The NHS

[happy_Alex]

I was going to add this to the David Cameron thread, but its off topic so I'm starting a new thread. Did anyone see Dispatches last night, about the NHS, where's all the money gone?

1. PFI Public works built by the private sector with private finance, which we (taxpayers) pay for at 3x intrest! But it dosen't show up on the chancellors books...

2. Bad mangement structure, brought about by years of initiatives layered one over the other, based in 'public sector market' philosophy, resulting in a massive bureuacracy.


3. The NHS Online ICT project (the largest ICT project EVER) was not implemented properly and the costs have spiralled out of control.

I really believe in public health and One social system, but this is a case where it's gone badly wrong, and in my opinion does not mean that there is anything wrong with nationalisation per-se.

Seems to be a case of "work filling the time available" where management perpetuates itself by creating tasks or appointing where it dosen't need to. I'll post back here later with some structure diagrams later.

 

[PrinceOfLeigh]

Good thread Alex.

I've been to-ing and fro-ing about the NHS myself for sometime. I don't have a great deal of knowledge about it's actual workings though.

From the outside looking in it appears that, as you say, the problem isn't 'nationalism' but rather the bureuacratic B.S which the Government makes the NHS, and others jump through.

The 'target driven' nature of living with a Labour Government for so long is what pushes me towards a Tory vote

 

[ComradeDavo]

The Labour government does have a problem with target setting. But then the Tories have a problem with a hardcore right wing.

 

[Mozza]

The problem is not the concept of the NHS, but rather New Labour's inability to organise a proverbial.

 

[GinandTonic]

The problem is not the concept of the NHS, but rather New Labour's inability to organise a proverbial.

In fareness the Tories were far, far worse.

The current problems stem from the attempt to intergrate the market into a public service institution. It works in some places, but often it is applied ideologically to situations where it is not apropriate. Eg private cleaning contractors with longish contracts do the worst job they can get away with to lower their bids and increase profits - then people die. It results in abserdities like the CAT scanner being used for cats. The Trust couldnt afford to pay to have operators for the CAT scanner at the weekend so they rented it out to a vet insurance co.

The PFI is a joke. Ken Livingsone was being pushed to use PFI for the tube and he resisted because he could borrow the money from the bank for just over half the cost!

In general it seems the NHS was mismanaged and now it is over managed. Intrducing competion to shake things up was a good idea, but those areas where it isnt working need to have it withdrawn.

 

[Scuffer]

The fundamental problem with the NHS is very simple.

Overexpectation

If we want a service that uses bespoke cleaning, tonnes of medical staff, fancy drugs, the latest equipment, free car parking (and the list of failings I've seen is very extensive) then someone has to pay for it.

It's also an absolutely colossal establishment, and personally I don't buy the idea it is over-managed either. Just think of all the different branches and aspects, the number of people and departments there actually are in the NHS. The number of buildings, of functions, of systems, of records, of supplies, of new research to co-ordinate.

Of course, it isn't perfect. Something so vast is bound to have absurdities and inconsistencies. But for the tiny price paid, it ain't so bad

 

[Hotpoint]

I work in the NHS (Contracts and Performance Manager at a Hospital Trust) and have a very simple solution to it's problems...

... leave it alone for ten years.

I mean that, leave it the hell alone for ten years. On average it gets a fairly major reorganisation every three years or so which means that just when we've sorted out the problems in one system they change it to give us a whole new set of problems.

It's not so much that the various reforms fail but rather that they never even give them the opportunity to work!

 

[kristopherb]

i know what your on about and the only way they can get more money is to
1)increase taxes
2)(my favourite)increase taxes of cigarates and give all taxes to the nhs.

 

[Joe Harker]

The fundamental problem with the NHS is very simple.

Overexpectation

If we want a service that uses bespoke cleaning, tonnes of medical staff, fancy drugs, the latest equipment, free car parking (and the list of failings I've seen is very extensive) then someone has to pay for it.

It's also an absolutely colossal establishment, and personally I don't buy the idea it is over-managed either. Just think of all the different branches and aspects, the number of people and departments there actually are in the NHS. The number of buildings, of functions, of systems, of records, of supplies, of new research to co-ordinate.

Of course, it isn't perfect. Something so vast is bound to have absurdities and inconsistencies. But for the tiny price paid, it ain't so bad

I agree totally with this, every one expects it to be like the private secter where they make enough money, the NHS is on a fairly tight budget

 

[StarWorms]

Only the important things should be available on the NHS. Those that actually improve lives and save lives - not things like breast implants.

