NHS Rant

[FortuitousFluke]

You wait it out, because the docs can choose to not to work but eventually they will realise the NHS is the only mass employer in the country so would back down.

Of course I wouldnt have let this situation arise in the first place, as someone should have seen gradual shortages come in, I would also have never changed the GP contracts in the 2000s like blair did removing their obligation to work out of hours.

This hourly rate conundrum is probably a major factor in the lack of NHS budget increases, the current government seen what happened when labour added money in the 2000s only for a big portion of it to be swamped up by wage increases to existing staff. This issue is probably holding the entire NHS back. As I expect if I can recognise the probem the big bosses will have recognised it in where by you cannot add more funds when you can be poached on by your own staff to swallow it all up, and suppliers to the NHS may also do the same thing unless the contracts are locked down well to existing prices. But knowing the short termism of the decision makers the contracts are probably not locked down.

You seem to think that contract negotiations, either with staff or suppliers, is a case of telling them how it's going to be and then reaping the rewards. In the real world it just doesn't work like that. It's a balancing act between what you need, what you can afford, and what is attractive to suppliers. If you put out a tender which isn't attractive to suppliers they simply won't bid, they'll find work elsewhere, I can tell you this as a certainty. If you put out a contract a price that's too low, they won't bid, or they'll find the gaps in your contract that allow them to cut corners so they can deliver and still make money instead of making a loss. If you lock down your prices with no yearly increases they'll estimate those increases and front load them into their pricing structures.

Suppliers aren't stupid, and they certainly aren't powerless.

 

[Dis86]

excellent from the security staff, I hope they didnt get fired for what they did.

I can confirm that they didn't.

 

[chrcoluk]

Given I used to be a manager of a large food manufacturer I do have some ideas how commercial contracts work, there is most definitely such a thing as a long term fixed price contract which may or may not track inflation, yes these contracts can be broken but obviously at a cost, such as breaching the contract so losing trust as well as financial implications.

Also the company I worked for put value in who they were supplying, if who you supplying is likely to be a reliable customer who is unlikely to go broke (such as a state funded entity) if you have sense you will recognise that security has value. On the flip side if the customer is deemed high risk e.g. a new business startup, then contracts would likely be short term only to reflect that.

What I am talking about tho is blatant inflation busting increases e.g. lets say you supply the NHS with bed linen, and you read in the news the government has increased annual funding by 20 billion, you may smell the treasure and suddenly decide you want an extra 50% for what you supplying, simply because "you can" and knowing the NHS now has more money. Thats the problem I am talking about if more money is put into the NHS, it can be put in, but it means absolutely nothing if the NHS doesnt produce more as a result, its entirely possibly to plough in money without any kind of capacity increase.

Football clubs have started having this problem as an example, they announce a large transfer budget or perhaps sell a player for a large fee, then clubs they want to buy from suddenly expect high fees knowing they got money to spend.

The answer is to pretend you poor but the NHS cannot hide a large injection of cash, it has to be declared to the voters of the UK.

 

[Minstadave]

You wait it out, because the docs can choose to not to work but eventually they will realise the NHS is the only mass employer in the country so would back down.

Of course I wouldnt have let this situation arise in the first place, as someone should have seen gradual shortages come in, I would also have never changed the GP contracts in the 2000s like blair did removing their obligation to work out of hours.

This hourly rate conundrum is probably a major factor in the lack of NHS budget increases, the current government seen what happened when labour added money in the 2000s only for a big portion of it to be swamped up by wage increases to existing staff. This issue is probably holding the entire NHS back. As I expect if I can recognise the probem the big bosses will have recognised it in where by you cannot add more funds when you can be poached on by your own staff to swallow it all up, and suppliers to the NHS may also do the same thing unless the contracts are locked down well to existing prices. But knowing the short termism of the decision makers the contracts are probably not locked down.

How can you wait it out? This is a dilemma that comes up every day, several times a day for multiple shifts across each trust in every hospital across the UK.

“There’s still no one to staff ED tonight” - Ah just wait it out.....

 

[chrcoluk]

How can you wait it out? This is a dilemma that comes up every day, several times a day for multiple shifts across each trust in every hospital across the UK.

“There’s still no one to staff ED tonight” - Ah just wait it out.....

