The NHS under the Tories.
Comments
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Blacktemplar wrote:Let's also not lose sight of the fact that like many (most?) huge, centrally-organised/funded Governmental bodies, the NHS is fantastically inefficient and wastes money on a colossal scale. My sister used to work for local NHS procurement, one of my friends is a District Nurse and some of the stories I've heard about overcharging for simple things like consumables, and the blatant waste in the system beggar belief.
That's an astonishingly broad platform of evidence on which to base that assertion.
Got an example of blatant waste, BTW? Or just hearsay?
BTW: 70%+ of NHS costs are staff. Another large percentage will be drugs and medical consumables (eg bandages)
Bog roll frankly is a drop in the ocean.
PS: NHS is a paragon of virtue compared to the MoD, and I've worked in both NHS and private sector, and the ability of the private sector to p155 money away is amazing, too. Just because an organisation is public sector does not make it inefficient: that's down to how it's run.
It's just a hill. Get over it.0 -
SecretSam wrote:Blacktemplar wrote:Let's also not lose sight of the fact that like many (most?) huge, centrally-organised/funded Governmental bodies, the NHS is fantastically inefficient and wastes money on a colossal scale. My sister used to work for local NHS procurement, one of my friends is a District Nurse and some of the stories I've heard about overcharging for simple things like consumables, and the blatant waste in the system beggar belief.
That's an astonishingly broad platform of evidence on which to base that assertion.
Got an example of blatant waste, BTW? Or just hearsay?
BTW: 70%+ of NHS costs are staff. Another large percentage will be drugs and medical consumables (eg bandages)
Bog roll frankly is a drop in the ocean.
PS: NHS is a paragon of virtue compared to the MoD, and I've worked in both NHS and private sector, and the ability of the private sector to p155 money away is amazing, too. Just because an organisation is public sector does not make it inefficient: that's down to how it's run.
I'm suggesting it's broadly indicative of the waste inherent in almost every large public body. It may well be a "drop in the ocean" in relation to the overall NHS annual spend, but that doesn't mean it's right. Consumables in a plc are also a "drop in the ocean" but that doesn't stop the majority of large companies spending a lot of time and effort on lean manufacturing, waste management, recycling and many other activities to eliminate NVA items.
As to examples of over-charging and waste, it was a few years ago, but I recall that photocopier paper at the time as bought by the NHS was 3-4 times more expensive than walking into PC World as Joe public and buying a single packet, disposable nitrile gloves were several multiples more expensive than even a quick browse online would yield, laptops were particularly good value, at roughly double retail... I'm sure there are many more examples. And as for waste, I know our local Clinic bought Tablets for all the District Nurses, which they didn't ask for, didn't want, received no training to use, had rubbish software installed, didn't communicate with the existing systems and in the end have been left lying in desk drawers. That doesn't sound like good planning or effective use of limited resources to me....
You're absolutely right: none of these examples are material or structural in and of their own right, but multiply them across the entire NHS and the waste soon mounts up. And even at that, cutting out waste solves none of the major structural or organisational issue the NHS faces, but surely a focus on these things at an organisational level can't be a bad thing?
I'll finish with another example that made me think about attitudes to waste and cost in public bodies. My employer recently contracted with a well-respected provider of computer systems. Their CV was littered with large Government projects in various sectors, and they came highly recommended by the Departments they had worked with. We've now binned them, as the original estimate of scope, delivery and cost was so unrealistic it was laughable. Their entire justification for asking almost double the bid quote was that the project was 'more complex' than envisaged and it was crystal clear that they realistically expected to just stick out their paws and we would continue to cross their palms with silver until the project was (hopefully) delivered, incidentally 18 months late. Needless to say they are no longer working with us.
