The real NHS

[alpine_saint]

http://www.dailymail.co.uk/health/article-2232291/Man-body-held-BLANKET-hit-15-tonne-lorry-makes-miraculous-recovery.html

 

Fantastic, dedicated people, performing miracles when given the opportunity and the resources to do so.

 

Why cant it always be like this ? People in need getting the treatment and care they need in time ?

 

My 18 year old niece has been diagnosed with a serious heart condition; she's got to wait 2 months for her next appointment (by which time she could be dead) and its in Winchester, because the waiting list in Soton is 5 months.

[Barry the Badger]

My girlfriend spent 2 years in hospital with Leaukaemia a few years back, I have nothing but good things to say about the NHS on that front, but it was an area where money had been invested. When the resources are available the staff are incredible, it's just that all to often they are working with one hand tied behind their backs.

[trousers]

I know I bang on about this every time an NHS thread crops up but the 'problems' in the NHS are more to do with how the money is spent rather than how much money is pumped in.

 

My sister-in-law is in a relatively senior position at an NHS hospital and some of the stories of inefficiency and waste I hear make you realise that you could double the amount of money pumped in and you'd still get the same problems.

 

That BBC documentary a while back where some industry expert geezer went in to identify what was wrong with the NHS (at an organisation level) encapsulated it nicely.

[View From The Top]

I know I bang on about this every time an NHS thread crops up but the 'problems' in the NHS are more to do with how the money is spent rather than how much money is pumped in.

 

My sister-in-law is in a relatively senior position at an NHS hospital and some of the stories of inefficiency and waste I hear make you realise that you could double the amount of money pumped in and you'd still get the same problems.

 

That BBC documentary a while back where some industry expert geezer went in to identify what was wrong with the NHS (at an organisation level) encapsulated it nicely.

 

Yep, management issues as opposed to frontline staff issues.

[bridge too far]

Yep, management issues as opposed to frontline staff issues.

 

Don't lose sight of the fact that many managers in the NHS are actually clinicians. When I last worked for the NHS, my service manager was a nurse specialist (in chronic chest disease treatment). As well as managing a team of about 20 district nurses and developing the service (home oxygen services) she also did home nursing visits.

[Thedelldays]

My lady friend is a nurse.

She will not work for the hospital direct but works for various agencies

 

Evenings and weekend she will work in say ICU and get paid £38 an hour at least for a 8-12 hour shift... she will do that 4 days a week . whilst the full time nurses there are on probably half that

 

Dread to think what the agency itself are getting our of it and she is fully booked up for months on end at a time

 

Incredible amount of money

[Frank's cousin]

My girlfriend spent 2 years in hospital with Leaukaemia a few years back, I have nothing but good things to say about the NHS on that front, but it was an area where money had been invested. When the resources are available the staff are incredible, it's just that all to often they are working with one hand tied behind their backs.

 

This, same for me, in that the now Mrs C was treated for ALL when we were going out, back in 1994.... been married for 16 years... NHS was brilliant. I appreciate there is a lot of wasted money on the so called red tape and management costs that many always complian about, and yes this is a problem, but teh biggest is that we simply dont spend enough on healthcare in this country, whatever the sytem, be it private or state, we spend a 1/3 per captita on healthcare compared to that of Germany - yes they pay a chunk from their gross salary and their employers do the same - direct into a fund that then allocates it to the health insurance provider for that each person is signed up to - who pay doctors and hospitals direct through a simple electronic system (who dont make claims and their is NO limit on treatment if its an approved therapy), but it ALL goes straight to cover their health insurance, and is not part of the governmental coffers - in addition, although the amount you pay is linked to your earnings as in a tax based system, the quality of care is STANDARD for all no matter how much yo pay in - a sort of combination of the principles of the NHS, but with a 'private' provider - great system, but you have to be prepared to pay for it, and we simply dont seem to have that mentality in this country....

Edited 14 November, 2012 by Frank's cousin

[Give it to Ron]

http://www.dailymail.co.uk/health/article-2232291/Man-body-held-BLANKET-hit-15-tonne-lorry-makes-miraculous-recovery.html

 

Fantastic, dedicated people, performing miracles when given the opportunity and the resources to do so.

 

Why cant it always be like this ? People in need getting the treatment and care they need in time ?

 

My 18 year old niece has been diagnosed with a serious heart condition; she's got to wait 2 months for her next appointment (by which time she could be dead) and its in Winchester, because the waiting list in Soton is 5 months.

 

Alpine get them to ask their doctor if they participate in the Choose and Book scheme at the doctors. Its not that well publicised but if the doctors do they can get an appmnt at private hospital far quicker and payable on the NHS.

and in a private hospital as well.