Its hard, because it hurts the patients, the immediate short term requirement is to man the ward, hence the ransom gets paid.

An obvious thing to shutdown is to stop having trusts compete with each other for staff, act as one single entity. Thats akin to one tesco store competing with another for a manager and going into a pay bidding war for him.

The problem needs to be dealt with by the NHS as a problem by the entire organisation, not as as an individual problem by individual wards, the entire approach needs to be changed.

Contracts should have had compulsory overtime implemented so a&e cover is provided without having to haggle with locums, so basically its covered under normal contracts. This is probably what should be done with every new recruit moving forward, which I think they tried to do recently when we had those protests from the junior doctors. Doctors are they doctors "to save lives"? If I remember right the union leader resigned after that ashamed that the negotiated deal was still turned down.

By the way its all too easy to shoot down what I am saying but you welcome to come up with something alternative, or is it the case you think there is nothing to be done and you would simply keep everything as it is?

 

[Jumper118]

One last item you should consider before any more inane points, healthcare has very high barriers to entry. Its a really highly regulated industry. Going back to my time in pharma, when we changed practically anything it was regulated, even the plastic bottles some IV was supplied in. These high barriers to entry make it harder for competitors to enter, the natural functioning of competition is suppressed by this.

they need to reduce the regulation as well as remove the NHS. i have said that multiple times.

I dont quite agree.

A for profit organisation always needs extra money to generate the profit, in addition shareholders tend to want profit growth year on year so the demand for profit is always growing. Profit could be compared to "waste" in state entities.

So the question is if the waste in NHS is more than the combined waste in a private healthcare and the profit making, if it isnt then a state funded NHS is better value for money.

I havent a clue as to exact reasons for the NHS problems.

But some reasonable assumptions are.

1 - Per adult head, our NHS is underfunded vs other top EU countries such as france and germany.
2 - Some staff seem to have a lot of clout in terms of their terms of employment, favourable hours and pay, my local hospital has been paying doctors to cover a&e over £70 an hour. That is clearly a ridiculous situation been abused by doctors, pure greed. It got so bad, several times a&e was left unmanned as managers had massive restrictions on authorising the doctors to work due to out of control costs, including the last time I went a&e.
3 - bad management of resources, so often I see nurses standing around chatting to each other or look like they struggling to stay busy, as well as admin staff, but doctors the opposite, when I left a consultants room after an appointment there was a queue of 3 staff waiting at the door for him, at a time he was 90 mins behind on appointments. So some resources clearly need shifting from nurse and admin staff manning levels to doctors. This massive shortage ironically is probably why problem #2 exists as the doctors know they in so much demand.

Healthcare is been compromised, high quality drugs no longer get prescribed, people have to either make do with less effective alternatives which can drastically reduce quality of life or even cause death, or no alternative at all. Doctors make assumptions that are dangerous like mistaking cancer for a minor infection, probably because the latter is cheaper.

There is doctors at my hospital which can barely speak english.

If the system was privatised, I can see some of these problems been dealt with especially #2. But I also feel overall funding would drop so problem #1 would get worse. Of course my private GP appointments have generally been productive, but I am paying a big wad of cash for those appointments.

A general observation based on the treatment given to me, my frends, family and what I read in the news, is that the NHS always value preserving life over maintaining quality of life. So if e.g. a condition doesnt have an immediate risk of killing you but is crippling you, then that would be lower priority than keeping someone in the last minutes of their life alive. Which is why so often people get brushed away, but then when the problem becomes real serious the NHS suddenly acts like it gives a crap. Also the 999 service is generally quite good as thats dealing with people in very grave situations. Its always going to be controversial on what people think is a better use of resources, so much of the NHS money is used to prolong life of the elderly probably at the expense of the working age who need treatment. For sure ideally there would be no choice to make and no compromise anywhere, but there is compromises currently been made.

Also since the abolishment of PCT's I feel the NHS has no public accountability, the complaints procedure since that got removed is a joke.

i would not want to put more money into a social system. it always is going to need more and more money. which means more and more tax. it will continue to grow and if they dont give it more funds the resources will be stretched and the quality of service will go down. It is not sustainable.