Again, I'm not suggesting this is necessarily a directly contributing factor to the position the NHS (and other Government departments) finds itself, but in my eyes at least it speaks volumes about potential inefficiency and complacency. I've only ever worked in the manufacturing sector, and believe me, focus on eliminating waste and maximising operational efficiency is front of mind every day for us."Get a bicycle. You won't regret it if you live"
Mark Twain0 -
Inefficiency is a factor. But let's remember something. The NHS budget for 2016 was £118bn. UK population for 2016 was 65,111,000. So we're getting - or trying to get - universal healthcare for £1,812.30 per head.
That's not very much money. I suspect, taken in the round, the NHS is surprisingly efficient given the demands placed on it.
The problem is that if you want to raise the amount spent per head, and you want to do it through direct taxation, you are asking the relatively small percentage of the population that pay income tax at all (about half of the UK doesn't) to pay quite a lot more. Say you wanted to raise tax only on higher-rate tax payers. There are only 4.7m of them (including those paying at the 45p "additional rate", all 333,000 of them). So every £100 per head of additional NHS spending is an additional £1,385 per annum of tax demanded from higher-rate tax payers.
(For comparison, there are 29m tax payers overall in the UK, so every £100 of NHS spending means £224 per head of additional tax - but I suspect £224 feels just as painful to a lot of basic rate tax payers as £1,385 would to someone earning £50k a year).
To catch up with the European average we actually need to spend an additional £13bn, or about £200 per head - so just double the tax figures above, and then ask yourself if you'd be happy to pay them.
The only other choice is to accept that, over time, the NHS will do less; I suspect it would be very difficult to achieve any real efficiency gains in an organisation of that size. It's not like running a corner shop.0 -
The Hospital documentary on Weds nights makes disturbing viewing. An intensive care unit at full capacity 24-7, which means that cancer surgery following chemo and radiotherapy is cancelled at the last minute, with who knows what effect on the outcome for the patients. Two entire teams of surgeons, anaesthatists, nurses etc standing around for hours, not able to do anything because there's no way of providing safe post-surgical care. And the fact that each morning there's a teleconference between several hospitals to discuss the availability of bed spaces, and there are none! But A&E is constantly filling up with new cases, some of which will need to be admitted. So people are waiting longer and longer to be admitted or discharged, longer to be assessed / treated, and many longer to make it out of the ambulance and into A&E, which in turn means fewer ambulances to answer new calls. People have criticised the description of the state of the NHS as a humanitarian crisis; it's certainly not the same as being bombed into oblivion in Aleppo, but to those NHS staff and patients caught up in it, it probably feels like a crisis a lot of the time.
If I'm referred to an oncologist I would hope to get an appointment quickly, and if I have to endure chemo and radiotherapy I want to be confident that any subsequent surgery will be done at the optimal time.
It's clear that the problems need to be tackled / properly funded on many levels.
Preventive healthcare & education, including some proper research into why people ingnore dietary and lifestyle advice / cannot give up eg smoking / eat themselves into type 2 diabetic blobs. Ditto for drug & alcohol abuse. Better mental health provision.
Better availability 7 days a week / open outside of working hours of walk-in clinics for minor injuries / ailments
Increased capacity in those areas which prove to be bottlenecks in hospitals
Improved provision for intermediate / social care; - lots of patients in hospital beds with no urgent medical needs and who could easily be cared for at home or in residential care if properly funded / supported.
Surely in a civilised society this is not beyond us?? I'd happily pay more tax if I knew it would solve some of these problems. And as long as I knew everyone in society was contributing their fair share.0 -
keef66 wrote:Surely in a civilised society this is not beyond us?? I'd happily pay more tax if I knew it would solve some of these problems. And as long as I knew everyone in society was contributing their fair share.
Forget the idea of a fair share. There is no such thing.0 -
I would happily pay more tax if it would solve problems but I don't necessarily believe it will. It also doesn't seem like per capita spending always results in a better global healthcare ranking.0
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KingstonGraham wrote:keef66 wrote:Surely in a civilised society this is not beyond us?? I'd happily pay more tax if I knew it would solve some of these problems. And as long as I knew everyone in society was contributing their fair share.
Forget the idea of a fair share. There is no such thing.
