Debate 3 - The NHS

[davieG]

Everything in life could be done better but for it's sheer size and continual political interference is it actually any worse than a private company would manage and doing a good job?

Without nit picking what could be done better?

[Jimothy]

Not saying I know all the inner workings of the NHS, but I guess a lot of people, me ibeing one, will say there needs to be less pen pushers upstairs earning huge salaries and more front line staff. Less people employed to ensure others meet targets.

And thats the other thing targets. I don't want to know I'm going in hospital and the hospital has failed in some way if I'm not out in a certain time. Treatment shouldn't be about time it should be about getting it right. I want people to go in to hospital and leave when they are better not when the clock says so. I can understand time targets in A+E with regard to how long it is before you get seen, nobody wants to sit around for 6 hours, but if they got rid of a few people in the first point I mentioned then they would have more money to employ nurses etc to ensure you would get seen in suitable time.

Pitty I'm at work I could rant for houses about the NHS.

[Dr The Singh]

Everything in life could be done better but for it's sheer size and continual political interference is it actually any worse than a private company would manage and doing a good job?

Without nit picking what could be done better?

Having a few family members work for the NHS, it's quite obvious it's been mismanaged!

There's too many middle management and supervisors, tey should be streamlined. Accountability is an issue, far too many things go wrong or are inefficient and no-one seems to be acountable.

Inefficient use of technology and wastage on IT projects that just will not work!!

Right people for the right job in the administrative roles of the NHS, there are far too many people that aren't skilled or qualified to do certain role. The system of recruiting has been abused for many years alot of the staff recruited in some high positions are frineds\families of those in charge. My Mrs has had 3 roles within the NHS, and 2 of the interviews were just a 'formality'!!

I could kee p in typing but my tea is getting cold...................

[Guest Basildon Fox]

Perhaps the abolition of the NHS may be a way forward with Health insurance run by non-profit making companies taking over. This would see smokers paying higher premiums than those who do not etc and could be linked in with NI. Very simplistic in it's form I know but as I have only just thought of it I do not have all the answers!!

[breadandcheese]

I have no idea about how to make the health service better, as I've never worked within it. However, the stat that gets me is that the NHS is the third largest employer in the world after the Indian railways and the Chinese army. There must be some job cuts that are possible without impacting on service.

[Guest]

Perhaps the abolition of the NHS may be a way forward with Health insurance run by non-profit making companies taking over. This would see smokers paying higher premiums than those who do not etc and could be linked in with NI. Very simplistic in it's form I know but as I have only just thought of it I do not have all the answers!!

I can't imagine living in a society where healthcare is only available to those who are insured. Weren't there figures recently during the US politicising of the NHS to show that their system was much more expensive per head and radically less effective? If I wasn't being so lazy I'd dig them out.

Obviously the points that other have made in this thread regarding more efficient use of resources within the NHS are the bottom line for me, I want more people actually trained and paid to take care of people, rather than assess whether targets have been met.

In this country though I suppose people still have the option of private healthcare in addition to the state healthcare if they can afford it.

[Bellend Sebastian]

My Missus reckons it's effectively being privatised via the back door.

A lot is made of there apparently being too many managers, but from what I hear where she works they are desperately short of any management nous whatsoever. Maybe they have managers and they're just shit - good ones don't come cheap, unfortunately

[Flynny]

My Missus reckons it's effectively being privatised via the back door.

Sexy.

[Head Honcho]

Not saying I know all the inner workings of the NHS, but I guess a lot of people, me ibeing one, will say there needs to be less pen pushers upstairs earning huge salaries and more front line staff. Less people employed to ensure others meet targets.

And thats the other thing targets. I don't want to know I'm going in hospital and the hospital has failed in some way if I'm not out in a certain time. Treatment shouldn't be about time it should be about getting it right. I want people to go in to hospital and leave when they are better not when the clock says so. I can understand time targets in A+E with regard to how long it is before you get seen, nobody wants to sit around for 6 hours, but if they got rid of a few people in the first point I mentioned then they would have more money to employ nurses etc to ensure you would get seen in suitable time.

Pitty I'm at work I could rant for houses about the NHS.

Relatively speaking It's probable that the private sector has just as many penpushers as the NHS so whats your point?

Explain to me why you think targets are bad?

Here's a target for you!

If a GP suspects someone may have cancer then the NHS must get them to a specialist within 2 weeks!