 

[Jumper118]

I wouldnt consider food cheap, there is a lot of people with malnutrition and we have food banks as evidence people are struggling to afford to buy food.

As an example 10 years ago I could buy 4 Cornish pasties for a £1, now they nearer a £1 each.
Sometimes the price inflation isnt crazy but instead the food amount is reduced so they reduce the weight of the food you buy in the packaging.

Food has most definitely got way more expensive despite competition in the market.

Gas and electric also has competition and has out of control cost increases, competition is by no means a guarantee prices will be restrained.

you sure about that?

 

[chrcoluk]

Jumper the private system would also be funded by tax, its simply just outsourcing, most probably I would imagine if you rich you pay at the door or via insurance, and if you poor the insurance is paid for by the state, but for political reason you would get the same kind of cover you expect now with the NHS. Ultimately as the population grows and costs of inflation a private system would also have year on year increases.

Nearly every single privatised project I have followed in the past decade or so has always cost the government more than expected. They seem to rarely work out financially well for the taxpayer.

you sure about that?

considering I have been buying my own food for over 20 years I am most definitely sure how much the cost of the food I eat has gone up to buy, and given I work at food banks I most definitely am sure about them.

Yeah I am not imagining things, it was over overtime.

So the government has recognised the issue.

https://www.express.co.uk/news/uk/7...-what-emergency-services-earn-NHS-BMA-jenkyns

This was probably aimed at solving out of hours manning problems, but they didnt want to play their part.

If the report is accurate I have no sympathy with them.

They have been offered a deal which is worth almost four times the overtime paid to the police for weekend and late night shifts.

Meanwhile firefighters receive no additional pay for working weekends and antisocial hours.

 

[Jumper118]

Jumper the private system would also be funded by tax, its simply just outsourcing, most probably I would imagine if you rich you pay at the door or via insurance, and if you poor the insurance is paid for by the state, but for political reason you would get the same kind of cover you expect now with the NHS. Ultimately as the population grows and costs of inflation a private system would also have year on year increases.

Nearly every single privatised project I have followed in the past decade or so has always cost the government more than expected. They seem to rarely work out financially well for the taxpayer.

no. i am not talking about giving private companies bits of the nhs. i am talking about destroying it completely, so it doesn't exist at all. the government wouldn't have anything to do with it. that is the key for this to work.

 

[Mercenary Keyboard Warrior]

they need to reduce the regulation as well as remove the NHS. i have said that multiple times.

I would argue the complete opposite. Take another real world example where this happened, lending. Once you unravel the controls that keep people honest they will become dishonest.
When you are talking literal life and death you absolutely require regulation. Its there for good reason.

Drugs trials
Ensuring clinical excellence
Ensuring controls on whats dispensed
etc etc

i would not want to put more money into a social system. it always is going to need more and more money. which means more and more tax. it will continue to grow and if they dont give it more funds the resources will be stretched and the quality of service will go down. It is not sustainable.

You seem to have a weak grasp on economics, and almost invisible grasp on how businesses work. So what has led you to this conclusion?

The main reason why the NHS requires more and more constantly (on a per head basis) is our understanding of disease and inherited conditions keeps improving. Our ability to treat what we understand keeps improving.
The only real way to stop the constant need for more is to draw a really black line and say we will treat up to here, but not past this point. Unfortunately public reaction to this is they do not accept it, if some super drug is developed and thats £100k a year to treat someone, we as a whole think it should happen.

no. i am not talking about giving private companies bits of the nhs. i am talking about destroying it completely, so it doesn't exist at all. the government wouldn't have anything to do with it. that is the key for this to work.

Well unfortunately for you, the vast majority, rich and poor, see the NHS as something to be supported and improved.

 

[Roar87]

Well unfortunately for you, the vast majority, rich and poor, see the NHS as something to be supported and improved.

Yeah we should teach basic economics in school really

 

[Mercenary Keyboard Warrior]

you sure about that?

Thats a rather intereting view that person is putting forward. But not generally accepted as how to measure prosperity. (But a bit like race, its not something that has a nice perfect definition)

Yeah we should teach basic economics in school really

How would teaching basic economics help this scenario?

Its complicated, hence why we should avoid trying to ask uninformed people to make decisions.

