NHS reform

[OldNick]

I think the NHS is great.I hate the waste and would like that to be addressed.It astonished me this morning when it was stated that the NHS is the 3rd biggest employer in the WORLD !!! Bigger than the Russian army FFS

[bungle]

I think the NHS is great.I hate the waste and would like that to be addressed.It astonished me this morning when it was stated that the NHS is the 3rd biggest employer in the WORLD !!! Bigger than the Russian army FFS

 

Hardly a new fact. Have you been under a rock?

[OldNick]

Hardly a new fact. Have you been under a rock?

So you dont think it needs to be addressed? I suspect the wider population do not know this and it certainly puts things into focus. That is one hell of a workforce and so there must be room for reducing it.Perhaps at management level instead of at the bottom.

[bridge too far]

So you dont think it needs to be addressed? I suspect the wider population do not know this and it certainly puts things into focus. That is one hell of a workforce and so there must be room for reducing it.Perhaps at management level instead of at the bottom.

 

There is a widely held misconception about 'management' Nick. Many, if not most, managers in the NHS are clinicians carrying out their 'proper' jobs as well as carrying out management responsibilities.

[anothersaintinsouthsea]

So you dont think it needs to be addressed? I suspect the wider population do not know this and it certainly puts things into focus. That is one hell of a workforce and so there must be room for reducing it.Perhaps at management level instead of at the bottom.

 

Think you should write to Gordon Brown and point it out.

[OldNick]

There is a widely held misconception about 'management' Nick. Many, if not most, managers in the NHS are clinicians carrying out their 'proper' jobs as well as carrying out management responsibilities.

Can you explain that,are you saying they are one minute seeing patients then the next filling out forms and doing costings and getting quotes?

[OldNick]

Think you should write to Gordon Brown and point it out.

Dont think he'd be interested.I noticed last night that the wind turbine contracts have gone to the North East not to the IOW etc nothing to do with elections comig up of course.

[Thedelldays]

NHS..what employs 1.5m (guessing a tad here)...im sure (for arguements sake) if it was a private company..it would provide the same service with a lot less employess...

 

pretty much the same for any government organisation

[bridge too far]

Can you explain that,are you saying they are one minute seeing patients then the next filling out forms and doing costings and getting quotes?

 

No but they are MANAGING the people who do - hence the title 'manager'. Pen pushers fill out forms, do costings and get quotes so that nurses and doctors don't have to.

 

Or would you rather nurses and doctors carried out these tasks instead of treating patients?

[badgerx16]

NHS..what employs 1.5m (guessing a tad here)...im sure (for arguements sake) if it was a private company..it would provide the same service with a lot less employess...

pretty much the same for any government organisation

Aren't you a Government employee TDD ?

[Thedelldays]

Aren't you a Government employee TDD ?

yep..and they are slashing the numbver of "civilians" within the MoD..there was/are over 28k civilian personnel employed to procure for the MoD...28,000 workers...

[bridge too far]

yep..and they are slashing the numbver of "civilians" within the MoD..there was/are over 28k civilian personnel employed to procure for the MoD...28,000 workers...

 

You know what'll happen TDD. They'll outsource the work to a private company who will use less people to do the work but cost more in real terms. That's what always happens.

[bungle]

You know what'll happen TDD. They'll outsource the work to a private company who will use less people to do the work but cost more in real terms. That's what always happens.

 

"Fewer people", surely?

[Saint Martini]

"Fewer people", surely?

 

Both?

[Johnny Bognor]

I think the wave of Labour "investment" will sort out the problem.

[bridge too far]

"Fewer people", surely?

 

Quite right Bungle - 10 out of 10.

 

I have Swine Flu and cannot, therefore, produce my usual high standard of grammar, spelling and vocabulary.

 

:oops:

[OldNick]

No but they are MANAGING the people who do - hence the title 'manager'. Pen pushers fill out forms, do costings and get quotes so that nurses and doctors don't have to.

 

Or would you rather nurses and doctors carried out these tasks instead of treating patients?

'Many, if not most, managers in the NHS are clinicians carrying out their 'proper' jobs as well as carrying out management responsibilities.'

How do those 2 statements not conflict. You started by saying that they were combined jobs but now just managers telling these people what to do.Can you not see why the public at large are confused why we have os many managers running the show.May i add many say the French and German systems are very good, do they have such a massive workforce.

i want the NHS to be strong, but at the same time if we can make it work efficientlythat can only be good for us all as taxpayers and patients.

