[News] Is the NHS Fit For Purpose

[happypig]

By definition they could afford the payments from a small amount of savings, some equity from moving from UK to France and a state pension. My dad passed away recently but they lived frugally intentionally. He had a stroke last year and was in hospital for three weeks. No bill during or after.

Beyond that I don't know, but I have worked with a couple of health insurers in The Netherlands and know their policy rules and have direct experience of the French heath system being much better than the NHS with my dad (private room, no wait in A&E on a trolley).

How much do you pay for dentistry and opticians here, given your humble lifestyle?

Dentist, yes, I’ll give you that, we probably pay a couple of 00 for checks/hygeinist; fortunately we’ve only needed a couple of fillings. Opticians, being over 60 I get free eye tests (and being at risk of glaucoma I get checked at the hospital too) and I get glasses from online retailers for a fraction of the cost of Specsavers etc.

 

[Baldseagull]

It isn't working as it should, but binning it is not the answer.
I think many of the problems stem from Blair era policies.
Hospitals built with PFI deals that are expensive and usary, and target setting leading to schemes that give the appearance of targets being achieved, but ultimately just eat money and delay things further, come to mind.

 

[Bold Seagull]

The most painful part about healthcare is the cost. We have a growing population, driven part by people living longer. The current government can talk about 'record levels of spending' because yes, go figure, we have many more people needing healthcare. There needs to be record levels of spending just to keep afloat, let alone improve the service.

Private involvement enriches the private sector (or the public sector of other countries, but that is another thread...), and we've seen it in utilities, in rail etc.

Our model of NI is actually still the envy of much of the world. A universal system of healthcare for all, paid for by all. Yes it is a huge behemoth of an entity, but it is something worth fighting for, because there is no turning back once it's gone.

 

[dazzer6666]

My office is on a research floor in a big London teaching hospital. My experience over the last 35 years exemplifies the problems and explains why I fear the problems can't easily be fixed. I will explain. Go to the last paragraph if TLTR

When I started in my job (as a postdoctoral fellow on 86, then an HEFC-funded university lecturer in 89) we had a simple culture. Our research floor had one administrative boss. Got a problem with the lifts or a leaking roof? We went to him, verbally explain the problem, and in a few days it was fixed. The hospital employed cleaners who would clean everything properly. Heating, lighting, phones, photocopying, plumbing, were all paid for centrally out of a hospital budget. We ordered all our research materials by fax and managed our research funds ourselves. A local fund manager would hold our income in a bank accounts, with all paperwork held locally. My boss negotiated directly with animal suppliers and had arranged a really great deal. There are lots of other things but these will do to illustrate change:

One of the first things I noticed when our floor manager was retired and replaced by multiple separate central services was the lifts went haywire. Someone had redesignated one of the three lifts as 'patient beds only'. Apparently a member of public had complained there was a sick person in their lift as they traveled to an appointment. This was not discussed with users. We have 3 floors of patient services and one research floor. As a result the other two lifts were permanently crowded. Every member of the public would call the up and down button, so from the ground floor six people would get in the lift which was on its way to where it had been called in the basement. In the basement there would be 8 people waiting for a lift and only one would be able to fit in because it was full of people who had travelled down from the ground floor to the basement when the wanted to travel up. And so on. It could take ten minutes to do a 4 floor journey. Meanwhile the patient bed lift stood empty, used maybe once can hour. Because nobody knew who managed this, and when we found out they did not answer the phone, and when we eventually got a response they told us a committee had made the decision....it took nearly 2 years to get our accesses to the third lift back. This is one long example of the shit that was happening due to management restructuring without any thought about the consequences.

Leaking roof. Used to be fixed in days. Now it takes years and eventually it resulted in lots of staff losing access to their space for months during a final fix. That took nearly 20 years to effect.

Cleaners? Privatized. Only 20% of what used to be cleaned is cleaned. Clinical waste left stinking in rooms. And so on.

Purchasing. We now use an online system which is incredibly complicated. We have to code every item for management purposes. The hospital and/or university sets a cost that it charges 'buyers' such as myself. So if I want to buy sutures I have to go through the system. 'Purchasing' will offer me sutures as a cost set by 'purchasing'. That cost is not the same as that required by the seller. The hospital/university charges buyers (me) a massive overhead. Hundreds of staff are employed to run this. Hundreds more monitor it, adjust it. update the ordering software, go to management meetings, prepare Gant charts etc.

