The NHS Thread - Part Two

[Wymsey]

What needs changing in the NHS, apart from trying to reduce the massive waiting lists for appointments and operations and possibly fewer senior managers?..

 

Starmer really needs to get this right during his tenure, as the healthcare system in the UK really seems dire in many ways.

[Trav Le Bleu]

Less middle management and more actual nurses and doctors.

[Leicester_Loyal]

Will never be fixed, same with any other public sector company (or most of them anyway), too much red tape, too many rules and too many people at the top who don't understand how the bottom works in order for it to be successful. It can be improved, but I don't think it'll ever be competent, no matter how many billions we throw at it.

[SecretPro]

Too many old people and that issue is only set to get worse.

 

Part of fixing the NHS is going to be a complete overhaul of social care, without that, the NHS will always be utterly over-run.

 

If you can get people out of hospital into the places they actually need to be to receive proper care (IE, better care homes, better in-home care, better mental health services etc) then you could free up so much bed space.

[Trav Le Bleu]

25 minutes ago, SecretPro said:

Too many old people and that issue is only set to get worse.

 

Part of fixing the NHS is going to be a complete overhaul of social care, without that, the NHS will always be utterly over-run.

 

If you can get people out of hospital into the places they actually need to be to receive proper care (IE, better care homes, better in-home care, better mental health services etc) then you could free up so much bed space.

Let me guess, you've always dreamed of being a Sandman?

[UniFox21]

A huge part of 'fixing' the NHS comes with providing better pre- and post- hospital care.

Improving local GP's etc, and you're seeing fewer hospitalisations, fewer people clogging up A&E. Which instantly reduces stress on hospitals.

 

Improve post-hospital care, so care homes, GP's again, and people spend less time in hospital as theres a support system in place.

[SecretPro]

1 hour ago, Trav Le Bleu said:

Let me guess, you've always dreamed of being a Sandman?

I didn't mean it in a negative way against old people - what I mean is, modern medicine is fantastic, but it's also keeping people alive much longer than the human body was designed for. This creates an enormous and growing pressure on the NHS as the population ages.

[RoboFox]

It very much feels like it's already too far gone. Decades of Tory governance has seen to that. 

 

The Conservative party does not believe in the NHS but for obvious reasons, dares not say so.

 

By underinvesting, making the jobs unrewarding and creating waiting lists, they wanted to encourage the public to turn to the private sector. The neoliberal shift in health governance from the 1980s onwards combined with the brutal austerity measures of the 2010s undermined its resilience long before COVID. 

 

There's a £40b shortfall in funding that might be a good place to start. 

[pleatout]

2 hours ago, Trav Le Bleu said:

Less middle management and more actual nurses and doctors.

https://lowdownnhs.info/nhs75/does-the-nhs-have-too-many-managers/

 

The highlights

• Only 3% of staff in NHS hospitals are employed in management roles
• a lot of staff hold management responsibilities whilst also working on the front-line in patient care
• employing full time managers will enable clinicians to focus on patient care. 
• Top NHS executives paid far less than industry equivalents
• Too few managers leads to expensive use of management consultants

Approximately 3% of staff in NHS hospitals are employed in management roles and this is a much lower level than in the economy overall in England, where 11% of staff are employed in management roles.  

 

 

The truth is the NHS is massively understaffed when it comes to managers.  There is too much to manage and too few to do it.  Resulting in the problems we have.

 

Oh and before the "Diversity Manager" argument comes.

 

Bear in mind the NHS does things to people that you wouldnt let your nearest and dearest do.  Cultural and religious sensitivity is needed.  You have to have someone somewhere that knows this stuff. And it isnt just about "immigrants".   Fish on fridays is still a religious thing for some folk.

 

Edited 6 November 2024 by pleatout

[pleatout]

2 hours ago, Leicester_Loyal said:

Will never be fixed, same with any other public sector company (or most of them anyway), too much red tape, too many rules and too many people at the top who don't understand how the bottom works in order for it to be successful. It can be improved, but I don't think it'll ever be competent, no matter how many billions we throw at it.

Go on then - give me an example of "red tape".  I'll give it a go to see if I can explain why.

[Leicester_Loyal]

7 minutes ago, pleatout said:

Go on then - give me an example of "red tape".  I'll give it a go to see if I can explain why.

