The NHS needs to get its finger out and stop whining about lack of funds. They are bloated and wasteful.

[littlebabyjesus]

Yeah it's not going to be an easy job. But once your care is being handled by both social services and the NHS, which is true for many old people, you now fall under two separate budget regimes. Several times my parents, who are very old and very vulnerable, have had to reapply for things they already had or fill out forms in triplicate as they transfer from one department to another. It's both stressful for them and inefficient for the services themselves. And of course stuff gets missed.

 

[StoneRoad]

IMHO, the NHS suffers from too much administrative management & political interference { treating it as a business, which smells like the american way }
and not enough investment in front-line staff, equipment & buildings. {too much 'just-in-time' and not enough maintenance}.
I also think that there is too much centralisation and concentration on big buildings in urban areas and not enough community-based preventative medicine.

Chucking more money at it isn't the simple answer ...

e2a - the need for more "social care" with an aging population isn't going to make things any easier, either !

 

[Sasaferrato]

Singapore spends less of its GDP on health than the UK. About half. It's a fact that they boast about.

MOH | Achieving more with less - Singapore's healthcare expenditure

But yes, it is not at all comparable.

A point touched on in that link is bed occupancy. This is an example of how 'business' thinking doesn't work well for health services. We saw the trouble 'just in time' ordering caused during the pandemic. Stock piles of essentials may be inefficient by some measures but they create resilience. Similarly, lower bed occupancy rates many be inefficient by some measures but they are the only way you can reduce waiting times. So if you want a mega-efficient, lean service and you want resilience and shorter waiting times, you're wishing for the impossible.

At one point I was the IV fluids czar at DMED Ludgershall, which was the huge army medical supply depot.

I had a million litres of various fluids under my command. My sole job was to keep track of the expiry dates, and arrange replacement with the manufacturer when it had a year of life left. We paid 5% of cost for this. Win/win, we had all the fluids we would need in the event of a major conflict, and the manufacturers got payment for bringing us new stuff and taking away the 'old' stuff, which was then sold to the NHS. The NHS turned over stuff rapidly, so a year's life wasn't a problem for them. The highlight of my time in the job was seeing 50,000 litres of normal saline heading out on two waggons, and two other waggons bringing the new stuff in that afternoon. I was 'critically low stock' for three hours. . There was no reason that the NHS couldn't have operated a similar system for PPE.

 

[Silas Loom]

At one point I was the IV fluids czar at DMED Ludgershall, which was the huge army medical supply depot.

I had a million litres of various fluids under my command. My sole job was to keep track of the expiry dates, and arrange replacement with the manufacturer when it had a year of life left. We paid 5% of cost for this. Win/win, we had all the fluids we would need in the event of a major conflict, and the manufacturers got payment for bringing us new stuff and taking away the 'old' stuff, which was then sold to the NHS. The NHS turned over stuff rapidly, so a year's life wasn't a problem for them. The highlight of my time in the job was seeing 50,000 litres of normal saline heading out on two waggons, and two other waggons bringing the new stuff in that afternoon. I was 'critically low stock' for three hours. . There was no reason that the NHS couldn't have operated a similar system for PPE.

The Milo Minderbinder of saline . . .

 

[kebabking]

I've written about my own experiences of fun and games with NHS administrative ineptitude before, so I won't rehash them - but I remember in the year or so before my MIL died, she had several comorbidities (diabetes, scoliosis, and cancer), she'd get a computer generated letter tell her that her appointment had been cancelled, and would be rescheduled - unfortunately it wouldn't tell her which appointment, or with who, or about what - and rarely contained any contact details, so we'd spend the day on the phone to every clinic in Worcestershire trying to find out what was cancelled and when.

This, as well as wasting out time, wasted the time of every receptionist the NHS employed at the time.

