NHS beds blocked because people need care/support after.
Being brutal, this isn't the hospital's problem, they are not there to provide lodgings. Whilst people bemoan outsourcing (something few people actually understand - they call it "privatisation" to make it sound bad) they are more than happy to outsource their family responsibility to the state. So few families care for family and so more demand dumped on the already stressed state. Until some brutal changes are made, the death spiral will continue and is why no amount of money will ever be enough. So instead of pumping in more to waste it, start reducing it and make them adapt. As someone said earlier, if you had a bonus for everyone for coming in under the annual budget, perhaps it may focus minds a bit more.
mickythefish said:
Legacywr said:
It's all too easy to blame it on the Tories, however we'd be in the same position no matter who had been in charge.
14 years lol, you are proper deluded. The only good thing this train wreck of a party has sealed its own fate, maybe things will change for the better.Legacywr said:
mickythefish said:
Legacywr said:
It's all too easy to blame it on the Tories, however we'd be in the same position no matter who had been in charge.
14 years lol, you are proper deluded. The only good thing this train wreck of a party has sealed its own fate, maybe things will change for the better.Healthcare systems of all varieties whether public, insurance based, part private, are all under immense stress. The NHS is however failing more severely than most. Relative underfunding is definitely part of the problem, it reaches a point where the wheels just fall off, and that is where we are now. Robbing Peter to pay Paul to balance budgets, an almost complete lack of maintenance in favour of fire fighting, etc.
Remember that healthcare brings some economic benefits, restoring working people to health and preventing or lessening the cost of treating conditions and reducing the cost of long term care in some circumstance.
It also keeps people alive and healthier albeit sometimes at great cost, which is only, to put it bluntly, delaying more costly ill health that affects nearly all of us eventually.
Add in the ageing population, increasingly expensive interventions and greater expectations and it just costs more, that's the reality.
We either need to pay more, or decide to limit the scope of services, but it's clear from the past 14 years (and the 15 before that) which party has the better record of squaring this circle.
July 4th can't come soon enough for most of us that work in healthcare.
Edited by 740EVTORQUES on Monday 1st July 12:32
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