Railway examples, you lose the competency due to an admin error and if you work on that bit of equipment (even though you know how and have done so for years), you can lose your job. 
 

Paperwork, has to be issued 24 hours in advance, if anything is slightly incorrect, the work has to be cancelled. If you proceed to do the work, you’re the one who is liable to lose your job. 

Struggle to get rid of employees, even the worst ones, they’ll likely be kept on, moved on to a different department or depot, or paid to go. 

 

I’m sure all public sector is the same, but I don’t have first hand experience of much of it, but I’m assuming it’s all the same. 

[pleatout]

8 minutes ago, Leicester_Loyal said:

Railway examples, you lose the competency due to an admin error and if you work on that bit of equipment (even though you know how and have done so for years), you can lose your job. 
 

Paperwork, has to be issued 24 hours in advance, if anything is slightly incorrect, the work has to be cancelled. If you proceed to do the work, you’re the one who is liable to lose your job. 

Struggle to get rid of employees, even the worst ones, they’ll likely be kept on, moved on to a different department or depot, or paid to go. 

 

I’m sure all public sector is the same, but I don’t have first hand experience of much of it, but I’m assuming it’s all the same. 

Struggling with railway examples, I can do NHS but I'll give it a go.

1st 2 - litigation & litigation 

 

If something goes wrong in a small business like say you pick up the phone dial a number and get number unobtainable - tbh so what?   When the coroner asks the same question about a phone in a hospital it tends to focus the mind a little. If the paperwork isnt right then no chance, if it goes wrong then we all love to hear "can we have an investigation and root cause analysis"

 

3rd example - Most people wont sue a small company for wrongful dismissal because they havent got enough money to make it worth their while if they win.  The public sector - woohoo, huge amount of glorious taxpayers money to go for. There are solicitors that specialise in this.  So when they are sacked it's water tight (in most cases - i know of 1that still stings) and that takes time and appeals and process.

[ftfagos]

Two things:

 

Copayments

 

A robust conversation with the GBP regarding what can and cannot be done in the last few years of life.

[Trav Le Bleu]

59 minutes ago, SecretPro said:

I didn't mean it in a negative way against old people - what I mean is, modern medicine is fantastic, but it's also keeping people alive much longer than the human body was designed for. This creates an enormous and growing pressure on the NHS as the population ages.

I know, I was just being whimsical and testing your movie knowledge at the same time. 

[dynamark]

i think most would agree that when you are in the care of NHS then it can be very good the problem is you cant get in reasonably quickley.

My early pay slips had tax and NHI deducted back in the 70s.We need to be aware that this is something that we actually pay for ourselves,start looking after our health and not expecting  to be bailed out by this almost religious thing.Why should a 20 stone smoking alcoholic  get treatment without question.

It will take a very brave govt to do anything seriious.I recently needed a cataract op after visiting the optician - done within 2 weeks private company.I have also waited nearly 2 years for a hip replacement  partly due to NHS poor communication.Due to the intense pain and effects I will be in Spire 2 weeks tomorrow at my cost 6 weeks after seeing the consultant and then back down the KP making a noise1

[pleatout]

9 minutes ago, ftfagos said:

A robust conversation with the GBP regarding what can and cannot be done in the last few years of life.

I'm not saying I agree with it but a consultant (medical) once said to me

 

Waiting lists are there for a reason.  Mrs Goggins is 90 and has a bad hip.  If I operate the operation will kill her, but she and her family are expecting me to do something.  Do I really want to be responsible for her untimely death? If I put her on a 2 year waiting list she'll probably die before she gets seen.

 

Sadly these are the choices that have to be made 

[UniFox21]

53 minutes ago, pleatout said:

Struggling with railway examples, I can do NHS but I'll give it a go.

1st 2 - litigation & litigation 

 

If something goes wrong in a small business like say you pick up the phone dial a number and get number unobtainable - tbh so what?   When the coroner asks the same question about a phone in a hospital it tends to focus the mind a little. If the paperwork isnt right then no chance, if it goes wrong then we all love to hear "can we have an investigation and root cause analysis"

 

3rd example - Most people wont sue a small company for wrongful dismissal because they havent got enough money to make it worth their while if they win.  The public sector - woohoo, huge amount of glorious taxpayers money to go for. There are solicitors that specialise in this.  So when they are sacked it's water tight (in most cases - i know of 1that still stings) and that takes time and appeals and process.