An ordering example: animal orders. The great deal my boss had negotiated was actively blocked when the hospital/university decided to take control. The cost charged to us users doubled. Nobody could explain the logic of this. We complained but we got nowhere. We pointed out that the people we raised our research funds from, such as the British Heart Foundation (BHF) were now being ripped off because the hospital/university had thrown away our deal. The hospital/university actually went to the animal supplier and say 'you know you charge these staff £15 a rat, well we want to bin that deal, and you can charge the going rate of £20 a rat'. The college then sold the rat to me adding another £10 a rat as an overhead. A doubling in cost to my funds (BHF and industrial research grants). No discussion, no explanation. Annoyingly the BHF went along with this, partly because it likes to be seen to be spending money on research and this seems to fit with that narrative. Can you see how absolutely f***ing stupid all this is?

Phones? Centralized, with the university/college paying the bills then charging senior staff like me to pay from their 'soft' money with, you guessed it, an overhead. I make a £1 call, the college charges me £2.50. There were of course massive costs setting all this up, mostly paying the salaries of the full time staff that 'manage' it all.

Photocopying ditto. Not that we photocopy anything now. But in the hospital they still do so because not everything is electronic. I had a surgery appointment in my own hospital a few years ago that was cancelled 3 times because (I discovered) they lost the paperwork in the internal post three times. Part of that is related to the massive redundancy in paperwork and management incoherence.

This is already TLWR so I'll stop here. But I could go on and on. Bottom line? The university/hospital has been inventing new systems processes and rubrics for 'efficiency' without having a clue about how to do it, or indeed why. The managers have turned a blind eye to the fact that more process means more people, more people to monitor the people, more people to review the progress of the monitoring, more people to create a strategic plan, more people to archive the plan, write reports, and so on.

It is as if the 11 men on the pitch had 100 other people on the pitch with them, measuring their stride and the average distance of passing etc., and interrupting the game every 15 seconds to review the data, set new targets, employ new staff to monitor the outcome, and create a new management stream to deal with the neglected metric of back passing. It really is like this. In the wider NHS I am sure the pattern is repeated. How can we fix it? No idea, but more money will simply be used to create new management, new processes, more bullshit.

Distressing really. Aligns with everything I see and hear from my trustee role at a special school (that has a huge clinical element) and what I hear from my daughter who is a nurse. Centralisation and ‘outsourcing’ have f*cked up so many services and industries, or at least massively increased costs and reduced efficiency.

Really don’t know what the answer is either. It’s a sacred cow politically but it’s in a ‘too big to fix’ state now - as a project it would be incomparable with anything ever done, cost billions and - given the track record - be almost certainly doomed to huge cost and time over-run and failure - it’d take years simply to set up the parameters of any review and get the people in place to start (as you say, new management and new bullshit), let alone get anything done.

The front line staff are incredible and for the most part (in our experience anyway) if you really need treatment then you’ll get it, and it’ll be very good but the negative aspects seem to be increasing at an alarming rate (along with waiting lists etc). Chucking ever more money into it isn’t the answer, because much of that cash isn’t going where it’s needed.

 

[Diablo]

The NHS and the people who work for the NHS are in the main brilliant. For emergency care it can not be bettered. The problems are the staff shortages due to poor pay and conditions. Accident and Emergency wards are full of people who should be at GP but can`t get appointment. Population increase and many more living into their 80s and 90s which increases patient nos. The only answer is a huge increase in budget.
Prob is where do all the billions needed come from ??

 

[jackanada]

If you're referring to PFI I believe this was introduced by Major - and significantly increased under Blair.

No specific reference to pfi though that is a rather egregious example of profit taking. And obviously pfi didn't stop being used and if anything it's implementation was even worse under subsequent conservative led governments.

 

[BLOCK F]

My office is on a research floor in a big London teaching hospital. My experience over the last 35 years exemplifies the problems and explains why I fear the problems can't easily be fixed. I will explain. Go to the last paragraph if TLTR

When I started in my job (as a postdoctoral fellow on 86, then an HEFC-funded university lecturer in 89) we had a simple culture. Our research floor had one administrative boss. Got a problem with the lifts or a leaking roof? We went to him, verbally explain the problem, and in a few days it was fixed. The hospital employed cleaners who would clean everything properly. Heating, lighting, phones, photocopying, plumbing, were all paid for centrally out of a hospital budget. We ordered all our research materials by fax and managed our research funds ourselves. A local fund manager would hold our income in a bank accounts, with all paperwork held locally. My boss negotiated directly with animal suppliers and had arranged a really great deal. There are lots of other things but these will do to illustrate change:

