NHS Fail

[No1newts]

https://www.google.co.uk/amp/www.bbc.co.uk/news/amp/36854557?client=safari#

So as a "punishment" for completely ******* up their budgets and not being able to do the basics of a management role, they are now to also fail at their patient targets as well. Wow, I wish my employer was so forgiving, you **** it up? Ah don't worry we'll make it easier so you don't next time

This may be a watershed moment and it really feels although the government are now allowing the NHS to fail so it gets so bad they can just remove it.

A better solution would be managing the thing properly, God forbid though

 

[No1newts]

It's abysmal that they think this is a solution. I can't think of a business that would do such a thing where failure is essentially rewarded. We need an NHS but a fundamental problem of it is that there is no consequence for them screwing up, they need some form of real accountable management system in place to try and rein it in. The fear is you go private, even management only that they cut the system but I would think wth a clear set of targets heavily bonus related for a management company it may be doable.

NHS management are just shielded from the real world and seem to never suffer for their actions, at least that's how it looks fro the outside.

 

[No1newts]

But they promised £8bn extra a year......

Surely Boris should have been made health minister instead of foreign and he could have produced that extra 350mill he lied, sorry I mean promised, us when we voted out.

 

[No1newts]

I dont see why you are defending fining financially pressed trusts. The fines which means taking away funds which make them more likely to get fined.

I agree to one extent in that you are only exacerbating a problem by fining them but at least there is a stick there, now they can quite simply do what they want free of charge.

To be fair, a lot of hospitals have been forced into this position. They are over budget because they are treating more people than ever (ie doing more work). They are not going to turn away a sick person because they are over budget. They are not going to tell a woman she should give birth a couple of months from now when they have more budget to deal with her.

In the cases of waiting, despite denials it would make any difference, two of my local A&E departments have been closed, so all patients now have to go to the one hospital in the area with an A&E, and it's no surprise they can't cope.

If you deny hospitals resources, it's no surprise the waiting lists get longer. Relaxing the targets is just a way for the government to divert attention from the fact they they are failing to keep the NHS running adequately.

I agree the whole NHS is/has been a shambles for more than a decade under successive governments but as I said above this feels like a pretty seminal moment in that rather than even pretending to give a **** they've essentially chucked in the towel and said "just go and fail" as that's essentially what they've done regardless of how you dress it up. Let's say this gets them back in budget (which it won't) is an 8 hour wait for treatment an acceptable compromise? Is missing out on cancer treatment ok if they allow it to happen?

They've basically just given up the ghost and just left it to die on all fronts now.

Not a peep about changing ways of working and re evaluating pay and conditions to ensure efficient use of cash?

This is the problem with the public sector, there is incentive to screw the end user as a means to get more money, and no incentive to actually manage the cost of delivering through service.

Indeed. There is no thinking outside the box, no thought to improve the service, to modifying it/missing it up to be more efficient, if a business is failing it fixes it or it knows it dies. The NHS doesn't have the axe over its head so it has no reason to reform or get better, it just sits screaming for more money whilst stumbling along in the same tired rut forever.

There needs to be some way to incentive it to improve but it's an extremely fine balance as you potentially end up privately owned.

 

[No1newts]

The argument of under funding may be valid but the simple fact is in any business with cash flow problems is they cut their cloth accordingly and find ways to adapt and get better. From the outside looking in (and with anecdotal evidence from friends/family who work in the service) there seems to just be no willing to improve, the solution seems to be keep demanding more. That isn't reality, even if it was met halfway and improvements were made alongside funding increases it might help but there is nothing (again from the outside looking in)

One thing they could do instantly is remove all plastic surgery & weight loss stuff, I don't know what the spending is on these services but I don't understand why they are offered free of charge.

my wife was in hospital for a few nights on the menu she had a choice of about 8 meals, simplify the menu to cut costs (you can bulk buy to reduce expenditure)

Why not stop using agency staff? I know they do vital jobs but if you give them a choice of a full time job or not a penny into their bank they would probably fold.

I'm not in the NHS and that took 2 seconds thought so I'm certain if there was a real, in depth review they could sort it out. I do change management and I know without seeing a single thing inside the NHS I could save huge amount of money with very little effort. You can do that in any business that hasn't been heavily leaned and I would hazard there is only one type of leaning the NHS know about (**** joke, sorry )

 

[No1newts]

I don't think you or I know enough about the NHS to have sensible suggestions for their efficiency savings. But I do know this is not a good one.