[alpine_saint]

For your sake, your kids sake and the forum's sake, please god stop reading the daily mail.

 

Why ? This was a good piece, very interesting, and full of praise for the NHS.

 

Perhaps you shouldnt believe the hype about the DM.

[Saintandy666]

The NHS isn't perfect, but for the amount we spend on it, which is comparatively less by GDP than most other countries, we get an awful lot. But as I said it isn't perfect. From family experience, it is extremely fast(at least where I live) for stuff like suspected cancers and so on, but it can be extremely slow and frustrating for things that aren't life threatening and merely just a cause of discomfort. But on the whole, the NHS is fantastic and we are very lucky to have it. I would never be able to live in a country like the US where there is a culture of trying to deny people who need treatment and so on(though with the healthcare reforms, hopefully that will begin change).

 

I'm sorry to hear about your niece though, but I'm sure it will all be sorted out.

[trousers]

Don't lose sight of the fact that many managers in the NHS are actually clinicians

 

Yep...that's one of the main problems.....expecting people who aren't naturally management material to manage rather than to do the job they were originally trained to do is a recipe for disaster (which, of course, happens in most industries)

[trousers]

I'm sorry to hear about your niece though, but I'm sure it will all be sorted out.

 

Yep, sorry, meant to echo that sentiment before I went off on one of my NHS rants. Hope it turns out OK for her

[bridge too far]

Yep...that's one of the main problems.....expecting people who aren't naturally management material to manage rather than to do the job they were originally trained to do is a recipe for disaster (which, of course, happens in most industries)

 

And the other side of that argument is that managers could be appointed who have little or no clinical knowledge of the service they are managing.

[alpine_saint]

Thanks andy, Trousers.

[Smirking_Saint]

And the other side of that argument is that managers could be appointed who have little or no clinical knowledge of the service they are managing.

 

You dont need to have a working knowledge of what you are managing, you just need to be able to pick up the processes and be able to manage the manageables.

 

Thinking a senior manager needs operational experience is often short sighted and leads in failure.

 

Obv there are situations within which a good manager also has a decent grasp on the subject he is managing

[trousers]

And the other side of that argument is that managers could be appointed who have little or no clinical knowledge of the service they are managing.

 

Yep, totally agree. There is more than one route to becoming a bad manager. People often end up in managerial positions for the wrong reasons.

[bridge too far]

An example: Every NHS Trust has to have a medical director. That work has to be undertaken by someone who understands the practicalities of running a clinical service and, most importantly, has the respect and confidence of other clinicians. Consultants, as I'm sure Mrs T will agree, can be a difficult bunch and many, if not most, wouldn't give the time of day to a manager that senior who wasn't 'one of them'.

 

And the same strictures and structures would apply to a private hospital.

[Smirking_Saint]

Yep, totally agree. There is more than one route to becoming a bad manager. People often end up in managerial positions for the wrong reasons.

 

This I can agree with, it depends at what level, above middle management this situation seems to occur less

[Jonnyboy]

My lady friend is a nurse.

She will not work for the hospital direct but works for various agencies

 

Evenings and weekend she will work in say ICU and get paid £38 an hour at least for a 8-12 hour shift... she will do that 4 days a week . whilst the full time nurses there are on probably half that

 

Dread to think what the agency itself are getting our of it and she is fully booked up for months on end at a time

 

Incredible amount of money

 

That's what happens when the private sector is allowed to encroach on essentials like the nhs and schools.

[the stain]

You dont need to have a working knowledge of what you are managing, you just need to be able to pick up the processes and be able to manage the manageables.

 

Thinking a senior manager needs operational experience is often short sighted and leads in failure.

 

Obv there are situations within which a good manager also has a decent grasp on the subject he is managing

 

Nonsense.

[trousers]

http://m.bbc.co.uk/news/health-20271968

[Colinjb]

Something essential, emotive and staffed in the best spirit isn't necessarily perfect.

 

I have nothing but the utmost respect for the frontline workers in the NHS, but the organisation shouldn't be beyond reproach.

[bridge too far]

http://m.bbc.co.uk/news/health-20271968

 

From the link:

 

"Trusts, he said, were reluctant to share information for fear of helping their competitors."

 

When I worked in NHS procurement, there were national contracts in place that achieved best price because of economies of scale. Nowadays, trusts negotiate individual contracts and that purchasing power has been diminished.

 

It's a bit like expecting individual Sainsburys stores to negotiate their own supply contracts and all to achieve the same price.

