NHS Fail

[SexyGreyFox]

The fact that different trusts pay different prices for items is a rather obvious place to start to be fair.

At one time NHS Supply prices were outrageous but now I think they are very competitive with Partners or Staples.
I ordered 3x 12" fans today for £10 each which might be cheaper than anywhere and a bag of 1000 elastic bands cost £1.10 which I thought was very reasonable.
I can't buy blank CD-R or DVD-R discs cheaper than NHS Supplies so they've really tightened that side up (at my Trust).

 

[Xordium]

any business who isn't far down the lean path there are clear savings generally easiest in processes around purchasing and similar departments.

The irony here and to show you really haven't got a clue is that the NHS is very lean focused. One of the biggest lessons it learned from lean was the usage of agency staff and yet say that is a problem.

Maybe you should really look into what you are on about and the effects etc before making these proclamations.

There are tons of savings that could be made, and in my opinion should be made in the NHS, but largely these are political decisions not management or medical.

 

[Cosimo]

Tear it down to the ground and start again.

What about doing something about the people who run it as they have never appeared to be capable of running the show? All on big fat salaries and never show any good result. They would have all been sacked in the real world.

 

[tom_nieto]

More like having large number of administration staff being paid well over market rate with excessive pension entitlements doing jobs that have been automated elsewhere or could be much more efficiently pooled.

Paying people to push trolleys of paper notes round because of the refusal to embrace modern technology.

Just two simple examples.

The problem is the workforce refuses to change.

How I wish that we could embrace modern rostering software and electronic noting systems in the NHS If you're not familiar with the disaster that was NHS connecting for health, it's definitely worth a read!

By allowing the NHS to miss its targets it is punishing the patients who will receive sub standard care. They are also providing the care providers who actually want to provide the best care. The only thing they are rewarding is the mediocrity which is the management system and the engrained working practises. The government is actually trying to stretch their front line staff by pushing seven day services (what does this even mean?) without the money to even effectively run a five day service. They're getting to the point where they'll turn around to the general public and say "it's so broken and the care that you're receiving is so bad that we have no choice but to privatise". And the general public may even call for it if the standards have slipped so much. I dread to think what would happen on that day.

 

[tom_nieto]

What about doing something about the people who run it as they have never appeared to be capable of running the show? All on big fat salaries and never show any good result.

This is a huge problem, but actually their salaries aren't all that bid compared to comparable private sector salaries. The NHS can't afford to hire the best, so it puts up with average. There are also a lot of people who become un-fireable after many years of service and make lateral movements.

 

[Xordium]

How I wish that we could embrace modern rostering software and electronic noting systems in the NHS If you're not familiar with the disaster that was NHS connecting for health, it's definitely worth a read.

I was involved in that in an advisory capacity as a user and it was apparent from the off it was never going to work because our end-users arguments and desires were constantly overridden in favour of the governmental preferences and the 'blue sky thinking' of the Microsoft product advisor.

A lot of places use modern rostering systems though but it doesn't matter where you go in the world you are rostering for a very chaotic environment. Add into that the nature of the workforce and their demands and you're always going to have problems. To those who say the workforce must adapt the fact is a large part of the workforce can't adapt by their very nature so it's kind of a silly suggestion unless you actually want no staff at all.

 

[No1newts]

The irony here and to show you really haven't got a clue is that the NHS is very lean focused. One of the biggest lessons it learned from lean was the usage of agency staff and yet say that is a problem.

Maybe you should really look into what you are on about and the effects etc before making these proclamations.

There are tons of savings that could be made, and in my opinion should be made in the NHS, but largely these are political decisions not management or medical.

Out of interest what would these be?

I have had admitted my knowledge isn't great so would be genuinely interested in hearing from someone closet to the organisation (which I'm guessing you are?)

 

[Yaayuh!]

It's almost as though the government doesn't want the NHS to survive and to privatise it through a big overhaul.

Oh that's not like the conservatives, surely.

 

[tom_nieto]

I was involved in that in an advisory capacity as a user and it was apparent from the off it was never going to work because our end-users arguments and desires were constantly overridden in favour of the governmental preferences and the 'blue sky thinking' of the Microsoft product advisor.

A lot of places use modern rostering systems though but it doesn't matter where you go in the world you are rostering for a very chaotic environment. Add into that the nature of the workforce and their demands and you're always going to have problems. To those who say the workforce must adapt the fact is a large part of the workforce can't adapt by their very nature so it's kind of a silly suggestion unless you actually want no staff at all.

I have never worked anywhere that has used an e-rostering system for medical staff. It's always been excel worksheets and a rota coordinator. I can only speak from a doctor's point of view of course. I don't think the workforce is any more chaotic or demanding than any other large service driven organisation is it?

