Just how can the NHS save money?
- Thread starter Admiral Huddy
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Business/politics mentality has taken over, which means "reducing" costs no matter how much it costs to do so. Cutting costs is an easily quantifiable way of measuring "success" in management, so it's hugely over-used. It doesn't matter if it increases costs later and/or in a way that can be ascribed to something else and it's unlikely that the person making the decisions understands anyway because they will be largely divorced from the actual work.
Random example from the company I work for. Without any details, so the company can't be identified. A piece of equipment was due to be replaced on an arranged date at a cost of £2500. It broke a few months earlier. The person who came out to it told the local manager that they could replace the whole thing that day instead of a few months later at a cost of £2500 as agreed or they could repair it at a cost of £900 then and replace the repaired equipment a few months later for another £2500. The new equipment was expected to last for many years, so it made no difference to have it replaced a few months early. The local manager wasn't allowed the authority to make decisions involving money (head office always knows best!), so they had to ring for authorisation. It was refused because repairing the equipment would "reduce" costs by £1600. £900 spent instead of £2500 spent, so that's lower costs right? Success! It increased the total cost by £900, but the other £2500 would be accounted for later and under a different label. Like outsourcing maintenance and minor works to an approved contractor rather than doing it in-house. Cut costs by increasing costs, that's the way to go!
As for approved contractors, does that ever work out cheaper or better in any way? I've known a business pay three times as much and accept a delay of several days when a properly qualified person was already on site for another job and could do the job there and then for a third of the cost. A simple case of "Do you want me to fix that while I'm here?". Half an hour's work for someone who knew what they were doing. That person was an approved contractor...but for the first job, not the second job. It was a simpler job in the same line of work, but that didn't matter. Not approved, you see.
I sometimes wonder if large organisations would work better if everyone above local management level was paid to go on holiday for a year or five. Probably not...but I'm not sure. There is a fairly large company (Triangle Wholefoods Collective, with ~160 employee-owners) that doesn't have any management at all and works very well (they're been going for 40 years), but they're a strange anomaly. It's a weird business - every employee-owner is paid £15.60 per hour and management is conducted by referendum. No joke, that really is how the business functions.
I keep seeing examples of this on Facebook, people going to A&E for stupid things like a burn to a thumb that you could quite easily deal with at home! Someone had a bad chest, booked a GP appointment. He's a smoker so it's probably a mild chest infection, just man up and ride it out. I used to have them loads as a smoker, I just put up with it and they'd disappear after a week or two.
Soldato
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imo it's a vicious circle with employers, employees and the nhs stuck in the middle, take a couple of days off work for a bad cold and they start asking for dr's notes because of people taking the mick out of sick leave, comes full circle round to it.
plus it's a measure of the nhs's success if people feel they can rely on it as the first go-to for any and all ailments.
granted though people are too willing to escalate, i won't go to the dr for an illness unless it knocks me down for a week or is something recurring/long term.
When I sprained my foot last year they said they don't normally get them back. They were gobsmacked when I drove the 25 miles to take them back 5 weeks after having them but they accepted them
You should have just left them there and walked off. They'd have taken them back.
Caporegime
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This gets bandied around a lot when the NHS is struggling but in my experience the NHS is overwhelmed by legitimate demand and chronic underinvestment/poor planning.
Soldato
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The nhs is something like the fifth largest employer on the planet. This scale makes it very hard to run efficiently and react quickly when needed. Added to that is the bureaucracy and continual political interference making it a very tough challenge.
I know it perhaps isn't popular because it is treated like some sacred cow by lots of members of the public but we ought to start charging people directly. Something like the Swiss system with an income based cap but also introduce some accountability ability to levy charges that go a little bit beyond that - so people can be charged for missed appointments, for turning up at A&E with something that is clearly not an emergency... or indeed where GPs are available at A&E for those time wasting idiots who turn up there then charge for those GP visits or tell them to go away/sent them to a walk in clinic.
The trouble with charging people like that, is people not going for fear they're going to be charged when they might have a genuine need and small problems that could have been sorted, then turning into much larger problems.
I'm going to say something unfashionable, but I asked a senior person in a NHS hospital if savings could be easily made, and they said there were spending huge amounts of money on people who were not entitled to anything but emergency care, because there's no system to deal with people who are either health tourists, or have leave to be in the country, but not receive more than emergency care. We're not doing checks in hospitals (ID cards would be needed for this probably).
I was told a story of a consultant who suspected someone was not entitled to the treatment they were being offered:
Consultant: "Who do I talk to about this?"
Admin 1: "You talk to person X."
Person X: "Not me, you talk to person Y."
Person Y: "Not me, Consultant is supposed to be doing it."
Consultant: "But I'm already in clinic seeing people, I don't have time, nor is it my job to police who gets into the hospital to get non-emergency treatment."
When even relatively simple procedures can cost thousands, and the difficult ones tens of thousands and more, the bills soon mount up. There should be a system in place to ID these people, and bill their relevant country of origin for the treatment given to their nationals. Much how hospitals abroad bill foreign nationals in their countries. It's low hanging fruit that's just not being picked up. I have no objection to people being treated, just we shouldn't be paying for it if they are not entitled. It would take a lot of pressure off the NHS, and at least put money back in the coffers to be used for other patients.
