The NHS is broken, what should happen?
- Thread starter Edie
- Start date
More funding. Broken down into smaller units that can be properly managed. Safe staffing levels, proper financial incentives, free parking, free coffee. Bring back the nursing bursary and make nursing and other allied health degrees free of charge immediately. Review European health services and adapt our funding model as soon as possible.
I could go on.
But I’m not a manager. I’m not a leader. I also want to know what you all think.
two sheds
Least noticed poster 2007
Any change we get from Johnson is likely to be towards the American system because that's where the real profits are for drugs companies, insurance companies and top management. Even people who are insured often have to pay 20% or so of their bills - which with bills costing hundreds of thousands - can bankrupt them. And if you haven't got insurance you're fucked.
That for me is the danger of a generalized question saying "what's wrong with the NHS". It softens people up for the government cutting funding because the service is "so poor" and so more and more people having to rely on private treatment, which means they can cut funding so more and more .....
So be careful what you wish for
Yes we should look at the specific things that can be improved, but don't forget that the overwhelming problem with the NHS is underfunding (again, as your first post showed). Stress on overworked nurses and doctors who know that if anything goes wrong they're the ones who'll be blamed, not the government or managers who load work on them with no proper reward or working conditions/time off.
Eta: and yes to your last post those are the sort of things we need.
That for me is the danger of a generalized question saying "what's wrong with the NHS". It softens people up for the government cutting funding because the service is "so poor" and so more and more people having to rely on private treatment, which means they can cut funding so more and more .....
So be careful what you wish for
Yes we should look at the specific things that can be improved, but don't forget that the overwhelming problem with the NHS is underfunding (again, as your first post showed). Stress on overworked nurses and doctors who know that if anything goes wrong they're the ones who'll be blamed, not the government or managers who load work on them with no proper reward or working conditions/time off.Eta: and yes to your last post those are the sort of things we need.
krink
I'll do it this afternoon
so
so more funding for more (but smaller) hospitals, resources etc. that's pretty much what everyone has said. the hard question is how do we make that happen. you said someone needs to make a decision - they are already being made by the government for more privatisation to make profits for themselves and their pals in big business and the rest of them.
so more funding for more (but smaller) hospitals, resources etc. that's pretty much what everyone has said. the hard question is how do we make that happen. you said someone needs to make a decision - they are already being made by the government for more privatisation to make profits for themselves and their pals in big business and the rest of them.
8ball
Decolonise colons!
Germany, when I last looked, was spending about double per head. The US is similar (with taxation spending in a similar ballpark to us and personal spending about the same again, with many outcomes a lot worse for a lot of the population).
Bang-for-buck, in terms of lives saved per equivalent spend, the last big analysis showed it was only Ireland that were doing better than us.
We're a little behind some places in terms of other metrics such as sorting out things which are a threat to quality rather than quantity of life (eg. getting round to knee operations and suchlike), and there are weaknesses in some areas of oncology. And mental health provision, which is pretty much a worldwide issue.
Take Germany, France, the USA or wherever and take away half of its resources - it will soon be "broken" (the USA being broken in any case).
StoneRoad
heckling from the back!
This has meant a couple of friends of mine - on different occasions - travelling over an hour by ambulance for treatment in the past few months ( instead of 20 minutes to a more local hospital - "recently rebuilt" with a walk in centre that opens at 08:00 ).
If we funded the NHS at the same level as Germany and France it would solve many problems. The laughable PFI and other privatisations on the sly need stopping right now and control handed over to the different trusts. I've just returned from a three week hospital stay with a emergency abdominal operation which literally saved my life. Everybody is stressed staff, patients,surgeons and yet day after day they carry on with a lack of resources that is criminal.
quimcunx
imprimeo, lamino, distribuo
They spend more money. That's how.
NHS consistently comes out as being 'best value for money' ie considering what little money we put into it proportionately we get a lot of it. Imagine how good it could be if we spent as much as Germany while keeping (& reinstating) the same principals which have kept it being good value for money.
Your friends were no doubt significantly better off for doing so. Sometimes a centre of excellence is a centre of excellence. Your local hospital probably doesn’t have a cath lab, or thoracic team, or can appropriately deal with complex injuries. Major trauma centres are evidenced to deliver better patient outcomes. Is t that preferable?
disclaimer: my hospital is a MTC
Where is your evidence for good value? (not asked in an aggressive way, I’m interested).
kebabking
Not a Girly Swot, but I like them....