We're taxed to heavily as it is, in fact we're often taxed for the same thing several times. There's plenty of money going to the government for them to sort it out. There has to be a leak somewhere - probably going to MPs pockets/down the drain.

Too much money is given to people for free. The stereotype single mother: Free house, free money, doesn't have to get a job, leeches of the tax payers.

Then we have immigration - people can come here, having paid no taxes and get free NHS treatment.

People always play the "waiting times are down" card. The reason for that is the NHS is paying private hospitals to treat their patients, leaving an even bigger black hole of money. That's a short term solution and will make the long term effects worse.

 

[ainwood]

i know what your on about and the only way they can get more money is to
1)increase taxes
2)(my favourite)increase taxes of cigarates and give all taxes to the nhs.

Won't work. This is the Labour strategy in New Zealand: There are problems with the health system, so lets throw more money at it. Oh - and we better make sure that the money is spent well, so lets set-up some new systems to monitor that spend. Oh - and lets do some system audits. Oh - and lets get some more administrators. Oh - and those administrators are going to need more information, so lets get the doctors to provide it for them. Oh - and those doctors need to gather that info, so lets get the nurses to do that.

Overall, that extra money certainly results in lower effective producitivity (output), and likely results in no extra improvement in services AT ALL*.

*OK - it depends on the point you're starting from, but just saying "more money" is not the solution. My suggestion for the NHS: Start charging a nominal GBP 5 per visit. Hopefully that's not enough to actually stop people needing treatment from getting it, but it is enough to stop the timewasters (eg. people who go to the doctor because they're lonely - yes, it happens).

 

[Hotpoint]

People always play the "waiting times are down" card. The reason for that is the NHS is paying private hospitals to treat their patients, leaving an even bigger black hole of money. That's a short term solution and will make the long term effects worse.

No we really are treating people faster, the numbers being sent to private hospitals or ISTC's is absolutely tiny. Not all of the increase in NHS finance was wasted, some of it was used to improve things.

 

[Scuffer]

Hotpoint, you might know this being in performance and contracts. One of the (surprisingly numerous) guidelines on cleaning gave the power to matrons power to take some action over poor cleaning by contractors. Has that ever been used, to the best of your knowledge?

 

[Hotpoint]

Hotpoint, you might know this being in performance and contracts. One of the (surprisingly numerous) guidelines on cleaning gave the power to matrons power to take some action over poor cleaning by contractors. Has that ever been used, to the best of your knowledge?

I'm afraid I don't know about any specifically matron related action (not part of my remit as it happens) but private companies do get hauled over the coals pretty frequently. IMHO the problem generally with the introduction of private firms performing services within the public sector is that Civil Servants(NHS or otherwise), don't realise just how cut-throat and ruthless private enterprise is and they often get screwed over as a result, they're just not forthright enough in setting out minimum standards and enforcing them.

As an aside one of the jobs I had before I joined the NHS was actually working for a Facilities Management Company with a contract for cleaning NHS Facilties (hospitals, Health Centres etc.) I was the Audit Manager with responsibilty for putting together the guidelines on how good the standard should be and we simply followed the existing NHS guidelines as it happened.

 

[Scuffer]

I'm getting OT a bit, but do you know where I might find out more actions against contractors, I'm doing research on it at the moment.
Also, (and I very much doubt you'll know this, but it's worth a shot!) how were those standards drawn up

 

[Hotpoint]

I'm getting OT a bit, but do you know where I might find out more actions against contractors, I'm doing research on it at the moment.

Also, (and I very much doubt you'll know this, but it's worth a shot!) how were those standards drawn up

No idea about actions against contractors (certainly not official ones) but I'll see if I can find out for you. As for the Cleaning Standards themselves they came from NHS Estates.

http://patientexperience.nhsestates...s/ch_content/cleaning_manual/introduction.asp

 

[Rossiya]

Well, you all know my opinion on the NHS.

 

[Hotpoint]

Well, you all know my opinion on the NHS.

Well I don't for one (and I doubt I'm unique).

 

[GinandTonic]

Well I don't for one (and I doubt I'm unique).

He believes that if we scrap the NHS healthcare would be free somehow. He has been rather coy about explaining how though.

 

[Scuffer]

Cheers, very good of you.

I'm aware of what the guidelines are currently, I was wondering if anyone knew on what basis they were chosen, like on risk of patient infections, benchmarked against someone other country, best achievable level, adapted from guidance for food production, that sort of thing. I don't think anyone will actually know becaue I suspect the actual answer is 'drawn up on the back of an envelope on the basis of what sounds good'. But some standards are better than none