I love the NHS, without it my brother would be dead, my mum would be dead, my eldest child would be dead - and the treatment I've had, and witnessed, in emergencies has been overwhelmingly brilliant, but the outpatient stuff seems to be accompanied by an ethos of inefficiency and waste.

That's about culture.

 

[littlebabyjesus]

Yeah, my dad has several comorbidities. He's been tested for Parkinson's, which he doesn't have. We were half hoping he would be diagnosed with that. Not to diss the people who advocate for Parkinson's, but there is a whole dedicated support structure in place for people with Parkinson's that just doesn't exist for other diagnoses. The NHS is a bit of a crapshoot in that regard. Don't have hard-to-diagnose mental health problems when you're old.

 

[Monkeygrinder's Organ]

The problem is that efficiency and reform are completely different things and often they are incompatible, however much politicians pretend otherwise. Reform does not save money in anything other than the long term. It actually costs money, as you have to keep business as usual running while you try new things.

The health and social care system needs reform, but unless Streeting has anything substantive to say about that, it’s probably not going to get more from Labour than efficiency and - worse - subsidiarity.

This pretty much nails it IMO. The NHS needs major reform, it also needs more money. The idea that you achieve efficiency just by squeezing the funding is absolute fantasy. This needs to be admitted honestly and the reform needs to be carried out by people with medical expertise - no-one with an MBA should be let within a mile of it in any capacity whatsoever.

Wes Streeting is a total cunt and there's no prospect of anything positive happening with him in charge.

 

[Serge Forward]

That turd Streeting is on a mission.
Wes Streeting says Labour has been too nostalgic about NHS as he argues it needs reform not extra money – UK politics live

Wes Streeting says Labour has been too nostalgic about NHS as he argues it needs reform not extra money​

Good morning. Wes Streeting, the shadow health secretary, is the main speaker at a conference organised by the Institute for Government thinktank today and, according to the overnight briefing, his speech will be an attack on “waste” in the NHS, and a declaration that Labour will make it more efficient. This is a relatively standard opposition party theme. The Conservatives used to say much the same when Labour was in power. But Streeting has also given an interview to the Sun to promote his message, and this will attract more attention because he has used it to accuse his own party of being too nostalgic about the NHS.

He told the paper:

I think there are times when the Labour party is led too heavily into nostalgia. It would be the easiest thing in the world to go into the next general election just saying ‘worst crisis in NHS history’, ‘you can’t trust the Tories on the NHS’, ‘you’ve got 24 hours to save the NHS’ and, by the way, here’s a nice sepia film of Nye Bevan.

When the Sun’s Harry Cole put it to Streeting that that was exactly how Labour campaigned on the NHS in elections, Streeting replied:

Well, we haven’t done very well in the last four, so I’m not planning to repeat those mistakes.

Streeting also restated an argument that he has previously made as shadow health secretary, saying that what the NHS needed most was reform, not extra money.

You can’t just keep on pouring ever-increasing amounts of money into a leaky bucket, you’ve got to deal with the bucket itself.

And on the topic of NHS funding, he told the Sun:

It’s not right to keep on asking people on low to middle incomes to pay high taxes when they’re struggling. And it’s not right that they don’t get much for the money they are putting in.

Interviewed in the Sun, of course

 

[Petcha]

He's absolutely right. Sorry.

I have friends who work on the frontline in the NHS as a nurse and a doctor and the mid and top management need sorting out, that's the consensus. So we can pay people who actually do the work more. Send in a consultancy and streamline it.

 

[Serge Forward]

By the way, I've got a feeling this thread should be in the politics/news boards. editor

 

[two sheds]

I have friends who work on the frontline in the NHS as a nurse and a doctor and the mid and top management need sorting out, that's the consensus.

Agreed

So we can pay people who actually do the work more.

You think that's going to happen?

Send in a consultancy and streamline it.

Yep more consultancies are exactly what we need

 

[Serge Forward]

He's absolutely right. Sorry.