Even the stable (ahem cough) genius (ahem cough) Trump recognises its complicated
https://www.theguardian.com/us-news/video/2017/feb/27/trump-healthcare-complicated-budget-video

 

[FortuitousFluke]

Given I used to be a manager of a large food manufacturer I do have some ideas how commercial contracts work, there is most definitely such a thing as a long term fixed price contract which may or may not track inflation, yes these contracts can be broken but obviously at a cost, such as breaching the contract so losing trust as well as financial implications.

Also the company I worked for put value in who they were supplying, if who you supplying is likely to be a reliable customer who is unlikely to go broke (such as a state funded entity) if you have sense you will recognise that security has value. On the flip side if the customer is deemed high risk e.g. a new business startup, then contracts would likely be short term only to reflect that.

What I am talking about tho is blatant inflation busting increases e.g. lets say you supply the NHS with bed linen, and you read in the news the government has increased annual funding by 20 billion, you may smell the treasure and suddenly decide you want an extra 50% for what you supplying, simply because "you can" and knowing the NHS now has more money. Thats the problem I am talking about if more money is put into the NHS, it can be put in, but it means absolutely nothing if the NHS doesnt produce more as a result, its entirely possibly to plough in money without any kind of capacity increase.

Football clubs have started having this problem as an example, they announce a large transfer budget or perhaps sell a player for a large fee, then clubs they want to buy from suddenly expect high fees knowing they got money to spend.

The answer is to pretend you poor but the NHS cannot hide a large injection of cash, it has to be declared to the voters of the UK.

Long term fixed price contracts absolutely exist, but over that period costs for those suppliers will likely increase so in the majority of those contracts they will have done their sums at the tender stage and submitted a higher price than they would have for a contract that included provision for inflationary increases. This has the potential to actually cost the buyer more money in the long term and also comes with a reputational risk for the benefit of potentially insulating them from unexpectedly large increases in costs.

Swings and roundabouts in terms of the value of the NHS as a customer too, they are unlikely to go bust but I'm willing to bet they're not terribly good at meeting their payment terms in relation to how quickly they pay their suppliers. I know a few large public sector organisations who find it tricky to get suppliers because of poor historical performance in this regard.

Your example isn't fantastic. Even if you're not refusing to uplift contracts you're still going to put a clause in which explains how uplifts will be managed. If you ever find yourself in a position where your contract compels you to comply with an unreasonable demand for an uplift then you need to sack your procurement manager.

The football example isn't relevant to existing contracts, and is a bit different because it relates to the sale of assets. The football club don't need to sell a player, but a cleaning company does need to clean to survive, you tackle that concern by undertaking a tender process to drive competition.

At the end of the day for supply contracts the NHS does an awful lot of work to drive down prices and costs, more could be done but they're not just rocking up to a supplier and taking the first offer, even if they wanted to there are strict laws governing the use of competitive process when public sector bodies want to procure goods and services.

 

[Jumper118]

I would argue the complete opposite. Take another real world example where this happened, lending. Once you unravel the controls that keep people honest they will become dishonest.
When you are talking literal life and death you absolutely require regulation. Its there for good reason.

Drugs trials
Ensuring clinical excellence
Ensuring controls on whats dispensed
etc etc



You seem to have a weak grasp on economics, and almost invisible grasp on how businesses work. So what has led you to this conclusion?

The main reason why the NHS requires more and more constantly (on a per head basis) is our understanding of disease and inherited conditions keeps improving. Our ability to treat what we understand keeps improving.
The only real way to stop the constant need for more is to draw a really black line and say we will treat up to here, but not past this point. Unfortunately public reaction to this is they do not accept it, if some super drug is developed and thats £100k a year to treat someone, we as a whole think it should happen.

i am not saying it needs 0 regulation. it needs to be reduced. they would have to go through it point by point and see which are required and which arent. It is the same with food, again, if you sell bad food you can poison people, but if someone gets poisoned at a food store then less people will go to them, they will loose customers and they might not recover and go bust if they continue. The same applies to healthcare.

this is the exact problem, there are an infinite number of health issues which will grow forever as the goalpost is moved further and further. there be a point where if you tax everyone 100% they still wont have enough money to treat everyone. The NHS cant create capital, it only reduces it.