 

[puppetworx]

This looks sustainable.

 

[Xordium]

Out of interest what would these be?

I have had admitted my knowledge isn't great so would be genuinely interested in hearing from someone closet to the organisation (which I'm guessing you are?)

The obvious one again is a political answer I am afraid. If one were to go back to the formation of the NHS then Beveridge idea was to form a health service free at the point of care to facilitate the stability of a healthy working population. What we have now is a health service (largely) free at the point of care for any possible condition irrespective of causation.

Two large groups dominate the usage of the health service - the young and the old. Now the young largely will have the potential to contribute to society the old will be asking society to honour their contributions to it. Here we have two problems. Firstly, not all the young will contribute to society and not all the old actually did contribute to society in any degree compared to what they expect from it.

Now tackling those problems needs to be a political decision. Add into that the significant usage from immigrant populations (and it is far more than is said due to the way the costcodes are applied to show the published usage), the will of the population to consume sugar and alcohol to excess along with other harmful substances and you can see the problems are largely political. All evidence demonstrates for what is put in financially the NHS does rather well in comparison to other services. Where it is failing we can also show it doesn't have the financial input. What the NHS has suffered from is being the political football of successive governments with constant redesign. However, the politicians of all flavours have never actually had the balls to ask and then detail the real questions they should be asking. It is worth considering a lot of our soon to be European ex-partners draw the line very differently when it comes to deciding is it ethical to treat a disease - it's not for their lack of ability. In my opinion one of the fundamental problems is the world also changed at the formation it was reshaping itself, following the Nuremburg trials, to trump the rights over the individual over the needs of society. I think we went too far with that and the problem is now an individuals' rights can be totally detrimental to society and all the other individuals found in it.

 

[muon]

Ok you don't understand, I'll spell it out.

I clearly stated I didn't know any NHS specifics, I clearly stated they quick spitballed ideas, I clearly stated I had no inside knowledge or expertise.

Note the above? That is what you have used as your criticism of the arguments (that were not even put forth as substantial points for discussion in the first place but let's not even bother going there) hence the irony in what you are saying. If you want an argument you'll have to go elsewhere.

You're welcome for the explanation, you could have just asked.

Can we get back on topic now?

Yes let's get back on topic. How do you know thry aren't efficient already? Do you have specific expertise in the affairs of one of the largest service entities in the world or don't you?

The NHS is consistently rated as the most efficient healthcare service in the developed world. We spend less than everyone else and health outcomes are still that what you'd expect of a developed country.

Youre annoyed that after years of austerity that trusts are now unable to balance their books, hence struggling with capacity and you believe we should fine them and ask them to potentially do the impossible.

At the same time this country has voted to leave the EU, reducing growth forecasts, reducing tax revenues, potentially impacting the availability of cheaper EU labour for the NHS.

 

[No1newts]

The obvious one again is a political answer I am afraid. If one were to go back to the formation of the NHS then Beveridge idea was to form a health service free at the point of care to facilitate the stability of a healthy working population. What we have now is a health service (largely) free at the point of care for any possible condition irrespective of causation.

Two large groups dominate the usage of the health service - the young and the old. Now the young largely will have the potential to contribute to society the old will be asking society to honour their contributions to it. Here we have two problems. Firstly, not all the young will contribute to society and not all the old actually did contribute to society in any degree compared to what they expect from it.

Now tackling those problems needs to be a political decision. Add into that the significant usage from immigrant populations (and it is far more than is said due to the way the costcodes are applied to show the published usage), the will of the population to consume sugar and alcohol to excess along with other harmful substances and you can see the problems are largely political. All evidence demonstrates for what is put in financially the NHS does rather well in comparison to other services. Where it is failing we can also show it doesn't have the financial input. What the NHS has suffered from is being the political football of successive governments with constant redesign. However, the politicians of all flavours have never actually had the balls to ask and then detail the real questions they should be asking. It is worth considering a lot of our soon to be European ex-partners draw the line very differently when it comes to deciding is it ethical to treat a disease - it's not for their lack of ability. In my opinion one of the fundamental problems is the world also changed at the formation it was reshaping itself, following the Nuremburg trials, to trump the rights over the individual over the needs of society. I think we went too far with that and the problem is now an individuals' rights can be totally detrimental to society and all the other individuals found in it.

Re the old treatment I think there should be some thought given to this but politically, considering the old are the highest turnout %, it would be political suicide for any party to suggest it unless it was a cross party initiative.