I have friends who work on the frontline in the NHS as a nurse and a doctor and the mid and top management need sorting out, that's the consensus. So we can pay people who actually do the work more. Send in a consultancy and streamline it.

Agree about mid and top management, but in the political climate, it's naive to expect 'streamlining' to do anything other than slash and burn.

 

[Silas Loom]

Yep more consultancies are exactly what we need

Well, if you want to pursue some specific time-limited change projects and pilots, best to do it with contingent labour which can be withdrawn fast. That means contractors and they are usually marshalled by consultancies.

 

[Petcha]

Agreed

You think that's going to happen?

Yep more consultancies are exactly what we need

Hopefully yes. Get rid of the fat cats at the top. And junior doctors are getting paid £15 fucking quid an hour while their bosses are getting paid hundreds of thousands a year.

That's what consultancies do. They're fucking ruthless but if they get rid of those fuckers at the top there's more in the pot for people who actually work.

 

[Petcha]

Well, if you want to pursue some specific time-limited change projects and pilots, best to do it with contingent labour which can be withdrawn fast. That means contractors and they are usually marshalled by consultancies.

I think we're talking about different sorts of consultancies.

 

[two sheds]

Well, if you want to pursue some specific time-limited change projects and pilots, best to do it with contingent labour which can be withdrawn fast. That means contractors and they are usually marshalled by consultancies.

Which is the problem. We've had consultancies continually reorganizing the NHS. The problem with consultancies is that (a) they normally have no experience of what they're reorganizing because they're top down and think they know the problem but they don't listen to the people who are actually doing the work (b) they're in for some specific time-limited change projects and pilots which means they come in, fuck it up, and then fuck off again with no responsibility for what actually happens because they've already got their money and (c) they're normally tories who believe (a) and (b) are the only way to improve things rather than putting the funds into the front-line services.

Short term contractors are what we had with the PPE fiasco rather than using the NHS purchasing that was already there and had experience of ... purchasing PPE.

 

[Silas Loom]

I think we're talking about different sorts of consultancies.

Clearly so! I am deeply unconvinced that the NHS needs delayering. It’s undermanaged if anything. It definitely needs restructuring, though.

 

[Petcha]

Which is the problem. We've had consultancies continually reorganizing the NHS. The problem with consultancies is that (a) they normally have no experience of what they're reorganizing because they're top down and think they know the problem but they don't listen to the people who are actually doing the work (b) they're in for some specific time-limited change projects and pilots which means they come in, fuck it up, and then fuck off again with no responsibility for what actually happens because they've already got their money and (c) they're normally tories who believe (a) and (b) are the only way to improve things rather than putting the funds into the front-line services.

Short term contractors are what we had with the PPE fiasco rather than using the NHS purchasing that was already there and had experience of ... purchasing PPE.

Oh yeh, they did a brilliant job of purchasing PPE to prepare for a pandemic.. lol

 

[two sheds]

Hopefully yes. Get rid of the fat cats at the top. And junior doctors are getting paid £15 fucking quid an hour while their bosses are getting paid hundreds of thousands a year.

Agreed

That's what consultancies do. They're fucking ruthless but if they get rid of those fuckers at the top there's more in the pot for people who actually work.

Nope, They'll try to cut costs by bringing in more contract workers to get rid of NHS staff with their 'expensive' terms and conditions and pensions - i.e. proper working conditions (which is a laugh for overworked NHS staff). And that will need more managers to arrange it all. That's what normally happens.

 

[two sheds]

Oh yeh, they did a brilliant job of purchasing PPE to prepare for a pandemic.. lol

Who, the NHS PPE purchasers?

 

[Petcha]

Who, the NHS PPE purchasers?

Yes

 

[Sasaferrato]

IMHO, the NHS suffers from too much administrative management & political interference { treating it as a business, which smells like the american way }
and not enough investment in front-line staff, equipment & buildings. {too much 'just-in-time' and not enough maintenance}.
I also think that there is too much centralisation and concentration on big buildings in urban areas and not enough community-based preventative medicine.