Exactly that.

Company needs proof the person is "competent" in whatever that may be in case anything goes wrong.

[Leicester_Loyal]

3 hours ago, pleatout said:

Struggling with railway examples, I can do NHS but I'll give it a go.

1st 2 - litigation & litigation 

 

If something goes wrong in a small business like say you pick up the phone dial a number and get number unobtainable - tbh so what?   When the coroner asks the same question about a phone in a hospital it tends to focus the mind a little. If the paperwork isnt right then no chance, if it goes wrong then we all love to hear "can we have an investigation and root cause analysis"

 

3rd example - Most people wont sue a small company for wrongful dismissal because they havent got enough money to make it worth their while if they win.  The public sector - woohoo, huge amount of glorious taxpayers money to go for. There are solicitors that specialise in this.  So when they are sacked it's water tight (in most cases - i know of 1that still stings) and that takes time and appeals and process.

 

2 hours ago, UniFox21 said:

Exactly that.

Company needs proof the person is "competent" in whatever that may be in case anything goes wrong.

Yep, rightly or wrongly I understand why those processes are in place, but those processes ensure that the smooth operational running of the public sector will never happen. There are so many rules and regulations, that it's almost impossible to run successfully, and I don't think that'll ever change. We'll always be spending billions for something that looks poor value vs. the private sector.

[Lionator]

7 hours ago, Trav Le Bleu said:

Less middle management and more actual nurses and doctors.

Currently in a recruitment phase for a new nhs post. I have been ready to start for 3 weeks and served my notice in my other role. As I am changing trusts, I have to do their local induction. They put these inductions on once a month and the November intake was full. Therefore I couldn’t do my induction until December, so at least four weeks of lost work. HR (or people management) would not budge on this at all, despite myself and my line manager going apeshit about it. And I’m not even frontline, the same thing is for doctors and nurses too. So there’s likely hundreds of weeks of frontline work lost due to some mad OTT bureaucracy. 

[coolhandfox]

Why not try the novel idea of fixing society, educating people to make healthier choices improving their physical and mental well-being.

 

Rather than fixing the broken, let's stop people becoming broken in the first place.

Edited 6 November 2024 by coolhandfox

[westernpark]

Society needs to become healthier. Public health is such an important tool to help protect the NHS against preventable disease action. Of course certain job roles will hit the headlines, costing the NHS‘unnecessary money’ but those who have allowed private sector health to flourish need to be questioned. They drive the rate up for the talent within the system. There needs to be a cap on those moonlighting in both sectors.

[Lionator]

19 minutes ago, coolhandfox said:

Why not try the novel idea of fixing society, educating people to make healthier choices improving their physical and mental well-being.

 

Rather than fixing the broken, let's stop people becoming broken in the first place.

Because we have an electoral system where parties don’t care about 40 years down the line. Since July, I’ve lost count of the time I’ve heard ‘nanny state’ in response to the minorest thing that Labour are trying to introduce health related. 

[Bryn]

8 hours ago, Trav Le Bleu said:

Less middle management and more actual nurses and doctors.

 

We actually don't have enough managers. And specifically, we don't have enough GOOD managers. We have thousands of people overpromoted into management roles, or clinicians who have percuniary or other malign interests in management, or clinicians who don't want to manage but are forced to.

 

I actually don't think we need a huge amount more doctors either. We do need some, if you compare our numbers to similar countries with better healthcare, but probably not as many as people fear. We definitely do need more nurses, and we need to far better incentivise, retain and train the ones we have. They should nurse - not deal with aggy patients and not provide personal care. There is nothing wrong with managing the expectations of patients and their families nor is there any shame in providing personal care, but we need to let nurses nurse and doctors doctor, and support them with an army of well looked after and well remunerated but ultimately cheaper staff who can perform auxiliary functions to let specialists do what we've paid a ton of money to train them to do. We've got doctors who have trained for years running round the hospital waiting  for computers to boot up and performing tasks they're overskilled for that our European counterparts laugh at us for doing - they're not beneath us but it is a waste of a resource, would you hammer a nail in with a $2.5m Da Vinci robot? Then why would you spend £250k training a doctor then pay them a salary to take bloods when a medical student will do it for experience and we could have happy and well supported 18-24 year olds doing it as an alternative to working in Costa? There's enormous amount of funding going into the blurring of roles in healthcare and the downsides are starting to manifest themselves. Do the people want the NHS to function as a sort of employment charity in which people have to be promoted upwards? Is society ready to deal with the aftermath of any reduction in the scale of the NHS and the mass unemployment that would follow?