Well fairness is a subjective thing. Perhaps I should have said contribution based on individual circumstances / ability to pay. Obviously a smackhead on benefits isn't going to be contributing as much as a hedge fund manager...0 -
Which is the great irony, since the smackhead will be in and out of A&E and will probably end up with a nice handful of chronic conditions requiring treatment for the rest of his life, while the hedgie will go private for most things and then have the decency to peg it early from a stress-related heart-attack. That's the challenge of socialised medicine, particularly when there's not much social pressure to be healthy.keef66 wrote:Well fairness is a subjective thing. Perhaps I should have said contribution based on individual circumstances / ability to pay. Obviously a smackhead on benefits isn't going to be contributing as much as a hedge fund manager...
Perhaps we should have a metabo law, like the Japanese. Although they stop short of punishing the bloaters. Sadly.0 -
964Cup wrote:Perhaps we should have a metabo law, like the Japanese. Although they stop short of punishing the bloaters. Sadly.
Presumably Sumo wrestlers have some kind of exemption??0 -
964Cup wrote:
Which is the great irony, since the smackhead will be in and out of A&E and will probably end up with a nice handful of chronic conditions requiring treatment for the rest of his life, while the hedgie will go private for most things and then have the decency to peg it early from a stress-related heart-attack. That's the challenge of socialised medicine, particularly when there's not much social pressure to be healthy.keef66 wrote:Well fairness is a subjective thing. Perhaps I should have said contribution based on individual circumstances / ability to pay. Obviously a smackhead on benefits isn't going to be contributing as much as a hedge fund manager...
Perhaps we should have a metabo law, like the Japanese. Although they stop short of punishing the bloaters. Sadly.
though the smackhead will die young so saving us a fortune in the long run.
maybe we could make people pay at point of access but you get a refund if your need is genuine.
my other solution would be regional pay bargaining0 -
"maybe we could make people pay at point of access but you get a refund if your need is genuine"
Apart from cosmetic surgery, what kind of medical attention would you say is not borne out of genuine need? Recreational endoscopy?
And how would the payment thing work? Paramedics called to somebody unconscious in a stairwell, suspect an overdose but could easily be a stroke or a diabetic coma. Do they refuse to treat them till they've found a valid credit card or have the details of their private health cover?
I know where you're coming from; I hate the fact that so much NHS resource is spent on treating things related to overeating, inactivity, smoking, drugs and alcohol. In theory these are all preventable / avoidable, but the reality is very different. People do these things to themselves for a variety of reasons, but getting them to change their behaviour is infuriatingly difficult.0 -
If we genuinely tackled lifestyle health issues, together with education at school on basic 1st aid, diet, cooking, Sport, we might be able to reverse the obesity and diabetes problems we ve got, the demands both health problems cost the NHS are huge and dwarf wastage and health tourism.
but so far, the Government refuses to tax certain foods and has cut sport in school, tbh action on this should have been done years ago.
its all very well saying we dont want the Nanny state but when people expect the state to treat their self inflicted health issues, for free, then it is reasonable for the state to "nanny" them.0 -
Blacktemplar wrote:Let's also not lose sight of the fact that like many (most?) huge, centrally-organised/funded Governmental bodies, the NHS is fantastically inefficient and wastes money on a colossal scale. .
You might be interested in this:
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
If you rank the nations by "2014", you'll see the US spends the most of their income on healthcare of any nation, at a whopping 17%.
UK is a long way down at 9.1%, behind many of its continental counterparts.
So, by comparison, it's rather cheap.
The incentives and cost management in healthcare are complicated.
The assumption that the NHS is a massively bloated organisation should be examined carefully.
I personally wonder if part of the costs are down to the relentless cutting at the management level (who bare the brunt of the blame game), leaving the NHS badly organised, but with high quality Drs & Nurses.
If you look at how much private sector firms pay for management in their own firms, you wonder if it's good practice to do the same at the NHS.
Then again, it's complicated, because the incentives aren't typical.0 -
Public health is a long term solution. In the short-term to medium-term, a massive issue is workforce. This govt and the coalition saw a massive drop off in medical staff training, nurse training, etc.