[bridge too far]

'Many, if not most, managers in the NHS are clinicians carrying out their 'proper' jobs as well as carrying out management responsibilities.'

How do those 2 statements not conflict. You started by saying that they were combined jobs but now just managers telling these people what to do.Can you not see why the public at large are confused why we have os many managers running the show.May i add many say the French and German systems are very good, do they have such a massive workforce.

i want the NHS to be strong, but at the same time if we can make it work efficientlythat can only be good for us all as taxpayers and patients.

 

There's no conflict there, Nick. I have worked in the NHS for 15 years and have just secured a job back in the NHS so I do speak from personal experience.

 

Most clincian / managers combine the two roles very successfully. The clincians in particular will work extra hours to do so (although they won't give up their private patients and, some would say, why should they).

 

But here's an example for you. Many years ago, if a ward required, say, more bandages, a nurse would phone up a bandage supplier and order a dozen bandages. The flaws with this process were a) valuable nursing time was being lost on simple clerical work and b) best value was not being obtained because a small volume was being purchased.

 

So each ward will now employ a ward clerk (some would say a manager but that's not the case because the ward clerk would earn far less than a nurse). That ward clerk would place an order via the supplies department who would have negotiated a contract with the bandage supplier to 'call off' bandages at a deeply discounted rate.

 

So valuable (and comparitively expensive) nursing time has been saved and the bandages have been purchased at a much better rate. Win Win!

 

In fact, it gets better, because most hospitals use a Materials Management System to ensure Just In Time deliveries to the wards - saving even more money.

[Special K]

There's no conflict there, Nick. I have worked in the NHS for 15 years and have just secured a job back in the NHS so I do speak from personal experience.

 

Most clincian / managers combine the two roles very successfully. The clincians in particular will work extra hours to do so (although they won't give up their private patients and, some would say, why should they).

 

But here's an example for you. Many years ago, if a ward required, say, more bandages, a nurse would phone up a bandage supplier and order a dozen bandages. The flaws with this process were a) valuable nursing time was being lost on simple clerical work and b) best value was not being obtained because a small volume was being purchased.

 

So each ward will now employ a ward clerk (some would say a manager but that's not the case because the ward clerk would earn far less than a nurse). That ward clerk would place an order via the supplies department who would have negotiated a contract with the bandage supplier to 'call off' bandages at a deeply discounted rate.

 

So valuable (and comparitively expensive) nursing time has been saved and the bandages have been purchased at a much better rate. Win Win!

 

In fact, it gets better, because most hospitals use a Materials Management System to ensure Just In Time deliveries to the wards - saving even more money.

 

So the internal market structure to the NHS, introduced by the Tories of course in the early 90's, finds an ally, nay supporter, in BTF! You suprise me, you lefty radical, you.

[OldNick]

There's no conflict there, Nick. I have worked in the NHS for 15 years and have just secured a job back in the NHS so I do speak from personal experience.

 

Most clincian / managers combine the two roles very successfully. The clincians in particular will work extra hours to do so (although they won't give up their private patients and, some would say, why should they).

 

But here's an example for you. Many years ago, if a ward required, say, more bandages, a nurse would phone up a bandage supplier and order a dozen bandages. The flaws with this process were a) valuable nursing time was being lost on simple clerical work and b) best value was not being obtained because a small volume was being purchased.

 

So each ward will now employ a ward clerk (some would say a manager but that's not the case because the ward clerk would earn far less than a nurse). That ward clerk would place an order via the supplies department who would have negotiated a contract with the bandage supplier to 'call off' bandages at a deeply discounted rate.

 

So valuable (and comparitively expensive) nursing time has been saved and the bandages have been purchased at a much better rate. Win Win!

 

In fact, it gets better, because most hospitals use a Materials Management System to ensure Just In Time deliveries to the wards - saving even more money.

And how many people does thatr process go through to order the bandages?

May i ask also the clincians keep their private work, can you give me an example? So they work extra hours , does that mean on overtime?

[bridge too far]

And how many people does thatr process go through to order the bandages?

May i ask also the clincians keep their private work, can you give me an example? So they work extra hours , does that mean on overtime?