Someone I know was recently told he needed some dental treatment that was not available on the NHS. It would cost him about a thousand pounds to do it privately. He elected to fly back to his country of origin for a couple of weeks, visit family, and get the work done and still end up a couple of hundred pounds ahead. Being charged can be a motivator to not misuse the NHS, it's just a question of identifying those who are not entitled to free NHS treatment and billing them (or their governments) in one form or another.
I was told a story of a consultant who suspected someone was not entitled to the treatment they were being offered:
Consultant: "Who do I talk to about this?"
Admin 1: "You talk to person X."
Person X: "Not me, you talk to person Y."
Person Y: "Not me, Consultant is supposed to be doing it."
Consultant: "But I'm already in clinic seeing people, I don't have time, nor is it my job to police who gets into the hospital to get non-emergency treatment."
When even relatively simple procedures can cost thousands, and the difficult ones tens of thousands and more, the bills soon mount up. There should be a system in place to ID these people, and bill their relevant country of origin for the treatment given to their nationals. Much how hospitals abroad bill foreign nationals in their countries. It's low hanging fruit that's just not being picked up. I have no objection to people being treated, just we shouldn't be paying for it if they are not entitled. It would take a lot of pressure off the NHS, and at least put money back in the coffers to be used for other patients.
Someone I know was recently told he needed some dental treatment that was not available on the NHS. It would cost him about a thousand pounds to do it privately. He elected to fly back to his country of origin for a couple of weeks, visit family, and get the work done and still end up a couple of hundred pounds ahead. Being charged can be a motivator to not misuse the NHS, it's just a question of identifying those who are not entitled to free NHS treatment and billing them (or their governments) in one form or another.
or they could go and see their GP for those small problems like they're supposed to
stopping people from turning up in A&E with some small/minor issue that isn't an emergency is the whole point
Soldato
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What you are trying to achieve makes perfect sense, the problem is often people are in A&E due to substance abuse, mental health issues and the failure to provide the services they need outside A&E due to various cuts which would remove their need to attend. Then you get into the would you rather spend significant funds treating people or simply on administering a system to more tightly filter who can attend potentially at odds with the core principles of the nhs. There are no easy answers and often solutions are counterintuitive.
If the GP is able to deal with something without referring them, they could probably have just stayed home and taken a paracetamol.
I'm not sure what that has to do with my post. I don't think it is correct either, GPs can prescribe a range of drugs. As for referrals, they don't necessarily require A&E visits.
You say going to the GP relieves pressure on A&E, so does staying home, and the outcomes are very similar - you either get better by yourself or you die.
I was talking to an ex-paramedic the other day, he said that the packet of plasters you can get in the Pound Shop costs the NHS tens of pounds because of preferred suppliers and contractual obligation.
Yes, £20-£30 for a packet of ******* sticking plasters, because contracts.
I can tell you confidently thats nonsense.
Whilst there are a lot of patients that arrive for things that could be sorted at home or a visit to a GP, I do think one of the way they could save money would be to run it like a business on the stock market trying to look after the shareholders, and whilst this shouldn't have an impact on the patients, the same as customers to a supermarket may have certain customer service standards. It seems as though they have a budget and will do all they can to use it all.
The issue with this is that there isn't the competition without patients paying and going private, I think the same applies with schools and a lot of other public sector departments. The movement of schools to business academies gives a headteacher who has very little business knowledge great power over funding, my mother commented that the school she works in had to change all the seats in classrooms because the headteacher didn't like the colour!
Sorry for the somewhat confusing rant of a post, so many thoughts across the public sector spendin.
The issue with this is that there isn't the competition without patients paying and going private, I think the same applies with schools and a lot of other public sector departments. The movement of schools to business academies gives a headteacher who has very little business knowledge great power over funding, my mother commented that the school she works in had to change all the seats in classrooms because the headteacher didn't like the colour!
Sorry for the somewhat confusing rant of a post, so many thoughts across the public sector spendin.
Soldato
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Which makes sense , the challenge is firstly how to run it as a business when it does not make a profit or have any competitors which can compete it out of business. The second challenge is if you do use a more business based model it changes the culture from how many patients can we treat to how much profit can we make heading potentially to a US style system.
Well not really, you can get treatment for a range of things from a GP, they're not just there to either recommend paracetamol or refer you. And yes people who could wait and be seen by a GP but instead chose to go to A&E are causing problems for the NHS.
For example a woman isn't going to get a prescription for oral contraceptives by sitting at home, they can go to their GP for them... though in some cases people actually turn up in A&E requesting them too. I'd assume that most people who go to a GP aren't going for something that will kill them imminently, if they are then they'll often be told to go to A&E or indeed taken there in an ambulance.
There are some businessy things you can do that the NHS are notoriously bad at such as preferred rates from preferred suppliers (we'll buy this equipment and stuff from you if you give us a good deal), prompt payment discounts (you give us a discount if we pay you sooner rather than later), more efficient use of resources (we won't have surgical teams twiddling their thumbs because there's no beds to move patients to), etc.