 

No room for competition like this in the NHS.

[buctootim]

The NHS really is incredibly complicated to manage. Most private companies provide a relatively small number of standard products which they make or sell to a smallish number of customers. Once you get into bespoke tailor made products / services things tend to get complicated. Providing individually bespoke packages of care to 3 million 'customers' a week from a huge range of specialties is like no other private business.

[Torres]

From the link:

 

"Trusts, he said, were reluctant to share information for fear of helping their competitors."

 

When I worked in NHS procurement, there were national contracts in place that achieved best price because of economies of scale.

 

And I bet these were hugely unwieldy, incredibly difficult to manage, always late, always over budget and rarely delivered what the hospitals actually needed, when they needed it, in the quantities they needed - just like every other government procurement programme.

[bridge too far]

And I bet these were hugely unwieldy, incredibly difficult to manage, always late, always over budget and rarely delivered what the hospitals actually needed, when they needed it, in the quantities they needed - just like every other government procurement programme.

 

Some of the construction projects, maybe. But rarely for supplies and services in my experience.

[alpine_saint]

And I bet these were hugely unwieldy, incredibly difficult to manage, always late, always over budget and rarely delivered what the hospitals actually needed, when they needed it, in the quantities they needed - just like every other government procurement programme.

 

Including submarines.

[Torres]

Some of the construction projects, maybe. But rarely for supplies and services in my experience.

 

We've had significantly different experiences then

[bridge too far]

We've had significantly different experiences then

 

My experiences go back 12 years for supplies and services so don't include the devolution of power to trusts. I last dealt with NHS construction contracts about 3 years ago and saw a significant improvement in delivery on time and budget. Whether that's still the case I don't know - although there's precious little going on nowadays as far as capital projects are concerned

[Pugwash]

Okay, I'll bite. There are many reasonably-sized capital projects going on across many NHS Trusts, generally set up as well as many private projects, sometimes better. Where these sometimes fall down is due to the lack of forward financial planning - one minute the money tap is full on, then off, then back on again. Priorities change almost at a moment's notice according to changes in funding and service pricing dictated by central government. Trusts often end up chasing the service that has the best payback in order to meet their financial obligations. One moment the emphasis could be on carrying out more surgical procedures, the next on children's services, then cancer services. Strategic planning has become very short-term, responding more to politically-led changes rather than clinical necessity. All leads to project briefing changes and inefficient spending and procurement methods.

[bridge too far]

Good points, Pugwash. It took us 10 years to deliver a major capital project in Oxford. So many hoops to jump through. Firstly, it's necessary to get what's called Outline Business Case approval (theoretical approval for the idea but it has to stack up financially). Then a whole tranche of bodies have to approve it, apart from the Treasury. There has to be a series of consultations with local health purchasers (the old Strategic Health Authorities and Primary Care Trusts) as well as local councils, residents and 'stakeholders' such as Associations for the Blind, Disability groups etc. etc.

 

During this process, it's highly likely that there will have been a change of government and that new care pathways will have been introduced. A good example of this was the introduction of the requirement for single sex wards by the last government when we were half way through this consultation process. That meant a wholescale redesign.

 

Eventually, hopefully, Final Business Case approval is sought and granted and then you have to go to the market and the whole EU procurement procedure. So up to 6 contractors could have to provide design and financial modelling to be shortlisted to 3 and then a preferred bidder selected.

 

Constant changes of government and service led requirements, each requiring changes to design, can eat up so much time and effort. But, if this process didn't happen, then taxpayers' money would be spent without any accountability. It's a minefield!

[bridge too far]

Oops!

 

http://www.bbc.co.uk/news/uk-politics-20600852

[Thedelldays]

the amount of nurses I know through my missus that are on about £35+ an hour and pay into tax avoidance schemes is insane

 

if the nurses are getting £35+ an hour through agencies...how much are the agencies getting paid?!

 

she is getting £55 per hour to work a 12 hour shift on xmas day....

mental money

Edited 4 December, 2012 by Thedelldays

[saintfully]

the amount of nurses I know through my missus that are on about £35+ an hour and pay into tax avoidance schemes is insane

 

if the nurses are getting £35+ an hour through agencies...how much are the agencies getting paid?!

 

she is getting £55 per hour to work a 12 hour shift on xmas day....

mental money

 

Sounds like the job for you then Delldays, whats stopping you?

[Whitey Grandad]

The NHS is brilliant at handling emergencies but poor at chronic conditions. There seems to be a different mindset.

 

On another tack, we were speaking to an Irish lady recently who lost her husband to a heart condition about twenty years ago. We didn't realise that Eire didn't have an equivalent health system.