 

You have to look at the overall cost Nick. I think you're a business man? Then you must know all about overall costs. The overall cost of employing a ward clerk and a supplies clerk to order bandages at a significantly cheaper rate has to be far less than the cost of employing an additional nurse (to cover the cost of the nurse who you would have doing the ordering) and the cost of the bandages ordered in dribs and drabs. Presumably you've heard of volume discounting?

In your business (assuming it's large enough) do you do all the wages, HR work, IT support yourself or do you employ people to do it for you because a) you haven't got the time and b) you haven't got the knowledge? If you were to cost your hours for doing these tasks, no doubt you would find it cheaper to employ someone to do them for you?

Clinicians' private work is sacrosanct to them. They will not give it up but will work their contracted NHS hours (and more). Most clinicians I've worked with work in excess of 90 hours a week so that they can do their private work. You must remember that they are independent contractors to the NHS.

[OldNick]

You have to look at the overall cost Nick. I think you're a business man? Then you must know all about overall costs. The overall cost of employing a ward clerk and a supplies clerk to order bandages at a significantly cheaper rate has to be far less than the cost of employing an additional nurse (to cover the cost of the nurse who you would have doing the ordering) and the cost of the bandages ordered in dribs and drabs. Presumably you've heard of volume discounting?

In your business (assuming it's large enough) do you do all the wages, HR work, IT support yourself or do you employ people to do it for you because a) you haven't got the time and b) you haven't got the knowledge? If you were to cost your hours for doing these tasks, no doubt you would find it cheaper to employ someone to do them for you?

Clinicians' private work is sacrosanct to them. They will not give it up but will work their contracted NHS hours (and more). Most clinicians I've worked with work in excess of 90 hours a week so that they can do their private work. You must remember that they are independent contractors to the NHS.

I dont know if you are trying to be patronising but it seems so. I think you are over playing how much having a chain of people is saving. i dont expect a nurse to buy the bandages and have examples in the past where inexperienced negotiators have done and then overpaid. Now I believe the tenders go up on the internet for people to bid on. That is an improvement as it makes competition.

It is easy to brush over overstaffing by trying to use the 'nurse out of work, or wasting her valuable time' card. There seems to me to be such a chain of command that we have a lot of maangers who are not needed. Something has to give, we cannot go on funding the NHS to the extent it is at present.Choices have to be made and whether it is frontline services or management go , that difficult decision will be made.I myself would like to see more management go but the NHS has grown to such an animal it is going to be difficult whatever route is taken.The pension liability alone is frightening.

[bridge too far]

But Nick! SOMEONE has to oversee the tendering process. SOMEONE has to order the bandages at the point of need. SOMEONE has to process the invoice. SOMEONE has to check in the delivery.

 

If we take your position to its logical conclusion, and we don't have any managers / administrative staff, who on earth do you propose does all the above tasks?

 

I'm about to start work back in the NHS administering the Home Respiratory service in Oxfordshire. At the moment nurses are having to do this and the time this takes could be much better used to treat patients. Because they are working in isolation and don't have the time or experience to instigate a joined-up service they've decided to employ me to do this.

 

The cost of employing me to do this is far less than the cost of employing additional nurses to cover for the nurses trying to administer this service at the moment.

[OldNick]

But Nick! SOMEONE has to oversee the tendering process. SOMEONE has to order the bandages at the point of need. SOMEONE has to process the invoice. SOMEONE has to check in the delivery.

 

If we take your position to its logical conclusion, and we don't have any managers / administrative staff, who on earth do you propose does all the above tasks?

 

I'm about to start work back in the NHS administering the Home Respiratory service in Oxfordshire. At the moment nurses are having to do this and the time this takes could be much better used to treat patients. Because they are working in isolation and don't have the time or experience to instigate a joined-up service they've decided to employ me to do this.

 

The cost of employing me to do this is far less than the cost of employing additional nurses to cover for the nurses trying to administer this service at the moment.

Of course you have to have these people but if we used the same overstaffing in the whole of the economy everything would come to halt as we would go bust. We are back to the usual problem with state run industries, overstaffing and inefficiency. It would be impossible to run the NHS down to the last penny saved, but surely you must see that with so much resource thrown at it we as a nation will not be able to afford it.Im sure if you were honest with yourself you could see that there are many jobs that could be absorbed and cuts made.

