NHS wastage

[Efour]

Why are you putting tablets in your eye?

5 stars

 

[Dolph]

The NHS is a mess, trusts having different colour uniforms from the next, each ordering their own stuff, should all be centralised and standardised so it can be bought in bulk at a discounted price, the whole thing is a mess, yes the cuts arent helping, but if it was managed properly then they wouldn't need as much in the first place..

The problem is that theory (single bulk procurement saves money) only works when the efficiency of central procurement is as good as it should be, and when there is sufficient strategic oversight to control the demands.

The reason the NHS moved away from that model was because the central procurement was so poor that any gains from purchasing power were wiped out by wider problems and a complete lack of incentive to actually do a good job as a monopoly provider.

 

[hurfdurf]

The problem is that theory (single bulk procurement saves money) only works when the efficiency of central procurement is as good as it should be, and when there is sufficient strategic oversight to control the demands.

The reason the NHS moved away from that model was because the central procurement was so poor that any gains from purchasing power were wiped out by wider problems and a complete lack of incentive to actually do a good job as a monopoly provider.

Well said and explained.

 

[robfosters]

i recently underwent a procedure on my eye, as a day case in hospital.
On leaving, a nurse gave me a bunch of eye drops, saying, “This one twice per day for three days, this one four times per day for two weeks, this one four times per day for a week, and keep those ones refrigerated, these painkillers for whenever you feel that you might need them.”
I said, “Hold on, twice a day for three days equals six tablets, the box you gave me holds twenty four tablets, likewise the four times per day for a week one equals twenty eight tablets, you’ve given me four boxes each containing twenty tablets.”
He said, “What you don’t need, throw away.”
I said, “Might it not be better if you gave me just the amount I need?”
He said, “I just give out what I’m told pal, if you don’t like it, contact the Department of Health.”
It’s no surprise that the NHS keeps needing more £ if this is normal.

Was it a cataract op?

I’ve been waiting 18 months for mine. Haven’t even heard anything yet and have been told I won’t for a long time. Backlog is utterly horrendous

 

[potatolord]

You want to see the number of medical records staff they employ to push trollies of paperwork around a hospital, because they haven't quite gone digital yet.

Jeez. Don't start me on that...

 

[FortuitousFluke]

The problem is that theory (single bulk procurement saves money) only works when the efficiency of central procurement is as good as it should be, and when there is sufficient strategic oversight to control the demands.

The reason the NHS moved away from that model was because the central procurement was so poor that any gains from purchasing power were wiped out by wider problems and a complete lack of incentive to actually do a good job as a monopoly provider.

The NHS is moving back in that direction somewhat with the ICS model, the slight difference is that the ICS now has a statutory requirement to manage budgets, so whilst procurement is likely to become more centralised or at least collaborative, their is still an onus on budgetary management.

What's more interesting (concerning?) is the drive for Trusts to become accredited under Central Government standards, as that feels like a precursor to centralising NHS procurement under Government oversight which would be a concern in regards to the politicising of the NHS, and the potential for privatisation.

 

[dlockers]

This is a short sighted way to view waste.

Managing 20 variants of the same pill where the only difference is pack size is not a cost effective solution to avoiding wasting 4 pills of a 24 pill pack.

 

[Nasher]

With all the outsourcing and contracting pretty much all government departments have become a race to the bottom.

 

[Jean-F]

The boxes hold a certain amount and are sealed. Once they are taken off site, you could be lacing them with all sorts, so they won't take them back and give them to anyone else. They must also be issued with the instructions/warnings/side effects/etc leaflet. It's not worth their time to take out sleeves of tablets that they then don't have a box/leaflets for.

I can understand all that, and I would expect it, but I was talking about returning hermetically sealed, unopened boxes, or not being given too many boxes initially.

 

[Pawnless Endgame]

At our hospital canteen, there are usually a few leftover meals. Staff members have asked on numerous occasions why they're not allowed to have these perfectly decent meals (that are still heated)? The answer is - they're not allowed to have it because it will change their tax code. So instead it goes to waste. Stupidity

I think in principle, the tax code change should only apply if the staff are guaranteed free lunches every day at work. These leftover meals aren't always guaranteed though, so because it's chance-based, I don't think it should be taxed. At my old work, we had a fridge in the staff kitchen with bread, cheese, ham etc and we were allowed to make our own sandwiches for free. There was also fruit in there, first come, first served and this didn't affect our tax code as the food wasn't always guaranteed. So in that case, we would go to the sandwich van outside instead.

 

[Tefal]

24 tablets might be the minimum amount sold per box. Or if there is a smaller one, someone decided it was not worth the extra storage space stocking 2 options. To be honest I thought this was about the confusing instructions as I was lost with what you were meant to be doing... I don't think I'd do well being old and drug dependant to survive with the speed they go through a complex amount of instructions.

It says on each box too

 

[Tefal]

You’re right, I put tablets when I meant drops, perhaps I should have said units, my bad.



I was confused when he was telling me, but I was given a printed page giving details of which med and how often.
I suggested that as the boxes were all sealed, could I take the unused, seals still intact stuff to a local pharmacy, I was told that a pharmacy would only scrap them anyway, once they’d been issued to a patient, that was it, no returns.