We need to recognise that the NHS cannot fix all of society's problems. It can't change that culturally, many/most families don't want to care for their own relatives or don't want to be cared for by their own families anymore, for all sorts of reasons, and it can't fix that the population is ageing and more people will need care. It can't fix the education system and truancy. It can't fix crime, we can't fix homelessness, it can't fix domestic abuse (we can be part of the response but the NHS is not the fix). It cannot end the culture wars surrounding transgenderism and sexuality. It's a healthcare provider and it needs to be allowed to manage healthcare.

 

We need to have a national debate to define the NHS' scope. The government should tell us how much things cost and how much money there realistically is, **** all these different nebulous pots of money that no-one understands. That's a really, really difficult conversation, which is why no government wants to face up to it. I think most people would agree that pregnancy and obstetric care, paediatric care and emergency care and intensive care should be free, and the most things should be at least subsidised. But everything? Should people pay a small contribution towards their chronic disease management - high blood pressure, diabetes and such? Should we make a distinction between different intensities of mental illness - do we treat neuropsychiatric conditions like schizophrenia the same as we treat people with anxiety and depression but who function well? Do people agree with funding fertility treatment and providing obstretic care to people who want and can afford to have large families? What about management of non-life threatening conditions such as that provided by audiology and opthalmology? Do we want to deal with the societal costs of abandoning these areas? I'm not offering my opinion on any of these here - my personal view is there is more than enough bloody money and wealth in the world to provide comprehensive free healthcare to every person on the planet - but not everyone shares my view.

 

We need to use the services we have far more effectively. Most services see far too many people or far too few to be really viable. Far too many people are being managed in the wrong setting. We need better alternatives to hospital admission.  General practice needs to be rejigged to be allowed to focus on urgent conditions that can be managed in the community and chronic disease management that they have specific training for and can manage in an appropriate time frame.  Specialist conditions, including frailty, need better input from secondary care (this is slowly starting to happen).  We need to invest in proper equipment. I'm paid at nodal point 4, my salary is  a matter of public record, I reckon I spend 10-20% of my day waiting for lifts, or computers, or broken electronic door locks, or for someone to answer a page or a phone, looking for equipment like the right kind of needle, trying to find patients in an overflowing A&E. It's pathetic, it's embarrassing and it's a waste of everyone's time and money.

 

We need to fix social care. Salaries in this country are far too low for there to be a viable alternative to socialised care unless we start properly tackling wealth inequality so we need to just get on and find the way to fund it properly.

 

I'm a doctor and I'd describe myself as a socialist, and even I don't think we need to spend another 80 years pouring money into a black hole. We need to work smart, not harder. We need appropriate capital investment, we need to recognise what it is our trained specialists do and respect and retain them, we need to find new ways of providing care that are actually successful and aren't just cheaper or more politically palatable.

That's a tiny part of how I feel. I honestly don't think it's that difficult to fix, there's just too many stakeholders and too many people trying to abuse the NHS for their own ends.

Edited 6 November 2024 by Bryn

[Raj]

Always heard the rumours that the procurement  process is so bad that a 20p pen could end up costing over a quid and a usb charger plug over £25 by the time an nhs trust has ordered something?

 

Not sure it's that bad? If it is then its fecked!

 

[Trav Le Bleu]

1 hour ago, Bryn said:

 

We actually don't have enough managers. And specifically, we don't have enough GOOD managers. We have thousands of people overpromoted into management roles, or clinicians who have percuniary or other malign interests in management, or clinicians who don't want to manage but are forced to.