I wouldn't disagree with the funding issue, and certainly not with the procurement issue - the MOD buys 100,000+ pairs of boots every year in bulk, it gets a much better price than 300 separate regiments/stations and ships would get if each of them bought separately - however the NHS also has a culture problem with the way it uses resources.
Example 1.
Last new year (3rd Jan or so) I developed a massive, excruciating pain in a bollock. Rang the GP, they said go to A&E - went to A&E, and within 30 minutes or so a Dr had taken a look and decided it wasn't a Torsion (which is the serious, time critical thing that it could have been). This is great. It still hurts, but it's not serious. The problem was that the NHS can't cope with that, so they wanted to put me on a bed in, in a cubicle, in A&E, not that I was going to be monitored or treated, but just as somewhere to park me until I can go somewhere else in the hospital to be seen by a specialist to determine why my balls hurt.
At no stage did it occur to the A&E staff that if I wasn't going to be monitored or treated, there was no point in me taking up a bed and a cubicle, I may as well be in the waiting room or the canteen.
When I suggested that I just wait in the waiting area because A&E was very busy and they needed the room, I just got blank looks.
If you've not enough staff A&E will fill up quickly - but if you fill it it with people who simply don't need to be there, it will fill up even quicker.
Example 2.
#2 (9) needed some specialist blood tests: they needed to take the blood, stick it in an ice box, stick the ice box on a motorcycle courier and take it 90 miles away to Cardiff, which is the only place locally (?) that can do the testing for whatever the hell it was they were looking for.
Three times we were given appointments to have the bloods taken at different local centres, and every single time we'd get there, do the paperwork, have the little numbing patch put on, and get to the point where they were taking the blood before the instructions were read and they said 'oh, sorry, we can't do this test, we're not set up for it here'.
Three times I took days off work, three times #2 took time off school, three things appointments were wasted, paperwork done, blood taking gear used, nurses dealing with us and not dealing with people they can actually help simply - and I do mean simply - because the people arranging these appointments refused to read the second paragraph of the instruction.
Eventually we got the bloods done in the Children's Clinic in the Worcester Royal Infirmary, and it was there that I learned that the blood was going by courier to Cardiff - if it had been mentioned sooner, I would have happily taken her to Cardiff myself to save both our time and whatever outrageous fee the courier was going to cost them - but no one thought of that...
I love the NHS, I think it's fantastic - and I have some experience of the alternatives, and they are not good - but there's some deeply wasteful attitudes and practices within it.
Example 1.
Last new year (3rd Jan or so) I developed a massive, excruciating pain in a bollock. Rang the GP, they said go to A&E - went to A&E, and within 30 minutes or so a Dr had taken a look and decided it wasn't a Torsion (which is the serious, time critical thing that it could have been). This is great. It still hurts, but it's not serious. The problem was that the NHS can't cope with that, so they wanted to put me on a bed in, in a cubicle, in A&E, not that I was going to be monitored or treated, but just as somewhere to park me until I can go somewhere else in the hospital to be seen by a specialist to determine why my balls hurt.
At no stage did it occur to the A&E staff that if I wasn't going to be monitored or treated, there was no point in me taking up a bed and a cubicle, I may as well be in the waiting room or the canteen.
When I suggested that I just wait in the waiting area because A&E was very busy and they needed the room, I just got blank looks.
If you've not enough staff A&E will fill up quickly - but if you fill it it with people who simply don't need to be there, it will fill up even quicker.
Example 2.
#2 (9) needed some specialist blood tests: they needed to take the blood, stick it in an ice box, stick the ice box on a motorcycle courier and take it 90 miles away to Cardiff, which is the only place locally (?) that can do the testing for whatever the hell it was they were looking for.
Three times we were given appointments to have the bloods taken at different local centres, and every single time we'd get there, do the paperwork, have the little numbing patch put on, and get to the point where they were taking the blood before the instructions were read and they said 'oh, sorry, we can't do this test, we're not set up for it here'.
Three times I took days off work, three times #2 took time off school, three things appointments were wasted, paperwork done, blood taking gear used, nurses dealing with us and not dealing with people they can actually help simply - and I do mean simply - because the people arranging these appointments refused to read the second paragraph of the instruction.
Eventually we got the bloods done in the Children's Clinic in the Worcester Royal Infirmary, and it was there that I learned that the blood was going by courier to Cardiff - if it had been mentioned sooner, I would have happily taken her to Cardiff myself to save both our time and whatever outrageous fee the courier was going to cost them - but no one thought of that...
I love the NHS, I think it's fantastic - and I have some experience of the alternatives, and they are not good - but there's some deeply wasteful attitudes and practices within it.