[Johnny Bognor]

I dont know if you are trying to be patronising but it seems so. I think you are over playing how much having a chain of people is saving. i dont expect a nurse to buy the bandages and have examples in the past where inexperienced negotiators have done and then overpaid. Now I believe the tenders go up on the internet for people to bid on. That is an improvement as it makes competition.

It is easy to brush over overstaffing by trying to use the 'nurse out of work, or wasting her valuable time' card. There seems to me to be such a chain of command that we have a lot of maangers who are not needed. Something has to give, we cannot go on funding the NHS to the extent it is at present.

 

The fact of the matter is that productivity has fallen 10% since 1997, despite the doubling of spending on the NHS and 'efficient' procurement procedures.

[OldNick]

But Nick! SOMEONE has to oversee the tendering process. SOMEONE has to order the bandages at the point of need. SOMEONE has to process the invoice. SOMEONE has to check in the delivery.

 

If we take your position to its logical conclusion, and we don't have any managers / administrative staff, who on earth do you propose does all the above tasks?

 

I'm about to start work back in the NHS administering the Home Respiratory service in Oxfordshire. At the moment nurses are having to do this and the time this takes could be much better used to treat patients. Because they are working in isolation and don't have the time or experience to instigate a joined-up service they've decided to employ me to do this.

 

The cost of employing me to do this is far less than the cost of employing additional nurses to cover for the nurses trying to administer this service at the moment.

so without going into your personal details going to be on less than a normal nurse.Are you going to do a job that at present 2 nurses are doing?

[bridge too far]

so without going into your personal details going to be on less than a normal nurse.Are you going to do a job that at present 2 nurses are doing?

 

I shall be working 3 days a week (because I look after grandchildren the other 2 days) and have taken a huge drop in salary to do this job. So that's a 0.5 FTE equivalent.

 

Currently there are at least 3 nurses (quite possibly more but I haven't started yet so don't know for sure) providing a home respiratory service for the whole of Oxfordshire.

 

They need to establish a number of protocols to manage the service and just don't have the time to do so in a way that is central and therefore efficient both in terms of cost and patient standards. In simple terms, they can treat more patients more quickly if they can leave the administrative dross to me. They also don't have the experience to, for example, set up databases and they don't understand NHS procurement to be able to negotiate contracts and deals (for home oxygen supplies for example) as I do.

 

In my previous job, I had a lot of dealings with major construction companies. Guess what! When costing projects, the QSs listed the materials needed for each job but a procurement CLERK did the actual buying. Because it's cheaper to do that than to 'waste' professional time on a process job. Exactly the same as in the NHS.

[bungle]

Nick, you are trying to save pennies. The best way of reducing the money we pay to the NHS would be to scrap the 'new' (must be getting quite old now), IT system. Having arguments over whether nurses should order 10 bandages at a high price or whether having someone whose job it is to order many hundred (thousand?) at a substantially lower price is at BEST going to be savings in pennies. I am, however, going to bow to the person with knowledge of what goes on, at that is BtF, not you.

[bridge too far]

Nick, you are trying to save pennies. The best way of reducing the money we pay to the NHS would be to scrap the 'new' (must be getting quite old now), IT system. Having arguments over whether nurses should order 10 bandages at a high price or whether having someone whose job it is to order many hundred (thousand?) at a substantially lower price is at BEST going to be savings in pennies. I am, however, going to bow to the person with knowledge of what goes on, at that is BtF, not you.

 

Thanks Bungle

 

The IT procurement has been a disaster. I suspect that the main providers don't have the nous to deal with such a major, major project. NHS IT procurement has been beset with difficulties since time immemorial. I vaguely recall a huge scandal with the old Wessex Regional Health Authority and an IT project many years ago.

 

However, at some point, I think it's important that there is a national database that clinicians all over the country can tap in to. Imagine having an unusual medical condition and being in a coma after a road accident, say, at the opposite end of the country. It could be life-saving for the A & E team treating you to have access to that data.

 

Already I can see how useful it is for my GP to look at test results on line instead of waiting for a piece of paper to arrive in the post and that's just a little example.

 

What the answer is, heaven knows. All major IT projects seem to fail these days, public and private.