Everyone's line of what they are willing to pay for is different, so why should everyone have to pay for the health failure of everyone else? The people who need more care should pay more, its as simple as that.

Well unfortunately for you, the vast majority, rich and poor, see the NHS as something to be supported and improved.

If that is the case they would have no problem with people opting out, but they dont give you that option at all.

What I am talking about tho is blatant inflation busting increases e.g. lets say you supply the NHS with bed linen, and you read in the news the government has increased annual funding by 20 billion, you may smell the treasure and suddenly decide you want an extra 50% for what you supplying, simply because "you can" and knowing the NHS now has more money. Thats the problem I am talking about if more money is put into the NHS, it can be put in, but it means absolutely nothing if the NHS doesnt produce more as a result, its entirely possibly to plough in money without any kind of capacity increase.

this is also a great point. if it was private a healthcare supplier they would put the price of their plans up to cover the extra costs or face making less profit, making them less competitive with their competition.

 

[Mercenary Keyboard Warrior]

i am not saying it needs 0 regulation. it needs to be reduced. they would have to go through it point by point and see which are required and which arent. It is the same with food, again, if you sell bad food you can poison people, but if someone gets poisoned at a food store then less people will go to them, they will loose customers and they might not recover and go bust if they continue. The same applies to healthcare.

Again your so overly simplifying it. What experience do you have of the regulations surrounding healthcare, can you suggest one thats not needed?

this is the exact problem, there are an infinite number of health issues which will grow forever as the goalpost is moved further and further. there be a point where if you tax everyone 100% they still wont have enough money to treat everyone. The NHS cant create capital, it only reduces it.

And the general population decide this based on elections and who the elect. As I pointed out and you quoted before the majority do not agree with your view.

Everyone's line of what they are willing to pay for is different, so why should everyone have to pay for the health failure of everyone else? The people who need more care should pay more, its as simple as that.

If that is the case they would have no problem with people opting out, but they dont give you that option at all.

Well thats how the UK works, so I suggest if you dont want to follow it you move somewhere they don't, i think your fighting a losing battle personally with expecting people to ditch the NHS
Nope there is no opt out, just as there isn't with general taxation, obeying our laws etc

 

[Jumper118]

Again your so overly simplifying it. What experience do you have of the regulations surrounding healthcare, can you suggest one thats not needed?



And the general population decide this based on elections and who the elect. As I pointed out and you quoted before the majority do not agree with your view.



Well thats how the UK works, so I suggest if you dont want to follow it you move somewhere they don't, i think your fighting a losing battle personally with expecting people to ditch the NHS
Nope there is no opt out, just as there isn't with general taxation, obeying our laws etc

i dont know the exact regulations for health there are thousands.

that is fine. i can try to change there view.

thats how the uk works now. it is constantly changing all the time. It is not a loosing battle. a battle is not lost until someone surrenders. people in the uk are mostly pro nhs because it is drilled into them from a young age, the media and tv and state all say its great. if nobody says anything against it, it will only get worse. one day the nhs will self destruct or be privatise. Its just a matter of time. If i asked you 20 years ago if we were going to leave the EU on the back of a public vote what would you have said.

I myself would have been for these awful social programs even just a few months ago, but my opinions have changed. I am not under the impression that this can happen overnight. just like you couldnt dismantle the nhs over night, it would have to be a gradual change.

 

[Mercenary Keyboard Warrior]

i dont know the exact regulations for health there are thousands.

So you are arguing from a position of naivety, yet you are certain they can be scrapped.

that is fine. i can try to change there view.

thats how the uk works now. it is constantly changing all the time. It is not a loosing battle. a battle is not lost until someone surrenders. people in the uk are mostly pro nhs because it is drilled into them from a young age, the media and tv and state all say its great. if nobody says anything against it, it will only get worse. one day the nhs will self destruct or be privatise. Its just a matter of time. If i asked you 20 years ago if we were going to leave the EU on the back of a public vote what would you have said.

Thats a valid point, I would have thought better of the UK citizens, but we have been shown how a lack of understanding can be used to get people to vote against whats in their best interests. So I wouldn't rule anything out.

