The NHS is broken, what should happen?

[fishfinger]

I wouldn’t describe it as a small fortune but bank/locum staff do get paid more than regular staff per hour.

My wife is now bank staff in the NHS after being full-time for 20 years. Her hourly rate (for exactly the same job) is lower than when she was a full time employee.

 

[BristolEcho]

My wife is now bank staff in the NHS after being full-time for 20 years. Her hourly rate (for exactly the same job) is lower than when she was a full time employee.

People are getting rich from this though.

Employment agencies, umbrella companies, and other scabs.

 

[kalidarkone]

My wife is now bank staff in the NHS after being full-time for 20 years. Her hourly rate (for exactly the same job) is lower than when she was a full time employee.

That was the case in my trust until management wised up that if they raised the bank rate they could spend less on agency doh!
Tell her to go agency.

 

[fishfinger]

People are getting rich from this though.

Employment agencies, umbrella companies, and other scabs.

Absolutely, not the employees though.

 

[kalidarkone]

Absolutely, not the employees though.

Apart from the ones working for the agencies who are earning daily what bank or substantive staff earn in a week.

 

[Orang Utan]

Is there a list of people who have died cos the ambulance took too long to come? An ambulance crew recently turned up to my work TWO HOURS after a 999 call about a man experiencing breathing difficulties. The nearest hospital, the biggest in Europe, is a stone’s throw away but it took that long to despatch a crew. I was used to long waiting times for A&E but was shocked that the ambulance service was in this state too. Two hours is not acceptable. If it had been a heart attack or even just a bad asthma attack it would have been too late. They were lucky it was ‘just’ an alcoholic having a whitey and he’d fucked off long ago by the time they arrived

 

[fishfinger]

That was the case in my trust until management wised up that if they raised the bank rate they could spend less on agency doh!
Tell her to go agency.

It's complicated, but she is needed in a particular department to do a job that her managers can't do and the senior management won't pay for the appropriate grade. She's not interested in working for an agency or any other department.

 

[kalidarkone]

It's complicated, but she is needed in a particular department to do a job that her managers can't do and the senior management won't pay for the appropriate grade. She's not interested in working for an agency or any other department.

Sounds like she could have them over a barrel.....yes we haven't helped ourselves with the good will culture and now it's taken for granted and used to screw us and the patients.

 

[BristolEcho]

Just to say kalidarkone you'd be more than welcome to get involved with the Bristol Care Workers Network. We are still quite small but slowly growing and starting to work on a new campaign.

 

[planetgeli]

This save the NHS mantra has become like a religion and it needs to stop

Buried on the bottom of page 1. Realpolitick. None of your namby-pamby socialist ideology. Let's make them pay. Twice if necessary. And if they can't pay, fuck 'em.

 

[Manter]

Why no?

I don’t think the taxation vs insurance model will solve any problems. It needs more money, but whoever collects and distributes that money, it will still be just money. And as you rightly say, money doesn’t solve the whole problem.

 

[kalidarkone]

Just to say kalidarkone you'd be more than welcome to get involved with the Bristol Care Workers Network. We are still quite small but slowly growing and starting to work on a new campaign.

Thanks but after many many years of caring for everyone else but me I am working on looking after myself and have no space for anything like that.

 

[kalidarkone]

I don’t think the taxation vs insurance model will solve any problems. It needs more money, but whoever collects and distributes that money, it will still be just money. And as you rightly say, money doesn’t solve the whole problem.

Yes this. Soon the NHS will be as it is now or worse but we will have to pay. Even now paying means you get a varied service in terms of quality but you get it quicker.

 

[hash tag]

Yes. In my department (surgery and recovery) almost a third of the recovery staff are Agency on £35 an hour. We are so strapped and short of staff that substantive staff are leaving -joining an agency and coming back and doing the same job as they were before but for £75K per annum (before tax) rather then 25-28K. Who can blame them? In fact becoming agency is the only reason I'd even consider becoming registered. I do not have any loyalty to the NHS any longer because they do not look after the patients or the staff. They have fucking shafted us all and the fucking managers are still playing along and facilitating the NHS collapse. The unions do nothing. Any care is down to individual people. The system is not fit for purpose.

livid

Permanent staff leaving to become agency staff and being paid more rings bells. Not forgetting it costs the nhs far more than the staff get paid because of the fees the agency charge

let's not forget, here in town we have employed a lot of ambulance crew from overseas in fixed contracts ( and they still struggle). They are costing a fortune in inflated wages, relocation costs, flights home....