[OldNick]

Nick, you are trying to save pennies. The best way of reducing the money we pay to the NHS would be to scrap the 'new' (must be getting quite old now), IT system. Having arguments over whether nurses should order 10 bandages at a high price or whether having someone whose job it is to order many hundred (thousand?) at a substantially lower price is at BEST going to be savings in pennies. I am, however, going to bow to the person with knowledge of what goes on, at that is BtF, not you.

Oh yes lets just order another computer system that bleeds more money.

BTF is about to start the job and so obviously knows more, but it doesnt get over the fact that there must be overstaffing.

[Johnny Bognor]

Oh yes lets just order another computer system that bleeds more money.

BTF is about to start the job and so obviously knows more, but it doesnt get over the fact that there must be overstaffing.

 

The fact that productivity has fallen 10% means one of two things:

- There are too many people (which could include bureaucrats)

- They are working less hard (which means they could lose a few, if the rest work like they used to)

Edited 17 September, 2009 by Johnny Bognor

[bridge too far]

Oh yes lets just order another computer system that bleeds more money.

BTF is about to start the job and so obviously knows more, but it doesnt get over the fact that there must be overstaffing.

 

But I've also worked in the NHS since 1991 (with a break of 5 years when I worked as an auditor in private practice but still auditing NHS Trusts amongst other public services). Much of that time was spent as a Procurement MANAGER (eek - unclean) for a very large NHS Trust. So I know a little bit about procurement. I know that, year on year and by clever procurement, the non-pay spend for that particular Trust met its target of a 5% reduction - yes reduction - in costs.

 

Nick, you still haven't answered my question. Who do you think should do ordering, invoicing, receipting, stock control etc. etc.?

[nathan]

Speaking from my experience (albeit brief) in the NHS. Money is wasted hand over fist. It was the easiest job I have ever had purely beacuse there was nothing to do. Seven people were employed to do a job that could have been done by two, but because the department needed to spend a budget we were all employed for nigh on 4 months.

 

I have a friend who still works for the NHS in an administrative role. Hid dept. ordered six brand new computers (they weren't depserately needed) but they did need new monitors, beacuse the ordering process was so convaluted. He is in a relatively low level job with no real responsibilities but has a blackberry, company car, and an exceptional pension. None of which he would get in a private company at that level.

[OldNick]

But I've also worked in the NHS since 1991 (with a break of 5 years when I worked as an auditor in private practice but still auditing NHS Trusts amongst other public services). Much of that time was spent as a Procurement MANAGER (eek - unclean) for a very large NHS Trust. So I know a little bit about procurement. I know that, year on year and by clever procurement, the non-pay spend for that particular Trust met its target of a 5% reduction - yes reduction - in costs.

 

Nick, you still haven't answered my question. Who do you think should do ordering, invoicing, receipting, stock control etc. etc.?

The question you put was obvious, of course you need staff, but IMO there are too many. Lots of businesses in the private sector are shedding jobs due to having to.The companies staff take on extra tasks and accept that is what is needed.Only the sucurity of the government increasing the budgets allows for the excess in not only the NHS but the civil service etc. Id love to know that whatever i did Id get an index linked budget and some to play around with and no doubt would end up being overstaffed as well.

[bridge too far]

The fact that productivity has fallen 10% means one of two things:

- There are too many people (which could include bureaucrats)

- They are working less hard (which means they could lose a few, if the rest work like they used to)

 

This is quite a good riposte - far better expressed than anything I could come up with

 

http://www.guardian.co.uk/society/2009/sep/17/productivity-public-sector-cuts

 

It's difficult to measure and increase productivity in the public sector. Unless we all go out and injure each other so that more people are treated in hospital :smt102

 

Or set fire to each other's houses?

 

Oh hang on - why don't we make people wait longer for operations - like they used to - so we don't need so many doctors and nurses and equipment.

 

Tch!

[bridge too far]

The question you put was obvious, of course you need staff, but IMO there are too many. Lots of businesses in the private sector are shedding jobs due to having to.The companies staff take on extra tasks and accept that is what is needed.Only the sucurity of the government increasing the budgets allows for the excess in not only the NHS but the civil service etc. Id love to know that whatever i did Id get an index linked budget and some to play around with and no doubt would end up being overstaffed as well.

 

Actually budgets aren't 'index-linked' as you say. As I just said, NHS Trusts are charged with reducing their costs year on year. If a Trust, or a department within that Trust, reduces its costs, its budget the following year is reduced accordingly. They don't even stand still - they reduce.

