The NHS Thread - Part Two

[Sol thewall Bamba]

Over eating being demonised like non-compliance with Covid regulations was. 

[pleatout]

12 hours ago, Raj said:

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!

 

It's complicated.....

 

I suspect that the pen example comes from someone somewhere doing an audit.  By the time a member of staff on a ward has requested a box of pens (quick google, box of 50 for about £5 inc delivery) and they've followed it through the system, totted up the time it takes to request them, order them, accept delivery at site, then deliver to the ward could well use up enough time to cost significantly more than 10p a pen.  But it does ignore the fact that receptionists, procurement staff, porters etc are there anyway and taking receipt of a parcel or delivering it to a ward really didnt cost anything.  All large organisations will have similar hidden costs.

 

USB chargers and similar - you can buy a cheap ebay "flame thrower" or a reputable brand and have it tested - again I dont recognise £25 but nor are they £2 - the costs incurred when a hospital burns down are significant.

 

It's value for money versus cheap.

 

[Raj]

40 minutes ago, pleatout said:

It's complicated.....

 

I suspect that the pen example comes from someone somewhere doing an audit.  By the time a member of staff on a ward has requested a box of pens (quick google, box of 50 for about £5 inc delivery) and they've followed it through the system, totted up the time it takes to request them, order them, accept delivery at site, then deliver to the ward could well use up enough time to cost significantly more than 10p a pen.  But it does ignore the fact that receptionists, procurement staff, porters etc are there anyway and taking receipt of a parcel or delivering it to a ward really didnt cost anything.  All large organisations will have similar hidden costs.

 

USB chargers and similar - you can buy a cheap ebay "flame thrower" or a reputable brand and have it tested - again I dont recognise £25 but nor are they £2 - the costs incurred when a hospital burns down are significant.

 

It's value for money versus cheap.

 

Surely a centralised system for such a big association like the NHS would be more cost effective where they buy things like this in bulk and filter down to the individual sites?

Surprised they don't manufacture alot of equipment themselves as a cost effective measure.

 

[pleatout]

2 minutes ago, Raj said:

Surely a centralised system for such a big association like the NHS would be more cost effective where they buy things like this in bulk and filter down to the individual sites?

Surprised they don't manufacture alot of equipment themselves as a cost effective measure.

 

Yep we do.  The discounts are massive.  The cost of paracetamol in the NHS is hilarious about a penny a lorryload. My point was, if you audit every point along the supply chain from request, to order, to purchase, to delivery to site, to delivery to user the cost can to calculated to be quite significant.  But that is true of any organisation.

 

NHS procurement between following competition law, government policy, best practice and value for money is tight enough to squeak.

 

As for manufacturing, its cheaper to buy. 

[Bryn]

1 hour ago, Sol thewall Bamba said:

Over eating being demonised like non-compliance with Covid regulations was. 

There’s no evidence for this, this is just punitive. There are evidence-based treatments for obesity and a dire need for a more sophisticated approach to it. I do agree that there is a general need for people to take more responsibility for themselves - but have a look at yourself in the mirror here. Are you doing your load-bearing exercises to prevent osteoporosis? Are you going to bed early every night to mitigate your risk of cardiovascular disease? Are you managing your stress levels to keep your cortisol levels down and reduce your chances of hypertension and diabetes? Are you eating your three portions of oily fish a week and minimising your alcohol intake to prevent stroke disease? 
 

If you are - fair, but you’re rare. Every single person on the planet can take a shade more responsibility for their own health and demonising one particular group is demonstrably counter-productive.

[Sol thewall Bamba]

19 minutes ago, Bryn said:

There’s no evidence for this, this is just punitive. There are evidence-based treatments for obesity and a dire need for a more sophisticated approach to it. I do agree that there is a general need for people to take more responsibility for themselves - but have a look at yourself in the mirror here. Are you doing your load-bearing exercises to prevent osteoporosis? Are you going to bed early every night to mitigate your risk of cardiovascular disease? Are you managing your stress levels to keep your cortisol levels down and reduce your chances of hypertension and diabetes? Are you eating your three portions of oily fish a week and minimising your alcohol intake to prevent stroke disease? 
 

If you are - fair, but you’re rare. Every single person on the planet can take a shade more responsibility for their own health and demonising one particular group is demonstrably counter-productive.

If you could wave a magic wand overnight and change one thing about the population to ease the stress on the NHS, it would be making everyone a healthier weight. It's not nice to say but it's true. 