 

[BristolEcho]

Thanks but after many many years of caring for everyone else but me I am working on looking after myself and have no space for anything like that.

Absolutely agree. Even more important in this sector I think.

 

[Callie]

The trust I work for have been pushing for staff to go onto bank to try to reduce the costs of agency staff. I do not believe those on bank get paid more than normal, substantive staff.

 

[purenarcotic]

Is there a list of people who have died cos the ambulance took too long to come? An ambulance crew recently turned up to my work TWO HOURS after a 999 call about a man experiencing breathing difficulties. The nearest hospital, the biggest in Europe, is a stone’s throw away but it took that long to despatch a crew. I was used to long waiting times for A&E but was shocked that the ambulance service was in this state too. Two hours is not acceptable. If it had been a heart attack or even just a bad asthma attack it would have been too late. They were lucky it was ‘just’ an alcoholic having a whitey and he’d fucked off long ago by the time they arrived

You know that you can call them back to tell them they are no longer needed? Means they can free up the crew to go to another job innit.

 

[Manter]

My two p’ennth;

• health, public health and social care need to be one coherent system. Fragmenting them means effective prevention doesn’t happen, and people are stuck in hospital too long when they would be much better in a less medicalised system.
• work on and invest in housing and education systems, urgently, and on social infrastructure like green space, health centres, etc People in shit housing struggling to eat properly and without the leisure mechanisms to relax and exercise etc are less well, physically and mentally. It’s not a quick fix, but we need long term investments to stop thy is being a crisis again in the next generation, or the one after that.
• look at the primary care system. It’s broken, so people end up sicker, or in emergency care. Enhance role of pharmacists, reimplement all the walk in centres they cut, consider removing GP’s ‘gatekeeper’ role for access to specialists (reason for this in my thinking is if you look at private insurance and insured models overseas, you often have a fast track past primary care for categories of illness. For example in BUPA schemes you can go straight to mental health provision, or for a health assessment, or for skin cancer screening because the first line ‘gatekeeper’ role adds cost and delay, and adds no value. But if someone doesn’t have BUPA they have to go through that initial hurdle,and it’s a barrier to access with no proven return)
• linked, make it easy for patients to access care, with few barriers. Walk ins, 111, online appointments for those who need/want them, no checking of documentation to see it you are ‘entitled’ to care....that ‘funnel’ is in place in discrete areas, and not in others, but only actually works if it is pretty much universal. Make the neck as wide as possible to catch everyone and don’t leave people unable to access care because of housing, refugee status, NRPF, fear... treating people earlier is basically better, and in a holistic system you recognise that may mean more cost in one area to save a fuck of a lot elsewhere. Whereas the false marketplace in the nhs means there are some perverse incentives.
• define national standards of care and define what is and isn’t covered. Make those hard decisions and draw those boundaries. What is the nhs and what is it not? Pharmas will continue to develop more and more expensive treatments for diseases of the rich, what do we cover and what don’t we cover? End the postcode lottery.
• there are some ‘stops’ for me too. Stop with the endless reorganisations- structure may be imperfect but iterate don’t do an expensive and disruptive restructure, again. There is only so much change people can stand. Stop with the internal and artificial ‘marketplace’ with things assigned fairly arbitrary values. Linked to that stop privatising all the high frequency, low complexity activity, leaving the NHS to try and manage all the difficult complex and high risk stuff. Stop with the incredibly narrow ‘care pathways’- treat the patient and trust the professionals to know what they are fucking doing!
• massively invest in numbers and education of nursing and ancillary staff. Resource properly (for median demand) not for low demand and then overpay for bank staff, which is a financial death spiral. Linked to that of course is dumping some of the random savings targets.
• there are some basic disciplines- most hospitals for example only get their actual budgets 5-6 months into the year, when they have been spending them merrily. That makes planning and management an absolutely impossible clusterfuck. Get the fucking basics right. Rostering, basic technology, an appointment and record system, systems that work and don’t waste hours of people’s time crashing, freezing, eating data.

God I could go on.... basically politicians use the NHS like a point scorer or a football, give it back to its leaders, staff and managers, trust them an treat them like adults.

 

[Manter]

The trust I work for have been pushing for staff to go onto bank to try to reduce the costs of agency staff. I do not believe those on bank get paid more than normal, substantive staff.

A service I know a lot about in London they do. C 30% more. Still more cost effective than agency mind, but feels like hiding money in a different bucket because the target was reducing establishment.... but the heads and materiel needed to deliver the service didn’t change, it was just put into different buckets and counted differently. The absolute cost has gone up, but establishment has gone down.
All part of the very odd accounting mechanisms used in what is a completely artificial internal market....