[Viking Warrior]

I'm not sure what sort of job your lady friend does to get that sort of money dell days . But a general nurse is on a pittance certainly less than 24k per year before tax etc my gf is in her final year of training her salary will be around 18 to 20k . As GeForce alps yes there are some genuinely very caring and dedicated staff working in hospitals and the equally many who do it because it is job there is a lack of empathy and compassion shown by some . This may be in part be to doth with the conveyor belt treatment regimes of get them in and ship out as fast as possible doctrine but there are many folk that should not be employed in the health and care profession . Care homes especially .

[Jonnyboy]

the amount of nurses I know through my missus that are on about £35+ an hour and pay into tax avoidance schemes is insane

 

if the nurses are getting £35+ an hour through agencies...how much are the agencies getting paid?!

 

she is getting £55 per hour to work a 12 hour shift on xmas day....

mental money

 

Are you getting senile?

[Thedelldays]

I'm not sure what sort of job your lady friend does to get that sort of money dell days . But a general nurse is on a pittance certainly less than 24k per year before tax etc my gf is in her final year of training her salary will be around 18 to 20k . As GeForce alps yes there are some genuinely very caring and dedicated staff working in hospitals and the equally many who do it because it is job there is a lack of empathy and compassion shown by some . This may be in part be to doth with the conveyor belt treatment regimes of get them in and ship out as fast as possible doctrine but there are many folk that should not be employed in the health and care profession . Care homes especially .

 

She is a nurse. Quite experienced but a nurse.

 

There are loads of them in derriford that are basically self employed. They are signed up through various agencies and work in the area. Some district work but mostly in derriford

 

She keeps saying that derriford is desperately short of experienced nursing full time as people like her just work through agencies and get no less than £35 an hour. Usually working in cardiac or general ICU.

 

There is one agency that is taking on that pay a minimum of £45 an hour but for hospitals in Exeter, Taunton and Bristol. What they offer is 2 long day shifts. Contribution for fuel and pay for your B&B for the night.

 

It's incredible money and no wonder big hospitals like derriford can't fill their positions.

 

Also, going through agencies and being self employed, they are all signed up to tax avoidance schemes that are all (for now) legal. Said company even provides her with mobile phone fully paid for.

 

When BTF mentions waste in NHS. I do wonder how much these agencies are getting paid if they themselves are dishing out mega money to nurses on their books.

[bridge too far]

A bit scary

 

http://www.guardian.co.uk/society/2012/dec/17/harmoni-gp-service-patients-risk

[trousers]

A bit scary

 

http://www.guardian.co.uk/society/2012/dec/17/harmoni-gp-service-patients-risk

 

Looks like another example of poor regulation to me. If these private companies were properly held to account by the government then said companies wouldn't be able to get into the position alleged by this article in the first place.

 

The Labour initiated initiative of outsourcing various components of the NHS to private companies is fine in principle but it needs to be matched with a stringent regulation process that doesn't allow companies to supposedly massage the audit figures.

[bridge too far]

Looks like another example of poor regulation to me. If these private companies were properly held to account by the government then said companies wouldn't be able to get into the position alleged by this article in the first place.

 

The Labour initiated initiative of outsourcing various components of the NHS to private companies is fine in principle but it needs to be matched with a stringent regulation process that doesn't allow companies to supposedly massage the audit figures.

 

So you don't expect a private health provider (as opposed to a company providing non-health services) to the NHS to tell the truth, act in the best interests of its patients, adhere to best clinical practice as a matter of course? You expect, as a matter of course, for its primary driver to be profit then?

[trousers]

So you don't expect a private health provider (as opposed to a company providing non-health services) to the NHS to tell the truth, act in the best interests of its patients, adhere to best clinical practice as a matter of course?

 

Yes, of course I expect a company to adhere to those basic principles of good business practice. I also expect those commissioning such companies to have watertight systems for detecting and swiftly dealing with rogue companies.

 

You expect, as a matter of course, for its primary driver to be profit then?

 

As long as they are providing the best value for money for tax payers and best levels of service to the patient then I have no problem whatsoever with a company making a profit out of running an efficient operation. A well regulated private-public sector hybrid is much better than a bloated public sector where people seem to be under the misapprehension that more money = better services.

 

The bottom line for me is getting the best possible service for the least amount of money. Maybe that's a utopia that doesn't exist but I'd venture there's some middle ground somewhere that, one day, a government will actually be able to put the theory into practice properly. Neither Labour (who instigated this) or the Tories (who obviously want to expand it) have been competent in making sure it works (yet).