One of the first things I noticed when our floor manager was retired and replaced by multiple separate central services was the lifts went haywire. Someone had redesignated one of the three lifts as 'patient beds only'. Apparently a member of public had complained there was a sick person in their lift as they traveled to an appointment. This was not discussed with users. We have 3 floors of patient services and one research floor. As a result the other two lifts were permanently crowded. Every member of the public would call the up and down button, so from the ground floor six people would get in the lift which was on its way to where it had been called in the basement. In the basement there would be 8 people waiting for a lift and only one would be able to fit in because it was full of people who had travelled down from the ground floor to the basement when the wanted to travel up. And so on. It could take ten minutes to do a 4 floor journey. Meanwhile the patient bed lift stood empty, used maybe once can hour. Because nobody knew who managed this, and when we found out they did not answer the phone, and when we eventually got a response they told us a committee had made the decision....it took nearly 2 years to get our accesses to the third lift back. This is one long example of the shit that was happening due to management restructuring without any thought about the consequences.

Leaking roof. Used to be fixed in days. Now it takes years and eventually it resulted in lots of staff losing access to their space for months during a final fix. That took nearly 20 years to effect.

Cleaners? Privatized. Only 20% of what used to be cleaned is cleaned. Clinical waste left stinking in rooms. And so on.

Purchasing. We now use an online system which is incredibly complicated. We have to code every item for management purposes. The hospital and/or university sets a cost that it charges 'buyers' such as myself. So if I want to buy sutures I have to go through the system. 'Purchasing' will offer me sutures as a cost set by 'purchasing'. That cost is not the same as that required by the seller. The hospital/university charges buyers (me) a massive overhead. Hundreds of staff are employed to run this. Hundreds more monitor it, adjust it. update the ordering software, go to management meetings, prepare Gant charts etc.

An ordering example: animal orders. The great deal my boss had negotiated was actively blocked when the hospital/university decided to take control. The cost charged to us users doubled. Nobody could explain the logic of this. We complained but we got nowhere. We pointed out that the people we raised our research funds from, such as the British Heart Foundation (BHF) were now being ripped off because the hospital/university had thrown away our deal. The hospital/university actually went to the animal supplier and say 'you know you charge these staff £15 a rat, well we want to bin that deal, and you can charge the going rate of £20 a rat'. The college then sold the rat to me adding another £10 a rat as an overhead. A doubling in cost to my funds (BHF and industrial research grants). No discussion, no explanation. Annoyingly the BHF went along with this, partly because it likes to be seen to be spending money on research and this seems to fit with that narrative. Can you see how absolutely f***ing stupid all this is?

Phones? Centralized, with the university/college paying the bills then charging senior staff like me to pay from their 'soft' money with, you guessed it, an overhead. I make a £1 call, the college charges me £2.50. There were of course massive costs setting all this up, mostly paying the salaries of the full time staff that 'manage' it all.

Photocopying ditto. Not that we photocopy anything now. But in the hospital they still do so because not everything is electronic. I had a surgery appointment in my own hospital a few years ago that was cancelled 3 times because (I discovered) they lost the paperwork in the internal post three times. Part of that is related to the massive redundancy in paperwork and management incoherence.

This is already TLWR so I'll stop here. But I could go on and on. Bottom line? The university/hospital has been inventing new systems processes and rubrics for 'efficiency' without having a clue about how to do it, or indeed why. The managers have turned a blind eye to the fact that more process means more people, more people to monitor the people, more people to review the progress of the monitoring, more people to create a strategic plan, more people to archive the plan, write reports, and so on.

It is as if the 11 men on the pitch had 100 other people on the pitch with them, measuring their stride and the average distance of passing etc., and interrupting the game every 15 seconds to review the data, set new targets, employ new staff to monitor the outcome, and create a new management stream to deal with the neglected metric of back passing. It really is like this. In the wider NHS I am sure the pattern is repeated. How can we fix it? No idea, but more money will simply be used to create new management, new processes, more bullshit.

Harry,
Thanks for taking the time to post. What an absolute dystopian nightmare you have presented. Jesus Christ, I just couldn’t work in an organisation like that, I’d be sectioned in about two weeks!

 

[Thunder Bolt]

It is clearly not fit for purpose.

‘Staggering’ paper use revealed as NHS told electronic records safer

One NHS trust estimated it generates 25 million pages of A4 each year

www.independent.co.uk

Just taking one example, paper use.... how is this much paper still being used in 2024? What a complete waste of money.