[Bryn]

It’s neither nice nor not nice to say, it’s just irrelevant.

[Sol thewall Bamba]

14 minutes ago, Bryn said:

It’s neither nice nor not nice to say, it’s just irrelevant.

It clearly isn't.

 

The third post in the thread said there were "too many old people" but you had no problem with that one! 

[Bryn]

8 minutes ago, Sol thewall Bamba said:

It clearly isn't.

 

The third post in the thread said there were "too many old people" but you had no problem with that one! 

Didn’t see that.

 

I specialise in Older People’s Medicine so can assure you I have nothing but love for providing healthcare to the elderly. However - the amount and type of resources allocated to them and the settings in which they are cared for is a valid discussion. The evidence of harm from just repeatedly throwing them at the NHS without due consideration of their circumstances is strong and getting stronger. That’s not to say we should stop caring for them - but you can definitely provide them with lower intensity care in the right setting at a lower cost with a better outcome.

[Wymsey]

What about fining those who miss their appointments?

[Raj]

1 hour ago, Wymsey said:

What about fining those who miss their appointments?

tenner each missed appointment- do it X number of times it goes upto £20.

Refuse to pay- refuse to see a Dr when you ask for one.

 

simples!!!

 

 

[Greg2607]

I actually do think that what Wes Streeting has been talking about is a really valid point.   We need to invest more into the community Care setting rather than relying on Hospitals and A&E taking the weight of a failing Primary Care setting. 

 

If we get access to primary care right and push more care out into communities (Mental Health as an example) then it would remove the burden on hospitals and also help to stop people arriving there in the first place with much better outcomes. 

 

it's a bit of a revolution and heavy reform that seems to be needed. Rather than tinkering around the edges with some process improvement. 

 

IF they get it right, it will transform most people's experience of healthcare in the UK. 

[young pug]

On 06/11/2024 at 20:37, Lionator said:

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. 

Is the induction mandatory for new NHS staff?
I’m currently in the application process for a role that I’ve had a conditional offer for. Five weeks after getting that I’m still waiting for a non conditional offer. They’ve had everything from me regarding references and background checks.

Is it normal for it to take this long?

 

[Lionator]

1 hour ago, young pug said:

Is the induction mandatory for new NHS staff?
I’m currently in the application process for a role that I’ve had a conditional offer for. Five weeks after getting that I’m still waiting for a non conditional offer. They’ve had everything from me regarding references and background checks.

Is it normal for it to take this long?

 

I think an Induction will be mandatory but it’ll vary by trust as to how it’s done. And yes, it’s utterly atrocious and I’ve experienced that delay across three trusts now. I’d give them a call and see where you’re at because it could be as simple as they’ve not ticked a box and that’s why it’s being held up. 

Edited 7 November 2024 by Lionator

[Jon the Hat]

I think we could legitimately rename this thread "Bryn educates everyone on the issue facing the NHS in a mature and thoughtful manner".  Well played sir.  We have all been guilty at some point of assuming there is some magic bullet, or one big issue that no none has dealt with properly.  Apart from the blanket "not enough money going in to provide the never-ending expansion of services we seem to expect" there clearly isn't.

[FOXYTALK]

They could do with some comfier seats in A&E. 5 hours on a plastic seat and I'm need an appointment myself. 

[FOXYTALK]

Currently worm with an ex NHS staff member. They mentioned they spent ££££'s on incompatible IT equipment just to spend their remaining budget. 

 

[Monk]

39 minutes ago, FOXYTALK said:

They could do with some comfier seats in A&E. 5 hours on a plastic seat and I'm need an appointment myself. 

Yet you pay money to sit on the same seat at the King power. 
 

a&e possibly the dirtiest place in a hospital, you need it to be easy clean. Make it too comfortable and you’ll have all kinds of people coming in to be more comfy than the streets. 

[Monk]

Just spent 6 months going through cancer treatment and got the all clear this week. 
 

Can barely fault the NhS from start to finish. Had tonnes of rather expensive treatment. The only thing was there was an easier route but it was reserved for edge cases due to cost. Still, got through it with amazing care from many many health professionals along the way. 

[FoxyPV]

Proper funding (not the pittance the Tories provided)

 

But more importantly, proper social care which helps avoid admissions and helps hospital throughput.