 

I actually don't think we need a huge amount more doctors either. We do need some, if you compare our numbers to similar countries with better healthcare, but probably not as many as people fear. We definitely do need more nurses, and we need to far better incentivise, retain and train the ones we have. They should nurse - not deal with aggy patients and not provide personal care. There is nothing wrong with managing the expectations of patients and their families nor is there any shame in providing personal care, but we need to let nurses nurse and doctors doctor, and support them with an army of well looked after and well remunerated but ultimately cheaper staff who can perform auxiliary functions to let specialists do what we've paid a ton of money to train them to do. We've got doctors who have trained for years running round the hospital waiting  for computers to boot up and performing tasks they're overskilled for that our European counterparts laugh at us for doing - they're not beneath us but it is a waste of a resource, would you hammer a nail in with a $2.5m Da Vinci robot? Then why would you spend £250k training a doctor then pay them a salary to take bloods when a medical student will do it for experience and we could have happy and well supported 18-24 year olds doing it as an alternative to working in Costa? There's enormous amount of funding going into the blurring of roles in healthcare and the downsides are starting to manifest themselves. Do the people want the NHS to function as a sort of employment charity in which people have to be promoted upwards? Is society ready to deal with the aftermath of any reduction in the scale of the NHS and the mass unemployment that would follow?

We need to recognise that the NHS cannot fix all of society's problems. It can't change that culturally, many/most families don't want to care for their own relatives or don't want to be cared for by their own families anymore, for all sorts of reasons, and it can't fix that the population is ageing and more people will need care. It can't fix the education system and truancy. It can't fix crime, we can't fix homelessness, it can't fix domestic abuse (we can be part of the response but the NHS is not the fix). It cannot end the culture wars surrounding transgenderism and sexuality. It's a healthcare provider and it needs to be allowed to manage healthcare.

 

We need to have a national debate to define the NHS' scope. The government should tell us how much things cost and how much money there realistically is, **** all these different nebulous pots of money that no-one understands. That's a really, really difficult conversation, which is why no government wants to face up to it. I think most people would agree that pregnancy and obstetric care, paediatric care and emergency care and intensive care should be free, and the most things should be at least subsidised. But everything? Should people pay a small contribution towards their chronic disease management - high blood pressure, diabetes and such? Should we make a distinction between different intensities of mental illness - do we treat neuropsychiatric conditions like schizophrenia the same as we treat people with anxiety and depression but who function well? Do people agree with funding fertility treatment and providing obstretic care to people who want and can afford to have large families? What about management of non-life threatening conditions such as that provided by audiology and opthalmology? Do we want to deal with the societal costs of abandoning these areas? I'm not offering my opinion on any of these here - my personal view is there is more than enough bloody money and wealth in the world to provide comprehensive free healthcare to every person on the planet - but not everyone shares my view.

 

We need to use the services we have far more effectively. Most services see far too many people or far too few to be really viable. Far too many people are being managed in the wrong setting. We need better alternatives to hospital admission.  General practice needs to be rejigged to be allowed to focus on urgent conditions that can be managed in the community and chronic disease management that they have specific training for and can manage in an appropriate time frame.  Specialist conditions, including frailty, need better input from secondary care (this is slowly starting to happen).  We need to invest in proper equipment. I'm paid at nodal point 4, my salary is  a matter of public record, I reckon I spend 10-20% of my day waiting for lifts, or computers, or broken electronic door locks, or for someone to answer a page or a phone, looking for equipment like the right kind of needle, trying to find patients in an overflowing A&E. It's pathetic, it's embarrassing and it's a waste of everyone's time and money.

 

We need to fix social care. Salaries in this country are far too low for there to be a viable alternative to socialised care unless we start properly tackling wealth inequality so we need to just get on and find the way to fund it properly.

 

I'm a doctor and I'd describe myself as a socialist, and even I don't think we need to spend another 80 years pouring money into a black hole. We need to work smart, not harder. We need appropriate capital investment, we need to recognise what it is our trained specialists do and respect and retain them, we need to find new ways of providing care that are actually successful and aren't just cheaper or more politically palatable.

That's a tiny part of how I feel. I honestly don't think it's that difficult to fix, there's just too many stakeholders and too many people trying to abuse the NHS for their own ends.

Sounds similar to my job.

 

It would benefit hugely from taking the time to step back, pause to realign, and work smarter.

 

But it's much easier to get everyone to work harder. Just throw more meat under the grindstone.

 

The first is more efficient in the long-term and if stuck to, sustainable; but the second gets results now... until the system breaks completely under stress.

 

Most of it is a laziness of management to spend their own time doing option 1 when other people can be doing option 2.