I agree. I have the NHS App, where appointments and results are input but still get letters sent out. Unecessary duplication.

 

[jcdenton08]

A lot of people’s opinions of the NHS as a whole are naturally skewed to the service quality of their primary care trust. The NHS in Wales, for instance, is an absolute shambles and failing by every single metric.

I am extremely grateful for the NHS and think of it as our proudest and finest institution, but investment has to go hand in hand in reform.

The truth is if more money was spent on social care before treatment becomes necessary outside of the NHS then service levels would hugely improve.

A root and branch overhaul of social care is needed far more desperately than a major NHS shake up.

Finally, I would like to thank the NHS frontline staff for all their hard work, diligence and resilience against all they’ve faced under a very poor and unsupportive government. Without the people - including quality migrants - there is no NHS.

 

[Kinky Gerbil]

You do realize that by stating this fact (which is not actually a fact) you are contributing to the weaponization narrative?

NHS: Are patients in Wales waiting longer for health treatment?

The Prime Minister claims the Labour-run NHS in Wales performs worse than England on some measures.

www.bbc.co.uk

Looks worse to myself

 

[Thunder Bolt]

NHS: Are patients in Wales waiting longer for health treatment?

The Prime Minister claims the Labour-run NHS in Wales performs worse than England on some measures.

www.bbc.co.uk

Looks worse to myself

You believe him?

 

[Mellor 3 Ward 4]

The NHS and the people who work for the NHS are in the main brilliant. For emergency care it can not be bettered. The problems are the staff shortages due to poor pay and conditions. Accident and Emergency wards are full of people who should be at GP but can`t get appointment. Population increase and many more living into their 80s and 90s which increases patient nos. The only answer is a huge increase in budget.
Prob is where do all the billions needed come from ??

Budget increases must go hand in hand with reform.

 

[Zeberdi]

The NHS not perfect but it's pretty damn good. During the pandemic it was magnificent. If that can-do spirit could be bottled and re-applied, it would be superb. Shudder to think what it must be like to live in America where your level of health care is largely dependent on the level of cover provided by your employer. For all its faults, and heartbreaking cases such as Ken's, the NHS provides cradle to grave healthcare and there can barely be a family in the land that hasn't has cause to praise the service and its people at some point in their lives. It's worth fighting tooth and nail for

Seconded.

The Tories have wanted to privatise the NHS for years because they are ‘the Party of low taxation’ - they have done their best to undermine NHS services by depriving them of a sustainable level of funding IMO - so the electorate then say, ‘hey, let’s fix the NHS by privatising it’ when in fact all it needs is appropriate funding for the level of care it is expected to provide, a reduction of unnecessary wastage and just better a balance between administration and clinical care recourses. That doesn’t require a massive overhaul or privatisation enterprise, that requires a government that will actually listen to doctors and nurses when they are told where it is struggling and what is needed.

The one area that I do think the NHS is very much broken though is in bed provision - I blame that on too many people using A&E because they can’t get an appointment with their GP. I also blame it on local authority Social Service care that is too slow to provide discharge care packages/and or nursing home care for in-patients. In the community, Primary Care for dentistry, mental health services and GP services is suffering from withdrawal of funding and more recently, a rapid expansion of housing development without the necessary Primary Healthcare infrastructure . It’s a crap shoot which part of the Country you live in whether Primary Care is meeting the needs of residents and in many areas it is not..

 

[BevBHA]

It’s full of waste of money job roles such as diversity and inclusion departments, meaning they have less money to pay the important jobs such as nurses, admin staff etc better money. Job of the NHS - to care for people and be there for them when they’re sick/injured. Gets rid of all roles which have no contribution to the core purpose of the NHS.

 

[Harry Wilson's tackle]

The maintenance contracts will also need a look at as the suppliers have a closed shop, kick backs?....... maybe

Harry,
Thanks for taking the time to post. What an absolute dystopian nightmare you have presented. Jesus Christ, I just couldn’t work in an organisation like that, I’d be sectioned in about two weeks!

Indeed. And imagine how it is for me, on the autism spectrum, triggered by ambiguity, upset by requests that don't make any sense, and angered by wanton tomfoolery.....

Here is the thing. To survive in any job I need to be managed wisely or left alone (don't we all?). I had a great boss when I was a post-doctoral researcher. He just got on with what needed to be done and ignored 'noises off'. And I travelled the world and had brilliant fun, while working hard and making 'career impact'. After I got the lectureship....I was left alone.