Chucking more money at it isn't the simple answer ...

e2a - the need for more "social care" with an aging population isn't going to make things any easier, either !

I was reading about advances in dementia treatment, so that people will live longer. Who is going to look after them when age strikes them down? We cannot look after people adequately at the moment.

 

[Silas Loom]

Which is the problem. We've had consultancies continually reorganizing the NHS. The problem with consultancies is that (a) they normally have no experience of what they're reorganizing because they're top down and think they know the problem but they don't listen to the people who are actually doing the work (b) they're in for some specific time-limited change projects and pilots which means they come in, fuck it up, and then fuck off again with no responsibility for what actually happens because they've already got their money and (c) they're normally tories who believe (a) and (b) are the only way to improve things rather than putting the funds into the front-line services.

Short term contractors are what we had with the PPE fiasco rather than using the NHS purchasing that was already there and had experience of ... purchasing PPE.

Restructuring is a long term political project that needs to be led by NHS England and its counterparts, not McKinsey. So we agree there.

I don’t think that the PPE fiasco provides enough of a reason to write off contingent labour and specialist ad-hoc support,

 

[two sheds]

Yes

I think it's the government and health experts that should have been predicting the pandemic. The PPE purchasers purchase PPE - until all the money was given to consultancies who are mates of the tories.

 

[nottsgirl]

Hopefully yes. Get rid of the fat cats at the top. And junior doctors are getting paid £15 fucking quid an hour while their bosses are getting paid hundreds of thousands a year.

That's what consultancies do. They're fucking ruthless but if they get rid of those fuckers at the top there's more in the pot for people who actually work.

I think the people at the top being paid too much is a societal problem rather than an NHS problem.

 

[two sheds]

Restructuring is a long term political project that needs to be led by NHS England and its counterparts, not McKinsey. So we agree there.

Agreed

I don’t think that the PPE fiasco provides enough of a reason to write off contingent labour and specialist ad-hoc support,

If contract labour and consultancies actually improved things we'd be living in a paradise right now because they're the ones who are routinely given the money to sort out infrastructure problems, and that's not worked out very well altogether.

 

[skyscraper101]

I was reading about advances in dementia treatment, so that people will live longer. Who is going to look after them when age strikes them down? We cannot look after people adequately at the moment.

You're right, though its not always that black and white.

There's living longer and, there's living longer. Dementia at any age is a pain because it requires all kinds of resources and often round the clock care. If they can treat it/manage it so that people can live longer without the added dementia then there's a case to be made for it. In an ideal world, we'd need minimal care in our old age and just slip away quietly from old age. At least that's how I'd like to go. I certainly don't want to spend my final years with no memory, being spoon fed and helped to the toilet and back.

 

[Monkeygrinder's Organ]

In general consultancies are brought in by senior management and they're made up of people who are fully committed to managerialism aren't they. They might identify a few lower paid middle management types who are disposable but they're not about getting rid of the people making big money at the top.

 

[skyscraper101]

Someone was drawing comparisons with Singapore earlier. Is there a better comparison?

I've heard Germany cited as a better model of efficiency due to the competitive providers and electable healthcare from mandatory employment-based health insurance. I'm certainly no expert here but are they (or any other state's) healthcare system something to learn from?

 

[Silas Loom]

I was reading about advances in dementia treatment, so that people will live longer. Who is going to look after them when age strikes them down? We cannot look after people adequately at the moment.

Healthcare is different from every other public service in that the more successfully it performs, the more resources it needs.

NICE sort of acknowledges this with quality-adjusted life years, but it barely touches the sides of the fundamental problem that keeping people alive means that they will ultimately need much more healthcare.

I’m not in favour of Logan’s Run or attestupa solutions, and they are unlikely to be vote winners, but you raise an underlying problem which no amount of restructuring can address.