Yes targets are high and sometimes unachievable but under the Tories you'd definitely silll be waiting at Xmas and if you were still alive at Easter maybe just maybe you'd have been seen by a specialist.

How is this a bad thing?

The NHS isn't perfect but it's far from broken!

[Bellend Sebastian]

Sexy.

It's difficult to get anything done with that sort of thing going on, let me tell you

[breadandcheese]

The NHS isn't perfect but it's far from broken!

It's definitely not broken, but the question is are we getting value for money? Whatever your political views are, as a country, we're going to have to either raise taxes or reduce public spending. I would rather we reduce public spending as I already think we're taxed rather highly. So for me, the question is, with all these extra billions having been spent on the health service, are we getting the value for all the increased spending?

[Jimothy]

Oh I think you misunderstand me when I mention targets. Targets for people with cancer etc to see a specialist is a good thing. (Although when my Mum found a lump on her breast one May she didn't get a scan until my Birthday (29th Dec) because the c*** of a doctor "didn't get round to sorting it". Luckily it was nothing) Targets to have an operation for a new hip etc in a certain time is fine.

I'm on about hospitals more than anything. Last year my Grandpa passed away. Had he come out of hospital he would have need to go into a residential home. Whilst in hospital he contracted hospital pneumonia, which is a lot nastier than normal pnemonia. Whilst he lay there pretty much looking like he was at deaths door the consultant asked us if we had a home ready for him to go to! How about sorting him out first, making sure he get through the bloody illness your paid to treat! The day they wanted him out he passed away, (so they got their wish) I'm not knocking the care they could have done nothing for him, but the fact remains how can targets like that be for the good of the patient? Before they even know how long it will take to make someone well again they are looking at shipping them out.

Oh and I know it would be worse with the Tories. It was last time, and it will be again god forbid they get in.

[lou]

Too many adminstrators/managers not enough nursing staff. Bring back the old style ward Matrons!

[Head Honcho]

Oh I think you misunderstand me when I mention targets. Targets for people with cancer etc to see a specialist is a good thing. (Although when my Mum found a lump on her breast one May she didn't get a scan until my Birthday (29th Dec) because the c*** of a doctor "didn't get round to sorting it". Luckily it was nothing) Targets to have an operation for a new hip etc in a certain time is fine.

I'm on about hospitals more than anything. Last year my Grandpa passed away. Had he come out of hospital he would have need to go into a residential home. Whilst in hospital he contracted hospital pneumonia, which is a lot nastier than normal pnemonia. Whilst he lay there pretty much looking like he was at deaths door the consultant asked us if we had a home ready for him to go to! How about sorting him out first, making sure he get through the bloody illness your paid to treat! The day they wanted him out he passed away, (so they got their wish) I'm not knocking the care they could have done nothing for him, but the fact remains how can targets like that be for the good of the patient? Before they even know how long it will take to make someone well again they are looking at shipping them out.

Oh and I know it would be worse with the Tories. It was last time, and it will be again god forbid they get in.

There are good and bad targets there is no doubt about that but you can't go cherry picking your targets.

Targets hit the headlines because of the way some hospitals use their budget to hit them. This is mismanagement and has nothing to do with the targets they are set, as the vast majority of hospitals are successful in if not hitting their target then by getting pretty damn close.

[Jon the Hat]

The NHS has so many entrenched problems it is hard to know where to start, so I will pick on some key areas.

Management: The NHS has many non-clinical managers who cannot fully understand the clinical side, and many clinical managers who do not understand the non clinical side. Failing to select people to manage on their ability to do so rather than on clinical excellence is a failure in career development. There is also a culture of promoting the longer serving rather than the best, and a vast number of the senior nurses for example trained completely differently to those who qaulified in the last 10 years. This leads to a failure to really adopt the lastest methods, and leaves the NHS decades behind US and Australian thinking.

Funding: Private healthcare is not going to go away. The more people who self fund, the more cash there is left to look after the rest, so incentivise employers to offer health insurance with tax breaks. There is and always will be a two tier system, and denying it will not make it go away. Neither will trying to drag everyone down to the NHS level. Deal with it and save some money in the process. This increase in private funding would result in additional private provision, which reduces pressure on the NHS. It will also require additional staff, which would need to be planned for.

Efficiency We now have insane levels of overhead. Trust level, PCT level, Health Authorities, there are so many providers it is madness. Also there are even more groups assesing the providers than there are types of provider. Full accountability in the Dept of Health is required. The rest can be done away with. Give them a % of total spend to work with. Anything not affordable in that doesn't get done.