How did I survive? Easy. I don't need to be managed, and am not managed. At all. I take time off when it suits me (when I have no commitments). I have never booked an official day off in 35 years (perhaps I should ask for 'owed' holiday - lol!). I am 'appraised' one a year by colleagues with no interest in my 'career'. As long as they do their part of the paperwork and tick the boxes..... and nobody reads my appraisal documents. It just gets filed.

But that's just wrong, isn't it? What is an academic career and how can it be facilitated? That's another story, perhaps...

I am also 'managed' via a central record of my research and teaching. I have published more than 100 peer reviewed papers despite low levels of grant income (I hate writing grant applications and I hate managing more than 2 PhD students/post docs). Despite that my 'h' factor is 39. I have the largest number of teaching hours in my 'school'. So my job has always been safe, and I have always put in a shift and felt pleased with my impacts.

And because I am not interested in status I have never applied for 'professorship' so have no 'targets' to meet.

I have essentially been completely neglected in my job over the last 35 years. As long as students don't complain about my teaching too much (I can be a bit rude to the lazy ones and some do gripe), and the student marks map to 'norms' and I have a research presence, nobody cares what I do.

From time to time however I do lose my rag, and have been on 3 'disciplinaries' (albeit informal) for 'upsetting' people. Frankly, I have no impact in the systems. I am on lots of committees but they are all useless and serve the purpose only of existing. My venting is done where I can have impact, writing research guidance for journals and societies, and calling out shit where I see it.

I would imagine that most 'old' large organizations are like this. Places like Google would be much simpler, and better 'rewarded' but more insecure. That's fine in competitive business. In 'services' (Education, medicine, social services, police, fire, military) setting a 'business model' is as f***ing stupid as setting a 'business model' in a marriage. Fine for medieval regimes perhaps, but here....no.

 

[Harry Wilson's tackle]

NHS: Are patients in Wales waiting longer for health treatment?

The Prime Minister claims the Labour-run NHS in Wales performs worse than England on some measures.

www.bbc.co.uk

Looks worse to myself

And so your conclusion is what? That the Tories are the best thing for the NHS?

You may be right but I would suggest that your experiment is flawed. The sample size is too small. And you are not evaluating all the relevant variables.

 

[chip]

I think we need to think more fundamentaly about what we think the purpose of the NHS acually is and where our priorities are. There are very many grey areas, eg with adult social care and public health. It really isn't stand-alone but involves unpallitable choices.

Seen HWTs post as I type and agree my "institution" is the same. We have more administrators and do more admin work ourselves ......?

 

[Guinness Boy]

I'm sure there are lots of things that could be done differently / better; however when two thirds of the UK population are classified as either obese (or at the very least overweight) and countless others knock back a bottle of wine most evenings, good luck to anybody trying to create a model of universal health care that has to cope with that shitfest.

But that's a hugely circular argument. If better food education and exercise advice was given routinely by specialists and the food that causes obesity was more heavily taxed, with the money ringfenced for NHS, then it starts to improve the other way, with more money and less need. Prevention is better than cure. But at the moment we cannot even fund the cure, never mind the prevention, and every time this is suggested there are people on the right (who might just have private health, supermarket and food businesses) telling us it's the Nanny State and we're having our freedoms taken away.

Talking of which, for all the good lockdown did for not letting the NHS get overwhelmed and keeping frontline heroes going, there's a huge amount of evidence that home drinking increased hugely with no pubs open and people bored. And many have carried on. Perhaps some of those knocking back booze at home got into the habit during Covid and are now addicted? Certainly there's a mental health epidemic as a result of lockdown. So we have an example of where helping the NHS has caused a long tail issue for the health of the population.

It's nowhere near as simple as saying 'oi, fatties and alkies, why not go for a jog?' (which I know isn't quite what you mean, but still...).

 

[dazzer6666]

The NHS and the people who work for the NHS are in the main brilliant. For emergency care it can not be bettered. The problems are the staff shortages due to poor pay and conditions. Accident and Emergency wards are full of people who should be at GP but can`t get appointment. Population increase and many more living into their 80s and 90s which increases patient nos. The only answer is a huge increase in budget.
Prob is where do all the billions needed come from ??

The billions are already there - they just aren't being spent very well.

 

[Me Atome]

As a Tory I am quite encouraged by what Wes Streeting says he plans for the NHS. Assuming Labour win the election, let's see what he can do.