 

[Orang Utan]

You know that you can call them back to tell them they are no longer needed? Means they can free up the crew to go to another job innit.

Aye, but it was the first we'd heard of it - it was someone outside - there's a couple of bus stops adjacent to our work where boozers sit and drink

 

[two sheds]

Great post

My two p’ennth;

• health, public health and social care need to be one coherent system. Fragmenting them means effective prevention doesn’t happen, and people are stuck in hospital too long when they would be much better in a less medicalised system.
• work on and invest in housing and education systems, urgently, and on social infrastructure like green space, health centres, etc People in shit housing struggling to eat properly and without the leisure mechanisms to relax and exercise etc are less well, physically and mentally. It’s not a quick fix, but we need long term investments to stop thy is being a crisis again in the next generation, or the one after that.
• look at the primary care system. It’s broken, so people end up sicker, or in emergency care. Enhance role of pharmacists, reimplement all the walk in centres they cut, consider removing GP’s ‘gatekeeper’ role for access to specialists (reason for this in my thinking is if you look at private insurance and insured models overseas, you often have a fast track past primary care for categories of illness. For example in BUPA schemes you can go straight to mental health provision, or for a health assessment, or for skin cancer screening because the first line ‘gatekeeper’ role adds cost and delay, and adds no value. But if someone doesn’t have BUPA they have to go through that initial hurdle,and it’s a barrier to access with no proven return)
• linked, make it easy for patients to access care, with few barriers. Walk ins, 111, online appointments for those who need/want them, no checking of documentation to see it you are ‘entitled’ to care....that ‘funnel’ is in place in discrete areas, and not in others, but only actually works if it is pretty much universal. Make the neck as wide as possible to catch everyone and don’t leave people unable to access care because of housing, refugee status, NRPF, fear... treating people earlier is basically better, and in a holistic system you recognise that may mean more cost in one area to save a fuck of a lot elsewhere. Whereas the false marketplace in the nhs means there are some perverse incentives.
• define national standards of care and define what is and isn’t covered. Make those hard decisions and draw those boundaries. What is the nhs and what is it not? Pharmas will continue to develop more and more expensive treatments for diseases of the rich, what do we cover and what don’t we cover? End the postcode lottery.
• there are some ‘stops’ for me too. Stop with the endless reorganisations- structure may be imperfect but iterate don’t do an expensive and disruptive restructure, again. There is only so much change people can stand. Stop with the internal and artificial ‘marketplace’ with things assigned fairly arbitrary values. Linked to that stop privatising all the high frequency, low complexity activity, leaving the NHS to try and manage all the difficult complex and high risk stuff. Stop with the incredibly narrow ‘care pathways’- treat the patient and trust the professionals to know what they are fucking doing!
• massively invest in numbers and education of nursing and ancillary staff. Resource properly (for median demand) not for low demand and then overpay for bank staff, which is a financial death spiral. Linked to that of course is dumping some of the random savings targets.
• there are some basic disciplines- most hospitals for example only get their actual budgets 5-6 months into the year, when they have been spending them merrily. That makes planning and management an absolutely impossible clusterfuck. Get the fucking basics right. Rostering, basic technology, an appointment and record system, systems that work and don’t waste hours of people’s time crashing, freezing, eating data.

God I could go on.... basically politicians use the NHS like a point scorer or a football, give it back to its leaders, staff and managers, trust them an treat them like adults.

Great post, I found myself nodding through all of that

 

[kalidarkone]

The trust I work for have been pushing for staff to go onto bank to try to reduce the costs of agency staff. I do not believe those on bank get paid more than normal, substantive staff.

Yeah so they want us to work even more in our own time for less money. Fucking having a laugh.
I'd love it if half the registered work force left and went agency......the work force are actually in a good position to negotiate better terms and conditions.....I don't understand why the unions are dragging their feet.

 

[purenarcotic]

Ultimately it’s about funding (though there’s plenty to be said for that funding to be appropriately managed) but not just in the NHS or LA social care but in all other areas. The NHS is ill because the country is ill. Poor quality housing, people not able to afford enough of any food, never mind the quality of it, not being able to heat your home properly, not being able to buy a warm winter coat, constantly stressing about money and bills and whether your zero hours contract will give you enough hours this week, being street homeless - these all contribute to fucking up your immune system, crushing your mental health, and in some cases increasing your chances of using substances to cope. Then you have the cuts to other services which means you can only get help at crisis point because they are so stretched they have to up their thresholds before they will help, so things get out of control and you need more intense support when you previously could have accessed it much earlier on and the crisis could have been prevented. You also have funders wanting more for less, so you reduce the time you can spend with people which is counter productive long term.