Plastic surgery is mainly about fixing birth defects, cancer damage, burns, and other disfigurements. I think you'll agree these are good things to offer people for free. Maybe you're thinking of cosmetic surgery? The NHS doesn't (usually) offer cosmetic surgery.

As for weight loss, it's a bit like trying to prevent people smoking. Spending money on stopping people smoking is great value as it saves money later on rather than dealing with complications (cardiovascular disease, cancer). Same thing with weight loss (diabetes, amputations, blindness).

I agree it's a good thing to have, but in a system where the money is now stupidly tight perhaps keeping people alive is enough and for cosmetic surgeries they can come at a price (perhaps even subsidised if deemed more needed)


I'm not saying this is right, I'm just suggesting that from the outside screaming for more money is not always the solution, you need to think outside the established norm.

It showed you gave it 2 seconds thought ...

If your inspired ideas of what one can expect from private change management then god help us.

(that's not a dig at private ideas more the poster who clearly think he is a change management expert but can't see the blatantly obvious points with his 'interesting' ideas)

I'm trying to think of a response but your either terminally stupid (in which case it's pointless) or being extremely ironic (then if so kudos as I partially bit )

Either way you just crack on

 

[No1newts]

Correcting language (I apologise profusely for my iPhone auto correct) the sanctuary of the defeated.

 

[No1newts]

THIS IS WORTH READING

Anyway here's a few little facts about our hospital.
Our A&E is capable of dealing with 250 patients a day but for some reason we get 400+ a day.
We opened up a walking wounded A&E called Ambulatory Emergency Care to deal with the A&E overspill to look at 30 patients a day - there are now over 100 a day.
I personally know two people who turned up at A&E this week - one with stress and the other with a runny eye.
Every day we need to admit 150 patients into wards however we have 200 patients a day who are Ready For Discharge, in other words they can go home.
Why can't/don't they go home? - because families won't collect them until the weekend and we can't take them home because the families won't let us.

I'm guessing when you say can't take them home it is the elderly you are referring too?

With regard to A&E visits could part of it be the struggle to get GP appointments so instead try A&E? Getting a GP appointment at times can be horrific which is just another side of the struggling services discussion really.

 

[No1newts]

Within the NHS we have two choices.

1. Run a deficit to accommodate tremendous pressure whilst implementing cost saving measures as quickly and safely as possible.
2. Fail targets (A&E wait times, cancer tests and treatments etc), get fined, funding reduced and slaughtered in the media.

What would you do? Which of the two evils would you choose?

But if there is no punishment for point 1 where is the motivation to cost cut and reform?

We have been at both your point 1 & 2 for a decade now and nothing has really changed when there has been accountability, when you remove it why would it suddenly then get better?

 

[No1newts]

Not just the elderly but mainly.
We could also take them to care homes but families say no.

Perhaps free bed for X time then charges after this point?

But like over running your car park space

 

[No1newts]

Snip

Are you purposefully being ironic? If not stop for a moment, can you see the irony in what you are saying in answering my points?

If you can let me know, or ask nicely and I'll explain.

 

[No1newts]

So you've started this thread, you've come up with some stupid ideas, and now you've been called out on them you can't respond to any of the points raised.

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?

 

[No1newts]

You say this...



and go on to suggest some of the most short-sighted cost saving measures and then get upset when Xordium calls you out on them. OK.

Bad wording there fair point, the very little effort part is what I meant. I missed that I had said "without seeing anything" my apologies, by that I mean with any business who isn't far down the lean path there are clear savings generally easiest in processes around purchasing and similar departments. My bad wording though.

 

[No1newts]

I think it has been driven to cut its operating costs and run more sensibly, turning profit from that beast is an impossible dream

 

[No1newts]

So your defence is effectively.


"Hey guys i have a stupid idea!!!"


"That idea is stupid"


"Omg you can't criticise it for being stupid i said it was stupid, THE IORNING!!!111!!!"

When I hadn't realised I had made a mistake then yes it was.

Whenever you do an PACS workshop on something new (or fixing something broken) best way to start is to throw out ideas that come in to your head to get things going no matter how crazy/stupid or whatever else they may be considered.

Always like the saying "when you eliminate the impossible whatever remains no matter how improbable, must be the truth" ok it's a slightly warped usage but you can consider everything no matter how stupid the basic idea sounds as it leads to further thinking perhaps reaching a solution no one would even considered in the first place without the initial daft idea.

 

[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?)

 

[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.

 

[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)

 

[No1newts]

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.

I'll have a read up.

Ta