Still, I am sure the private sector would solve all this by pulling doctors and nurses of thin air.
It's just a hill. Get over it.0 -
So your teenage son/ daughter gives in to peer pressure and takes a drug and has an adverse reaction. No treatment as it's their own fault.keef66 wrote:"maybe we could make people pay at point of access but you get a refund if your need is genuine"
Apart from cosmetic surgery, what kind of medical attention would you say is not borne out of genuine need? Recreational endoscopy?
And how would the payment thing work? Paramedics called to somebody unconscious in a stairwell, suspect an overdose but could easily be a stroke or a diabetic coma. Do they refuse to treat them till they've found a valid credit card or have the details of their private health cover?
I know where you're coming from; I hate the fact that so much NHS resource is spent on treating things related to overeating, inactivity, smoking, drugs and alcohol. In theory these are all preventable / avoidable, but the reality is very different. People do these things to themselves for a variety of reasons, but getting them to change their behaviour is infuriatingly difficult.
Or your partner is the victim of a sexual assault and the result is their self worth no longer exists, they hate them selves that much. They self harm again no treatment as it's self inflicted.
Where do you draw the line.0 -
Webboo wrote:
So your teenage son/ daughter gives in to peer pressure and takes a drug and has an adverse reaction. No treatment as it's their own fault.keef66 wrote:"maybe we could make people pay at point of access but you get a refund if your need is genuine"
Apart from cosmetic surgery, what kind of medical attention would you say is not borne out of genuine need? Recreational endoscopy?
And how would the payment thing work? Paramedics called to somebody unconscious in a stairwell, suspect an overdose but could easily be a stroke or a diabetic coma. Do they refuse to treat them till they've found a valid credit card or have the details of their private health cover?
I know where you're coming from; I hate the fact that so much NHS resource is spent on treating things related to overeating, inactivity, smoking, drugs and alcohol. In theory these are all preventable / avoidable, but the reality is very different. People do these things to themselves for a variety of reasons, but getting them to change their behaviour is infuriatingly difficult.
Or your partner is the victim of a sexual assault and the result is their self worth no longer exists, they hate them selves that much. They self harm again no treatment as it's self inflicted.
Where do you draw the line.
yep this ^^^ you cant ration care based on lifestyle choices.
we are the apparently the 5th or 6th richest country in the world, yet cant fund a decent Health service, cancer drugs not available, cancer ops cancelled, these are not minor things.
just a question of priorities isnt it?0 -
mamba80 wrote:Webboo wrote:
So your teenage son/ daughter gives in to peer pressure and takes a drug and has an adverse reaction. No treatment as it's their own fault.keef66 wrote:"maybe we could make people pay at point of access but you get a refund if your need is genuine"
Apart from cosmetic surgery, what kind of medical attention would you say is not borne out of genuine need? Recreational endoscopy?
And how would the payment thing work? Paramedics called to somebody unconscious in a stairwell, suspect an overdose but could easily be a stroke or a diabetic coma. Do they refuse to treat them till they've found a valid credit card or have the details of their private health cover?
I know where you're coming from; I hate the fact that so much NHS resource is spent on treating things related to overeating, inactivity, smoking, drugs and alcohol. In theory these are all preventable / avoidable, but the reality is very different. People do these things to themselves for a variety of reasons, but getting them to change their behaviour is infuriatingly difficult.
Or your partner is the victim of a sexual assault and the result is their self worth no longer exists, they hate them selves that much. They self harm again no treatment as it's self inflicted.
Where do you draw the line.
yep this ^^^ you cant ration care based on lifestyle choices.
we are the apparently the 5th or 6th richest country in the world, yet cant fund a decent Health service, cancer drugs not available, cancer ops cancelled, these are not minor things.
just a question of priorities isnt it?
I was referring to parts of the French system which is recognised as one of the best in the world. It is more focussing people's mind on what they need than rationing by price.0