 

[Manter]

Sorry, that was long and ranty and full of spelling mistakes. Just seen too many people broken by a system that is just missing stuff that seems so obvious. Really really good people- an orthopaedic surgeon, an ER tech, an emergency dispatcher, all pushed to the brink by a system that structurally makes it impossible for caring people to give of their best. Breaks my heart.

 

[Manter]

Ultimately it’s about funding (though there’s plenty to be said for that funding to be appropriately managed) but not just in the NHS or LA social care but in all other areas. The NHS is ill because the country is ill. Poor quality housing, people not able to afford enough of any food, never mind the quality of it, not being able to heat your home properly, not being able to buy a warm winter coat, constantly stressing about money and bills and whether your zero hours contract will give you enough hours this week, being street homeless - these all contribute to fucking up your immune system, crushing your mental health, and in some cases increasing your chances of using substances to cope. Then you have the cuts to other services which means you can only get help at crisis point because they are so stretched they have to up their thresholds before they will help, so things get out of control and you need more intense support when you previously could have accessed it much earlier on and the crisis could have been prevented. You also have funders wanting more for less, so you reduce the time you can spend with people which is counter productive long term.

Yes yes yes. And I think it’s worth adding that at the other end of the scale there are more extreme and expensive interventions being developed and we do need to have a conversation about whether we should be finding obscure corners of nuclear medicine when we have kids presenting with rickets.

 

[kalidarkone]

Sorry, that was long and ranty and full of spelling mistakes. Just seen too many people broken by a system that is just missing stuff that seems so obvious. Really really good people- an orthopaedic surgeon, an ER tech, an emergency dispatcher, all pushed to the brink by a system that structurally makes it impossible for caring people to give of their best. Breaks my heart.

No it was a great post and seemed clear and susinct.

 

[two sheds]

Great isn't it. All the really positive stuff from above are the sort of things that were in the Labour manifesto, which was rejected so we have Johnson and the tories

 

[kalidarkone]

Yes yes yes. And I think it’s worth adding that at the other end of the scale there are more extreme and expensive interventions being developed and we do need to have a conversation about whether we should be finding obscure corners of nuclear medicine when we have kids presenting with rickets.

Yes that is the present dichotomy reflecting financial polarisation of which I've never seen the like in this country. The gap is ever widening.

 

[Spandex]

Theres a number of problems with the NHS that add up to the crisis, most of which have been mentioned already.

For a start the UK health service receives less per capita funding than other comparable countries.

Then the huge cuts to social care over the last decade mean not only bed blocking, but people not getting the support they need to stay out of hospital in the first place, passing the burden from local authorities onto the NHS.

But it's not just lack of funding and staff being overstretched and underpaid. The structure of the NHS is a mess. It's an artificial market within a massive bureaucracy that gives the worst of both worlds. The bureaucracy that would normally allow control, planning and efficiencies of scale is scuppered by it being fractured and marketised. And that's happened because politicians want the supposed benefits of a competitive market: cost savings and innovation.

'The market' they want to emulate works by new businesses starting up, those that make money succeeding and those that don't failing. Those that succeed can find cheaper ways of doing things - often by treating staff and suppliers worse - and sometimes throw up new ideas, the much vaulted innovation. But 30% of new businesses fail within 2 years, 50% during the first 5 years and 66% within the first 10 years. Politicians and business leaders point to the successes and say 'that's what we want', choosing to overlook the huge number of failures; a failure rate that would never be acceptable within a state run bureaucracy.

The compromise neoliberal politicians have found between what they want - a privatised health service (except for those bits that can't make money) - and what the public find acceptable isn't going to work. But that's fine for those politicians and their money making mates, as they can then point to its failures and say 'it's not working, let's do it my way'.

The NHS is in desperate need of reform, but not by anyone who'll be in power for the foreseeable future.

 

[Edie]

Yeah so they want us to work even more in our own time for less money. Fucking having a laugh.
I'd love it if half the registered work force left and went agency......the work force are actually in a good position to negotiate better terms and conditions.....I don't understand why the unions are dragging their feet.

honestly it’s because NHS angels. My trust have posters which say ‘Love the NHS, join the bank’.
But fuck that. Pay people, properly. Financially incentivise them. Value them. And give them free coffee.