Oh are these the single use little plastic pipette drops?


They probably give you extra incase you **** up.

Plus they're likely a bit of a pain to store sterile once you've taken say 6 off a strip of a box of 20 and given the box with the expiry etc away

 

[Jean-F]

Was it a cataract op?

I’ve been waiting 18 months for mine. Haven’t even heard anything yet and have been told I won’t for a long time. Backlog is utterly horrendous

No, it was chelation of right cornea, in layman’s terms, removal of calcium deposit by scraping, sounds horrendous but with a local anaesthetic it was virtually painless.
Plus the drop dead gorgeous Chinese ophthalmologist who did it made me wish that she’d take her time and stay hovering over my face for ever.
I had it done to the left eye a couple of years ago, prior to having the left cataract done, that time by a beautiful Greek ophthalmologist, (I’m beginning to see a pattern here at St. Thomas’s Hospital), and I’m assuming that this right one will be a prelude to having the other cataract procedure.

 

[dave28]

With all the outsourcing and contracting pretty much all government departments have become a race to the bottom.

Yes to the cheapest bidder from several hours drive away who they know nothing about.
I used to work for the Gov and they would give the window cleaning contract to a firm 60 miles away.
No thought of giving the contract to the locals who live in the community around them.

 

[cheesefest]

No, it was chelation of right cornea, in layman’s terms, removal of calcium deposit by scraping, sounds horrendous but with a local anaesthetic it was virtually painless.
Plus the drop dead gorgeous Chinese ophthalmologist who did it made me wish that she’d take her time and stay hovering over my face for ever.
I had it done to the left eye a couple of years ago, prior to having the left cataract done, that time by a beautiful Greek ophthalmologist, (I’m beginning to see a pattern here at St. Thomas’s Hospital), and I’m assuming that this right one will be a prelude to having the other cataract procedure.

I had eye drops (see a previous post) as had collagen cross linking (CXL) on both eyes. Got an eye condition called Keratoconus which means my corneas have become thinner and shaped like cones so affects vision. This procedure stops/slows down the process. Once the general anaesthetic wears off 2-3 hours of the procedure, it feels like some throwing hot sand in your eye and then poured acid onto it. The pain is awful. Can’t tolerate much light. Couldn’t watch tv for a week.

 

[Duke]

Why are you putting tablets in your eye?

Probably didn't see it coming.

 

[Nasher]

Yes to the cheapest bidder from several hours drive away who they know nothing about.
I used to work for the Gov and they would give the window cleaning contract to a firm 60 miles away.
No thought of giving the contract to the locals who live in the community around them.

And they usually sub-contract it to someone else and just take a cut for doing nothing. Quite often the people who are supposed to do the work just never turn up.

 

[DB_SamX]

Tell me about it... I am on immunosuppressant injections worth £1-2k each. At one point the NHS changed the injection to a newer one with little warning. I asked Llyods, who are employed by the NHS, if I should return the final older one i had in the fridge, yet to be injected. The pharmacy said they/NHS had no mechanism for accepting returns. I had no choice but to throw it away come expiry date.

 

[Werewolf]

Tell me about it... I am on immunosuppressant injections worth £1-2k each. At one point the NHS changed the injection to a newer one with little warning. I asked Llyods, who are employed by the NHS, if I should return the final older one i had in the fridge, yet to be injected. The pharmacy said they/NHS had no mechanism for accepting returns. I had no choice but to throw it away come expiry date.

I suspect the risk of accepting any return is high and your medication is at the extreme end in terms of cost so not necessarily worth having a specific process for a very small handful of medications.

Remember once a medication is outside of the pharmacy/hospital there is zero guarantee that they'll have not have been stored outside of the safe requirements, you might store them brilliantly but for every you, there is likely someone who isn't as careful.

So you balance the cost of "wasted" medications, vs the cost of trying to make sure the returned ones are safe or dealing with the issue when someone gets given a medication that was returned and turns out to have been rendered at best ineffective, at worst dangerous because of how they've stored it.

Almost all of the instances of "waste" that people like to go on about will have at least some element of a hidden cost, or risk assessment that makes the "waste" cheaper in some way (either straight up handling cost, or in terms of risk/liability).

 

[DB_SamX]

I suspect the risk of accepting any return is high and your medication is at the extreme end in terms of cost so not necessarily worth having a specific process for a very small handful of medications.

Remember once a medication is outside of the pharmacy/hospital there is zero guarantee that they'll have not have been stored outside of the safe requirements, you might store them brilliantly but for every you, there is likely someone who isn't as careful.

So you balance the cost of "wasted" medications, vs the cost of trying to make sure the returned ones are safe or dealing with the issue when someone gets given a medication that was returned and turns out to have been rendered at best ineffective, at worst dangerous because of how they've stored it.

Almost all of the instances of "waste" that people like to go on about will have at least some element of a hidden cost, or risk assessment that makes the "waste" cheaper in some way (either straight up handling cost, or in terms of risk/liability).

Fair points, thanks.