Save the NHS!

D.P. said:
Point 3 is a contradiction of the others. The immigrants pay more taxes and use less services on average. They are needed to pay for the aging population.
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I fully agree. I wasn't saying migration is a bad thing and certainly migration is needed for the exact reasons you state. However the infrastructure simply isn't there to support such a big net migration; it's not like theres flex in the already overstretched public services.

I know it may be simplistic to think this way but a small city would need a hospital, schools, local authority services, police services, yet all that's happening at the moment is real term cuts to these services.

Simply, money has to be spent to support all of the points I was making but guess the majoriy of tax payers don't have the stomach for the 2k tax rise suggested today.
 
mikeh501 said:
- All medicines should be bought centrally, with a view to more central purchasing of other items.
- All this decentralised commisioning done by doctors should be killed off. They are not purchasing professionals, and dont have any incentive to not spend the budget.
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1) That's already done as far as I'm aware. The framework agreements are put in place by NHS Supply Chain etc. and they're called off by individual trusts as needed.
2) Agreed on that part. Doctors / clinicians / scientists have a horrible arrogance when it comes to procurement. Never learned "look after the pennies and the..." These ******* just buy new equipment when it suits them to ensure their budgets are replenished the next year. I spend most of my days persuading them not to set money on fire, or to have a BBQ so I'm at least left with a less bitter taste in my mouth.
 
mikeh501 said:
- £10 to see your GP. £20 to be seen in A&E. Would absolutely sort some of the wheat from the chaff.
- Completely remove all over the counter medicine from free prescriptions.
- Miss an appointment without calling. Get billed for it.

- Anyone from outside the EU has to have travel insurance, and the NHS need to check it and bill them.
- Anyone from inside the EU gets the same as a UK citizen so long as there is reciprocal benefits in place for us.
- All medicines should be bought centrally, with a view to more central purchasing of other items.
- All this decentralised commisioning done by doctors should be killed off. They are not purchasing professionals, and dont have any incentive to not spend the budget.
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The last four are currently meant to already be done.
The £10 to see your GP won't help, as those who are exempt from payments and on benefits take up the vast majority of appointments as it stands.
I haven't seen A&E figures but i wouldn't be surprised if a similar pattern emerges there.
 
miceormen said:
1) That's already done as far as I'm aware. The framework agreements are put in place by NHS Supply Chain etc. and they're called off by individual trusts as needed.
2) Agreed on that part. Doctors / clinicians / scientists have a horrible arrogance when it comes to procurement. Never learned "look after the pennies and the..." These ******* just buy new equipment when it suits them to ensure their budgets are replenished the next year. I spend most of my days persuading them not to set money on fire, or to have a BBQ so I'm at least left with a less bitter taste in my mouth.
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They don't do any procurement, they are in effect trustees of their local health economy and hold NHS Commissioners to account.

I would accept, having first hand experience, these people are not clued up on finance, risk and governance arrangements as you would hope.
 
MM-Seat said:
They don't do any procurement, they are in effect trustees of their local health economy and hold NHS Commissioners to account.

I would accept, having first hand experience, these people are not clued up on finance, risk and governance arrangements as you would hope.
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Ah. The ones I deal with at least have me and the finance director between them and the money they want to spend.
 
MM-Seat said:
So is this GP practices that you deal with?
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Nah. I work in a support service for the NHS, providing clinical and lab equipment for it and R&D sites. Slowly I'm changing things but like any business there's a mentality of spending the limit so they're allocated the same budget the year after. The amount of money I've seen go out the door needlessly is easily in the tens of millions, and I know there's plenty more doors like it. There's a variety of reasons behind it, but ironically the biggest is a determination to outsource risk for equipment (maintenance, repairs or just buying new), because they don't want to take responsibility for looking after it themselves. Ostensibly because they can't be arsed. I'm aware from fellow procurement professionals this is a growing concern for people and services as well as capital equipment.

Tl;Dr; the NHS is killing itself slowly by privatising its own responsibilities. The Tories are just joining in.
 
miceormen said:
Ah. The ones I deal with at least have me and the finance director between them and the money they want to spend.
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Conversely from the other side trying to convince some management twerp sat in an office counting beans that yes that bit of kit is loads cheaper but utterly useless in clinical practice is an equally frustrating experience.
 
Destination said:
The last four are currently meant to already be done.
The £10 to see your GP won't help, as those who are exempt from payments and on benefits take up the vast majority of appointments as it stands.
I haven't seen A&E figures but i wouldn't be surprised if a similar pattern emerges there.
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Id charge them too! Maybe £5 if your on benefits - but it has to be something meaningful!
 
The issue with charging for missed appointments is that people won’t pay, and you either just ignore them not paying in which case people rapidly will catch on, or you enforce it. If you enforce it it’ll end up costing more than it brings in.

Charging upfront for appointments goes against the fundamental principle of the NHS being free at the point of access. If you charge for GPs people will go to A&E. If you charge for A&E are you prepared for the fallout when kids die because their parents won’t take them?
 
Minstadave said:
Conversely from the other side trying to convince some management twerp sat in an office counting beans that yes that bit of kit is loads cheaper but utterly useless in clinical practice is an equally frustrating experience.
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indeed, we have this. The new material that miles cheaper per ml but... drips out of the end of the tube so many fewer applications can be made, and indeed its *****.
 
Its not about the charge, its about changing peoples behaviour. A free service will never be valued and will always be used more than is actually necessary.

Taking those points in turn...
- Its not the sum of money in absolute terms, its how much it means to the individual. There is a level for every individual where its meaningful even if they are on benefits. There are plenty of examples where people die already where they blame everyone but themselves.

- If people dont pay, id drag them through court. There cant be an easy get out, otherwise whats the point. Its a regressive argument in that you end up with why bother doing anything, which isnt an answer.

- As for admin. If tesco can sell a tin of beans for £40p and make money its not beyond the wit of man to have someone with a CC machine or till in a doctors surgery. Its a non-argument. And even if it just broke even, its still worth doing. Its not about making money, its about nudging the behaviour of people to only use the service where necessary.
 
A couple of years ago in my patch there was free gym and exercise sessions on referral and the take up was poor. They added a £1 fee (still less than the cost of running) and it was taken up better as a valued service by patients.
 
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