It is a similar problem afflicting social support where a initiative was put in using current data as the ultimate answer, now an aging population is putting extreme strain on services.

It's not a nice thought as you want to look after people but at some point a hard decision needs to be made before it all falls down.

 

[No1newts]

Yes let's get back on topic. How do you know thry aren't efficient already? Do you have specific expertise in the affairs of one of the largest service entities in the world or don't you?

The NHS is consistently rated as the most efficient healthcare service in the developed world. We spend less than everyone else and health outcomes are still that what you'd expect of a developed country.

Youre annoyed that after years of austerity that trusts are now unable to balance their books, hence struggling with capacity and you believe we should fine them and ask them to potentially do the impossible.

At the same time this country has voted to leave the EU, reducing growth forecasts, reducing tax revenues, potentially impacting the availability of cheaper EU labour for the NHS.

I never suggested fines were right, indeed I would agree that I completely irrational, but if you don't have a punishment for failure where is the compunction for a trust to push to succeed. We know they will miss budget, this is a sad fact, now we are also allowing them to miss patient care targets.

It feels although the government have tossed in the towel and now accepted failure on all fronts as inevitable.

 

[Xordium]

I have never worked anywhere that has used an e-rostering system for medical staff. It's always been excel worksheets and a rota coordinator. I can only speak from a doctor's point of view of course. I don't think the workforce is any more chaotic or demanding than any other large service driven organisation is it?

I think it is. I think the medical workforce has undergone, especially so in where I used to work, to being more like the nursing workforce as the amount of women in posts has increased. Now due to inherent cultural expectations towards women and childcare and the economic penalisation for men who may wish to take onboard that work (along with the still ever present cultural stigma against those men) then you are going to have a more chaotic workplace. I don't see this as bad thing at all I think the increase in the amount of women is beneficial but it does present a whole new load of problems. But problems are for solving and largely they are. But if you take an allied profession eg the fire service and the way they roster you can see that one is by far the simpler system to rota in. That is also due to the nature of the work too.

 

[Xordium]

It's not a nice thought as you want to look after people but at some point a hard decision needs to be made before it all falls down.

Well not really because it is an unanswerable question each way so it comes down to preference. For example, if a profoundly disabled child is born then what is the greater harm supportive palliative towards a near certain death in short order or sustaining a life for protracted period with multiple investigations and procedures and all the tolls and attachments that will place on the kid and the family over time towards a near certain death over a longer time frame. I would argue the latter is far more "wrong" but I can't prove that and neither can people who disagree with prove the former is more "wrong". That decision is made very differently in other countries and they are then able to use that money to use elsewhere. We however do lose the learning that can be done in that sustaining of life but then that is hardly an ethical thing to do you are effectively treating that child as a guinea pig. It is a matter of societal preference at the end of the day at the moment it's obvious which one we do but we've never used that knowledge to then monopolise of income streams as Labour stopped the private earnings thresholds. If it were me I'd be honest as a politician and put the two cost estimates to the public for a referendum.

1) Treat everything to world best standards (which won't happen instantly) at an drastically increased tax cost of xyz that will be gained across the population equally.

2) Treat reduced to worlds best standards (which won't happen instantly) at an probably slight increased cost of xyz etc etc

and then add is 2 or 3 questions on who the money would be collected etc as a broad goal eg how the Germans do it, how we currently do, etc.

 

[No1newts]

Sensible suggestion and chimes with what I loosely believe as well. We *want* an NHS but we need to be realistic in the format that it comes in.

I have also thought a top up system of some sort where you are allowed free care to X amount but anything on top of this you pay a top up. Hopefully might dissuade misuse but the flip side is the introduction of a two tier system of those who can't and cannot afford further care.

Only problem with your referendum is that it's the elderly who mainly vote so we would inevitably end up with option 1 so they get continued better care and the younger generations foot the bill (though also able to draw on the benefit of great care)

 

[bledd]

Time to buy more £25 cat5e cables for the NHS

 

[Xordium]

Only problem with your referendum is that it's the elderly who mainly vote so we would inevitably end up with option 1 so they get continued better care and the younger generations foot the bill (though also able to draw on the benefit of great care)

I would make it a mandatory vote for everyone who was in highschool upwards. Children of that age can be deemed Gillick competent to consent to medical treatment so they should be able to decide too. TBH from what I've seen from the recent referendum highschool children were able to articulate the main points for both sides better than an awful lot of adults including the politicians ...

You should look at how Germany fund their health it is not too far away from what you envision.

 

[mid_gen]

they need some form of real accountable management system in place to try and rein it in.

This does not exist in the public sector. Even the most extreme failures simply result in the individuals involved being shunted off to another department.