Yes yes yes. And I can add to these. A lot of it just doesn’t make sense.
oryx
Sitting on the bok of the day
Explain how.
8ball
Decolonise colons!
If no one has stumped up before I next log on (stuff to do), I’ll dig up the best recent analysis I know of (can’t remember whether it was WHO or Cochrane). We were very narrowly pipped by Ireland on the criterion I posted.
We have clear inefficiencies, but the great deals we get on a lot of drugs is a major strength (and pisses the Americans off no end - Trump was whining about it recently).
If you sell something, you try and get the best price. If you buy something, you try and get the lowest price. If the NHS is repeatedly buying goods at way above market value this is not the problem of the supplier. I suspect like killer b says it may have something to do with constraints, but I don’t know or have evidence of that. I think it may also be a lack of control. From being too big and no one being in charge and accountable and competitive.
kebabking
Not a Girly Swot, but I like them....
Actually - and this is from experience of working in the MOD procurement system - it's far more likely to be that the people in the NHS (and we're talking about hundreds of different organisations) know fuck all about procurement and contracts, and that they are getting rolled over by people are much better at it.
You will get a much better price for 10 million burns dressings if there's one contract, negotiated by one skilled, experienced and valuable/well paid contracts department, than you will for 10 million burns dressings divided by 300 trusts all asking for slightly different things and negotiated by 300 different procurement teams, very few of which are any good at negotiating contracts.
oryx
Sitting on the bok of the day
Since the 80s the NHS has become marketised with outsourcing and PFI contracts. If you're familiar with contracts between the public and private sectors (I am but rather in housing than health) then it's apparent that the private sector will screw over the public. kebabking has mentioned this in his post above.
The public sector traditionally are not used to being marketised and have learnt the hard way.
Certainly in housing it's becoming more and more common for providers to take services like repairs back in-house as the providers are realising that external contractors not only provide a generally poor service but rip the client off.
Sasaferrato
Super Refuser!
Absolutely. I lived in Germany for seven years, and had German friends, so I know how the system works.
When a friend's husband needed a hip replacement, his GP asked 'When is it convenient for you?'. He had the operation the following week.
Whilst we continue to limp along with the current NHS model, things will not improve.
Something to consider:
Provided that standards are met, and costs do not increase, other than an ideological blind spot regarding the NHS, what reason is there that the current model continues?
Personally, I really don't give a toss who provides health care, as long as it is provided in a competent manner.
how long ago?
Plumdaff
joy in people
A lot of things end up more expensive in the long run because everything is so focused, always, on penny pinching in the short term. That's why you can't go out and buy a chair, because ward budgets are so tight they don't allow for spontaneous discretionary payments even if it would save you money long term. My organisation spends heaps of time making people jump through hoops and sit on waiting lists for treatment because in the short term services can't cope and there aren't enough staff trained in the right skills, even though it would be much, much cheaper to just treat people quickly. You end up having to go here there and everywhere for tests because different services are fighting in order to save a £1 by not offering a seamless service. I, like many NHS work in a disgusting building that is slowly rotting. There's no money for maintenance.
It's a bit like the Terry Pratchett thing about shoes. You end up as a poorer person spending more on lots of cheap pairs of shoes than the rich person who buys one expensive pair that lasts.
Tldr it is about more money.
It's a bit like the Terry Pratchett thing about shoes. You end up as a poorer person spending more on lots of cheap pairs of shoes than the rich person who buys one expensive pair that lasts.
Tldr it is about more money.
WouldBe
Dislicksick
My local pharmacy has started putting up notices about the cost to the NHS for returned drugs. The last one had 50 packs of 28 iron tablets cost £116.50
you can get a pack of 200 from the supermarket for £2. 
8ball
Decolonise colons!
i) This won't happen
ii) Add "doesn't exacerbate health inequalities" and maybe it will be worth discussing (though it still won't happen).
hash tag
Books, not bombs
I have received more than my fare share of treatment over the years and more recently sobs has Mrs T. The staff, though very stretched have in the whole been magnificent. All credit to them.
Before I say too much, I would like to ask are doctors and nurses still being paid a small fortune to provide cover on areas like A&E and are there still a lot of contract nurses being paid well over what NHS staff get paid?
Before I say too much, I would like to ask are doctors and nurses still being paid a small fortune to provide cover on areas like A&E and are there still a lot of contract nurses being paid well over what NHS staff get paid?
two sheds
Least noticed poster 2007
Isn't it relevant if someone's claiming insider knowledge? I've known sas almost 20 years and afaik he's not lived in germany in that time.We'll have none of that
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