I myself would have been for these awful social programs even just a few months ago, but my opinions have changed. I am not under the impression that this can happen overnight. just like you couldnt dismantle the nhs over night, it would have to be a gradual change.

You lost me here, exactly what awful social programs are you now against?
Why were you for them before, but against them now. How did you become enlightened?

 

[Jumper118]

So you are arguing from a position of naivety, yet you are certain they can be scrapped.



Thats a valid point, I would have thought better of the UK citizens, but we have been shown how a lack of understanding can be used to get people to vote against whats in their best interests. So I wouldn't rule anything out.



You lost me here, exactly what awful social programs are you now against?
Why were you for them before, but against them now. How did you become enlightened?

arguing from a point of principle. in times where there is socialism, there is less growth in the economy and less growth means the standards of living can increases at a lower rate or decrease.

we wont get into this topic, lets just say 50% think the other 50% are dumb and misinformed on both sides.

All social programs other than the military, which are required to protect the boarder, and the police to prevent vandalism, damage or theft of property. other than that everything should be private with minimal regulation.


As for your last question i am not sure. I was a combination of a large number of things that all added up to the point where i was annoyed and started watching 50+ hours on economic and political video on the youtubes and reading a few books and political manifestos. I wont go through everything, because it would be a waste of my time and would amount to 'cool story bro'

 

[Mercenary Keyboard Warrior]

arguing from a point of principle. in times where there is socialism, there is less growth in the economy and less growth means the standards of living can increases at a lower rate or decrease.

we wont get into this topic, lets just say 50% think the other 50% are dumb and misinformed on both sides.

All social programs other than the military, which are required to protect the boarder, and the police to prevent vandalism, damage or theft of property. other than that everything should be private with minimal regulation.

So your pretty much describing America then. Standards of living are another of those things that are very difficult to measure, because a lot of things can improve your standard of living, like environment, but are very hard to put a value against.
I suspect you are confusing standard of living with purchasing power. Especially after watching videos like that one you linked.

In regards the 50%, well you brought it up. If you want to see a snap shot of how the two groups manage to come across you need to go no further than the Brexit thread in SC. Where the majority of the leavers show clear failings over and over in regards understanding how things really work, and not really being able to debate much stronger than parroting DM headlines.

So lets look at a few of the social programs that you would ditch.

Fire and rescue, so go back to the days of paying a private fire service to cut you out of your car if you have an accident, or your house catches on fire?

What about the roads, would you propose all new roads are tolled, as we wouldn't want that social program would we? All existing to be sold off and run as private enterprises?

I presume you would also ditch state pension?

You forgot to mention what changed your mind. Please enlighten how you found the light.

 

[Jumper118]

So your pretty much describing America then. Standards of living are another of those things that are very difficult to measure, because a lot of things can improve your standard of living, like environment, but are very hard to put a value against.
I suspect you are confusing standard of living with purchasing power. Especially after watching videos like that one you linked.

In regards the 50%, well you brought it up. If you want to see a snap shot of how the two groups manage to come across you need to go no further than the Brexit thread in SC. Where the majority of the leavers show clear failings over and over in regards understanding how things really work, and not really being able to debate much stronger than parroting DM headlines.

So lets look at a few of the social programs that you would ditch.

Fire and rescue, so go back to the days of paying a private fire service to cut you out of your car if you have an accident, or your house catches on fire?

What about the roads, would you propose all new roads are tolled, as we wouldn't want that social program would we? All existing to be sold off and run as private enterprises?

I presume you would also ditch state pension?

You forgot to mention what changed your mind. Please enlighten how you found the light.

That could probably be done on a local level, it could be done through a home insurance or car insurance policy. there are lots of ways to make this work.

roads private for sure. the roads maintained and run by the government are terrible. private roads would be great, you can have automatic toll system using number plates, or a card for and area. or you can pay nothing and have a dirt track. nobody would have incentive to put stupid speed cameras everywhere as well.

yes ditch state pension, a state pension is really bad. it requires the working population to grow forever and you end up like japan with an againg population which you cant pay for. the pensions lapse and everyone has to work to death anyway.

everyone in the uk has the state has to do X, Y and Z and there is no other option from a very young age, you just cant think outside this box you have been given.

i did say in the last paragraph of my previous reply.