 

Increases in NHS spending are largely capital - i.e. buildings, equipment etc. and therefore cyclical / one off. They are predicated by the comparitive cost of doing nothing and it has to be demonstrated that it is cheaper to replace a building / piece of kit than to retain and maintain.

[Johnny Bognor]

This is quite a good riposte - far better expressed than anything I could come up with

 

http://www.guardian.co.uk/society/2009/sep/17/productivity-public-sector-cuts

 

It's difficult to measure and increase productivity in the public sector. Unless we all go out and injure each other so that more people are treated in hospital :smt102

 

Or set fire to each other's houses?

 

Oh hang on - why don't we make people wait longer for operations - like they used to - so we don't need so many doctors and nurses and equipment.

 

Tch!

 

That's a seperate issue and a seperate argument. That riposte is no different to me saying, why should I pay more tax as I didn't cause the crunch?

 

It is a clever distraction from the debate at hand and the fact of the matter is that we were spending unsustainable amounts on the NHS long before the credit crunch.

 

So here's a solution. Why don't we hire the 3 million unemployed (thus fixing one problem) and overstaff all of the public services - services would approve no-end across the board and we would have no unemployment. Job done.

 

Oh no, I forgot, someone has to pay for it.

[OldNick]

Actually budgets aren't 'index-linked' as you say. As I just said, NHS Trusts are charged with reducing their costs year on year. If a Trust, or a department within that Trust, reduces its costs, its budget the following year is reduced accordingly. They don't even stand still - they reduce.

 

Increases in NHS spending are largely capital - i.e. buildings, equipment etc. and therefore cyclical / one off. They are predicated by the comparitive cost of doing nothing and it has to be demonstrated that it is cheaper to replace a building / piece of kit than to retain and maintain.

Well that is a stupid practice. There is no incentive to save if you are penalised the following year. The natural instinct is to spend up to budget so you dont have less the next year.I remeber when a schoolkid the staff rushing around to spend any budget left so they didnt have less the following year.Even as a 10 year old that seemed ridiculous.

[OldNick]

That's a seperate issue and a seperate argument. That riposte is no different to me saying, why should I pay more tax as I didn't cause the crunch?

 

It is a clever distraction from the debate at hand and the fact of the matter is that we were spending unsustainable amounts on the NHS long before the credit crunch.

 

So here's a solution. Why don't we hire the 3 million unemployed (thus fixing one problem) and overstaff all of the public services - services would approve no-end across the board and we would have no unemployment. Job done.

 

Oh no, I forgot, someone has to pay for it.

They've been doing that for the last 10 years.

[bridge too far]

That's a seperate issue and a seperate argument. That riposte is no different to me saying, why should I pay more tax as I didn't cause the crunch?

 

It is a clever distraction from the debate at hand and the fact of the matter is that we were spending unsustainable amounts on the NHS long before the credit crunch.

 

So here's a solution. Why don't we hire the 3 million unemployed (thus fixing one problem) and overstaff all of the public services - services would approve no-end across the board and we would have no unemployment. Job done.

 

Oh no, I forgot, someone has to pay for it.

 

Not a bad idea actually! Because it's better for the economy to have people in work. Not only does it reduce the costs of JSA at a stroke, but those people will then all pay tax and NI and buy stuff, reducing the burden on the rest of us. Brilliant!

 

Much, much better than slashing public services and increasing the costs of unemployment dramatically. That would mean less taxes, less consumer spending, and many more houses being repossessed (thus decreasing the value of everyone's house).

 

BTW did you read all the letters? Or just the first one?

[OldNick]

Not a bad idea actually! Because it's better for the economy to have people in work. Not only does it reduce the costs of JSA at a stroke, but those people will then all pay tax and NI and buy stuff, reducing the burden on the rest of us. Brilliant!

 

Much, much better than slashing public services and increasing the costs of unemployment dramatically. That would mean less taxes, less consumer spending, and many more houses being repossessed (thus decreasing the value of everyone's house).

 

BTW did you read all the letters? Or just the first one?

yep all those people in jobs that are paid for by new national debt. No wealth creating of course to pay for it. No wonder we have a trade balance that makes me wince. Give them more money so we can import more and get us deeper in the mire.

How it would mean less taxes lord knows, the more the nation borrows the more taxes we pay.If only it was so easy.