 

It also requires a societal perspective change that prevention is better than cure 

[Grebfromgrebland]

13 hours ago, Monk said:

Just spent 6 months going through cancer treatment and got the all clear this week. 
 

Can barely fault the NhS from start to finish. Had tonnes of rather expensive treatment. The only thing was there was an easier route but it was reserved for edge cases due to cost. Still, got through it with amazing care from many many health professionals along the way. 

Glad to hear you're on the mend. 

 

Once the NHS spots your life threatening condition they're great. 

 

The real issue is that these things aren't getting spotted at all or being discovered too late. 

Edited 9 November 2024 by Grebfromgrebland

[pleatout]

On 08/11/2024 at 20:44, FOXYTALK said:

Currently worm with an ex NHS staff member. They mentioned they spent ££££'s on incompatible IT equipment just to spend their remaining budget. 

 

I love these stories.  Not true though.  What kit have they "bought" that's "incompatible"  with Windows 10/11, Edge/Chrome and MS Office 365?

 

NHS is 70% Dell and 90+% Microsoft and about 50/50 Apple/Android for phones.  

 

 

You'd have go along way to buy something that is incompatible.

[Wymsey]

 

 

[dsr-burnley]

They need to have a way of getting rid of the incompetents.

 

I have the good fortune to live on the Lancashire/Yorkshire border, so I have the choice between East Lancashire Trust and Airedale Trust.  

 

13 years ago, I had a gall bladder operation, and because I had a choice, I chose Airedale.  As would most people in this area.  And as I had an operation coming, I did some research.  Blackburn had cancelled 5,000 operations in the previous 5 years, for all sorts of reasons including not enough theatres ready, surgeon but no anaesthetist, anaesthetist but no surgeon, both surgeon and anaesthetist but no nurse, lights not working in the theatre, etc etc etc etc etc.  Airedale, meanwhile, had cancelled 15.  

 

13 years later, it's still the same.  East Lancashire Trust is run as incompetently as it ever was, Airedale is still run well.

 

An example of someone who needs sacking.  A friend of mine had a heart attack.  He knew what it was, so did his wife, so they rang 999 and were told the ambulance would be half an hour.  Now, if the ambulance had arrived in half an hour, that would have been poor and worthy of investigation.  But it didn't, because when half an hour was up they were told it would be a further 2 hours.  (So they dashed off to hospital by car, Airedale of course!, and he survived.)  Now, if the ambulance service had rung up after half an hour and said there was a delay and make your own way to hospital, that would have been abysmal service and action needed urgenly to improve it.  But they didn't even do that.

 

What Lancashire ambulance do is, when you first ring up, tell you not to ring back to see where the ambulance is, because you risk getting your first call cancelled and put to the back of the queue.  And on this occasion, when the ambulance didn't turn up, my friend's wife did ring back to be told that the ambulance wasn't coming - but the ambulance service weren't going to tell her unless she rang.  They were going to let him wait for at least two more hours until he died or got better.  They told him an ambulance was coming when it was not.  For that, someone should have been sacked.  If someone wasn't following procedures, obviously them; if procedures were followed, then whoever set the procedures should have been out on their ear.

 

How many people are in responsible roles but can't do them?

[Parafox]

On 07/11/2024 at 12:13, Bryn said:

Didn’t see that.

 

I specialise in Older People’s Medicine so can assure you I have nothing but love for providing healthcare to the elderly. However - the amount and type of resources allocated to them and the settings in which they are cared for is a valid discussion. The evidence of harm from just repeatedly throwing them at the NHS without due consideration of their circumstances is strong and getting stronger. That’s not to say we should stop caring for them - but you can definitely provide them with lower intensity care in the right setting at a lower cost with a better outcome.

 

A bit late in my response, but as a fairly low level professional in the NHS, I entirely agree, even from a point of view from the frontline, out on the streets. It seems obvious to all of us involved in patient care that the elderly are treated very badly by the NHS in much the same way that MH is.

 

It seems to be considered by Gov as a necessary burden but a burden nonetheless which soaks up money.

 

As you say, with the correct and dedicated focus on how these sectors are important and directing treatment correctly, so much could be improved, financially and compassionately.

 

Sadly, the NHS is becoming a victim of it's own success. As was mentioned, we are able to keep people alive for longer, even beyond what would have been a natural death 50 years ago, which clearly adds to both expectations and cost.

 

It's probably right that we can do that, but surely there has to be a point where it becomes unsustainable for the money available?