Otusourcing No. No. No. It is not cheaper if they do not clean the hospital properly. Stop it now.

Bored. Out.

[Zingari]

Too many adminstrators/managers not enough nursing staff. Bring back the old style ward Matrons!

how come , I still think of Kenneth Williams and Hattie Jacques whenever I come across the word "Matron"

[lou]

how come , I still think of Kenneth Williams and Hattie Jacques whenever I come across the word "Matron"

ditto

We would never have had all the problems with MRSA etc if we had the old Matrons..... cleaning would be far far better!

[Guest Basildon Fox]

how come , I still think of Kenneth Williams and Hattie Jacques whenever I come across the word "Matron"

Exactly the picture that came into my mind. "OOOHHH Matron."

[stez]

The NHS has so many entrenched problems it is hard to know where to start, so I will pick on some key areas.

Management: The NHS has many non-clinical managers who cannot fully understand the clinical side, and many clinical managers who do not understand the non clinical side. Failing to select people to manage on their ability to do so rather than on clinical excellence is a failure in career development. There is also a culture of promoting the longer serving rather than the best, and a vast number of the senior nurses for example trained completely differently to those who qaulified in the last 10 years. This leads to a failure to really adopt the lastest methods, and leaves the NHS decades behind US and Australian thinking.

i suggest a job swap, i'm sure people wouldn't mind having their appendix taken out by keith from accounts

[Tommy G]

Difficult one.

To be fair if it was that straightforward it would already be run successfully. It's just such a mess i think it's more about damage limitations right now than trying to turn it around even more.

throwing money at it has proved that it doesn't work. Waiting lists have been cut considerably since labour came into power, yet basics such as cleaning and understaffed wards are still a big problem.

If you don't like it and CAN afford to I suggest BUPA or some other form of PHC.

[Jon the Hat]

i suggest a job swap, i'm sure people wouldn't mind having their appendix taken out by keith from accounts

haha. I was thinking more along the lines of gradually getting rid of the operational managers who don't have a clinical background, and replacing them with ones who do, by carefully identifying those with potential to be good at it.

[lavrentis]

Just thought I'd add that I have nothing but praise for the NHS. They saved my young nephews life when he got Meningitis from the instance when my Doctor saw him all floppy, apparently dying he instantly called for a Paramedic, just because he knew but didn't tell my sister which then arrived quickly. He was hours from dying apparently and when at the hospital managed to get him into a stable state all wired up to machines. After 3 weeks I think in there, he was right as rain with no effects from the Meningitis which a very small percentage of people who had this type of Meningitis actually get away with no effects to his hearing and his vision. He still goes for checkups on his vision and hearing but the NHS were brilliant on this occasion.

[lou]

Just thought I'd add that I have nothing but praise for the NHS. They saved my young nephews life when he got Meningitis from the instance when my Doctor saw him all floppy, apparently dying he instantly called for a Paramedic, just because he knew but didn't tell my sister which then arrived quickly. He was hours from dying apparently and when at the hospital managed to get him into a stable state all wired up to machines. After 3 weeks I think in there, he was right as rain with no effects from the Meningitis which a very small percentage of people who had this type of Meningitis actually get away with no effects to his hearing and his vision. He still goes for checkups on his vision and hearing but the NHS were brilliant on this occasion.

Most of the time they do an incredible job and Ive nothing against the brilliant staff who work so bloody hard. Its the politics higher up that spoils things

[Jon the Hat]

Most of the time they do an incredible job and Ive nothing against the brilliant staff who work so bloody hard. Its the politics higher up that spoils things

And the fact that when you get away from the exciting bits like ITU the brilliant staff ratio declines noticeably. Where incompetence is clearly visible, the NHS is exceptional. That same light needs to be shone everywhere else - and constantly - to avoid things getting fixed and then deterioriating as focus moves elsewhere. This means real, reactive measurement, and that must be local not national to be effective.

[stez]

haha. I was thinking more along the lines of gradually getting rid of the operational managers who don't have a clinical background, and replacing them with ones who do, by carefully identifying those with potential to be good at it.

hopefully you don't mean turning doctors into manager? i'd prefer doctors to stay as doctors, and maybe introduce some sort of medical management course, or degree, or whatever. to provide the necessary medical management knowledge