[bridge too far]

Well that is a stupid practice. There is no incentive to save if you are penalised the following year. The natural instinct is to spend up to budget so you dont have less the next year.I remeber when a schoolkid the staff rushing around to spend any budget left so they didnt have less the following year.Even as a 10 year old that seemed ridiculous.

 

Come on Nick - you can't have it both ways! On the one hand you moan about public spending and then, when I show you what actually happens when cost targets are achieved, you say that's stupid! Which one do you want. It's your money they're saving.

 

There always was a rush to 'spend up' at the end of the fiscal year. You ask any supplier to the NHS. My ex-husband had a furniture factory that produced the sorts of chairs you see in waiting rooms. They always had to gear up for the March rush.

 

The difference this time is that if the target isn't reached, the Trust / department is punished anyway. So there's not quite the incentive to spend up now.

[bridge too far]

Here's an interesting fact I learned the other day. Apparently our debt % GDP is not as high as it was after WWII. Then it was 80%!

 

It IS more cost effective to have everyone in work. Just think about it logically. However that does bring problems. Firstly, workers have better wage bargaining strengths (supply and demand and all that) and secondly, if some of those employed are on very low wages, it behoves the rest of us to support them through benefits so that their cheapskate employers don't have to.

[badgerx16]

yep all those people in jobs that are paid for by new national debt. No wealth creating of course to pay for it. No wonder we have a trade balance that makes me wince. Give them more money so we can import more and get us deeper in the mire.

How it would mean less taxes lord knows, the more the nation borrows the more taxes we pay.If only it was so easy.

I the thought the increase in national debt was generated by the Government bailing out the failed Casino Capitalists in the international banks :cool:

[bridge too far]

I the thought the increase in national debt was generated by the Government bailing out the failed Casino Capitalists in the international banks :cool:

 

Do you suppose some of that bail-out went on 'knicker allowances' at £90 a night?

 

http://www.guardian.co.uk/money/blog/2009/sep/17/knickers-90-pounds-lawyers-allowance

[badgerx16]

Do you suppose some of that bail-out went on 'knicker allowances' at £90 a night?

 

http://www.guardian.co.uk/money/blog/2009/sep/17/knickers-90-pounds-lawyers-allowance

From what I've heard, I would think there are some MALE lawyers who would claim discrimination that they don't also get a lingerie allowance

[Special K]

Nick, you are trying to save pennies. The best way of reducing the money we pay to the NHS would be to scrap the 'new' (must be getting quite old now), IT system. Having arguments over whether nurses should order 10 bandages at a high price or whether having someone whose job it is to order many hundred (thousand?) at a substantially lower price is at BEST going to be savings in pennies. I am, however, going to bow to the person with knowledge of what goes on, at that is BtF, not you.

 

Yet another Nu Labour balls up.

[Johnny Bognor]

Don't worry guys, Labour are discussing their investment strategy

http://news.bbc.co.uk/1/hi/uk_politics/8262168.stm

[OldNick]

Come on Nick - you can't have it both ways! On the one hand you moan about public spending and then, when I show you what actually happens when cost targets are achieved, you say that's stupid! Which one do you want. It's your money they're saving.

 

There always was a rush to 'spend up' at the end of the fiscal year. You ask any supplier to the NHS. My ex-husband had a furniture factory that produced the sorts of chairs you see in waiting rooms. They always had to gear up for the March rush.

 

The difference this time is that if the target isn't reached, the Trust / department is punished anyway. So there's not quite the incentive to spend up now.

and so the doubling of the cost of the NHS has gone where? if we are getting all these savings in real terms the cost and increase in spending is more! It gets worse.

[bridge too far]

and so the doubling of the cost of the NHS has gone where? if we are getting all these savings in real terms the cost and increase in spending is more! It gets worse.

 

Because if you'd read my posts thoroughly you would have seen that I explained that:

 

a) there has been a large increase in capital spend. This is for new buildings (of which there have been many - I know - I was a Project Manager on a huge one in Oxford of over £100m) and for new equipment. There comes a point when it is cheaper to renew than to retain and maintain. Many health buildings had been allowed to deteriorate in the 80s and 90s and were unfit for purpose.

 

b) pay increases.

 

My posts were primarily explaining how non-pay spend for day to day items has been targeted to decrease year on year and, in my experience, this has happened.

 

Is that clear enough for you?