[News] Is the NHS Fit For Purpose

[Harry Wilson's tackle]

Me, even as a bit of a pinko I don't thin it's fit for purpose. It's designed for 70 years ago and seems to be stuffed full of people covering for themselves at the top level, with allegations of bullying and incompetence rife.

The US is worse though.

A good midway would be a system similar to The Netherlands or France which both require medical insurance as mandatory, but this is normally covered by an employer and cannot just be cancelled by the insurer. Care is free at the point of need with insurers covering most bills.

There would need to be a think about how to treat the homeless and digitally disenfranchised but the schemes tend to work in both countries.

As for getting rid of administrators that isn't a panacea, because you don't want Drs and Nurses spending all day filling in forms and arranging admin, you want them treating people. But I reckon there's definitely overspending on inefficiencies and a full audit should be done on expenses polices and how much is being spent on diversity and inclusion.

I would also make it illegal for Physician Associates to take GP appointments.

It isn't the way it is paid for that is the problem. It is the way it has evolved, with bean counters and bean counting and 1970s style workplace behaviour in parts of it.

As a pinko myself, I 'support' the NHS as a concept, but it needs to be fixed or it will become even more of a money pit, with even slower and more hit and miss service. However I have no idea how it can be fixed without sacking vast numbers of people and parachuting in brand new stripped down rubrics.

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 in a separate post.

 

[happypig]

No, it isn't.

My family retired to France and were covered affordably, despite never having worked there. And in The Netherlands insurers aren't allowed to lapse the mandatory policy that pays most bills even if someone's in prison. They make their money from selling add ons to the rich, mostly dental and vision add ons which people also pay for here (but just the same, basic dental is covered for a small fee).

Define “affordably”.
I took early retirement when I was made redundant in 2019. We live a humble, but affordable, lifestyle. There’s little room in the budget for health insurance.

 

[jackanada]

A few points.
We do have an insurance based model. It's called national insurance. Any other system has far higher admin costs.
The problems with departmentalisation and arse covering have been exacerbated by the part privatisation of the NHS, I don't see how further privatisation is going to magically make people think more holistically and help other departments out.
Vast sums are extracted from the NHS as profit, it seems odd that eliminating this is not seen as an option to increase efficiency.
Many workers are low waged in the NHS. Many of them go above and beyond because they see themselves as a public service in the national interest. Profit taking and executive pay only erode this motivation.
The restructuring by Cameron to allow private companies to further benefit from NHS contracts cost around £6 billion to implement and raised admin costs by £2 billion per annum.
Water and Railways are a good indicator of what privatisation actually means for public services. I.e. higher costs, poorer service, more debts to service and less resilience in return for shareholder profits.

 

[beorhthelm]

people confuse the service with the funding and payer model. too many think any change to the service means end of gov picking up the payments, killing off any serious debate on change. need to focus on what services and how they could be better delivered first, then look at the funding and payment models.

 

[Mellor 3 Ward 4]

It isn't the way it is paid for that is the problem. It is the way it has evolved, with bean counters and bean counting and 1970s style workplace behaviour in parts of it.

As a pinko myself, I 'support' the NHS as a concept, but it needs to be fixed or it will become even more of a money pit, with even slower and more hit and miss service. However I have no idea how it can be fixed without sacking vast numbers of people ane parachuting in brand new stripped down rubrics.

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 in a separate post.

All of the above.

No, it's not fit for purpose - and needs a huge amount of change - the world's 6th largest employer with an annual budget of circa 180 BILLION.

However, meaningful change won't happen whichever Govt. is in charge as too many of those who work in it don't want, and won't accept change.

BTW my wife works for the NHS and see it first hand every day.

 

[Flounce]

Absolutely. I have nothing but praise for all the staff involved in the NHS.

Same

 

[Guinness Boy]

Define “affordably”.
I took early retirement when I was made redundant in 2019. We live a humble, but affordable, lifestyle. There’s little room in the budget for health insurance.

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?

 

[BLOCK F]

No, it isn’t fit for purpose.

 

[ROSM]

Is the concept of a health service that is free at the point of use, that provides good levels of care and protection and treats all on society as equals, one that is still valid for 2024? In my view, yes it is.

Is the current model effective? No it isn't. So it isn't currently fit for purpose but that doesn't mean we should just throw it away.


The end to end process isn't joined up whether it's GPs/ primary care, a&e, specialists, preventative health or social care, nothing flows and a failure in one puts pressure on another. National insurance was the insurance scheme. If we need another such as the french/Dutch model then there has to be a rebalance of funding

 

[Herr Tubthumper]

I’d follow the follow the German system in funding and administration…..but do you want to pay 7% of your income with the employer making up the other 7%? Probably not.

 

[Harry Wilson's tackle]

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 Wilson's tackle]

All of the above.

No, it's not fit for purpose - and needs a huge amount of change - the world's 6th largest employer with an annual budget of circa 180 BILLION.

However, meaningful change won't happen whichever Govt. is in charge as too many of those who work in it don't want, and won't accept change.

BTW my wife works for the NHS and see it first hand every day.

Agree. And cannot see what the problems are or how to fix them. Or even acknowledge there are problems it is all 'it is what it is'.

This is not a can do culture. I am incidentally shocked at how easily the doctors themselves accept it all without question.

I have been trying to meet up with some middle ranking consultants to plan a way of developing a new heart drug. It has taken a month of emailing and we still haven't even arranged a phone meeting. Now, call me old fashioned, but how can I hope to create a new company, nimble in thought word and deed, to take a new drug into the clinic with people like this? They are f***ing USELESS and they cannot see it. Their days are carved up, their outlook is professional but inflexible. They are doc bots. And that is what we train now. Doc bots

 

[beorhthelm]

I’d follow the follow the German system in funding and administration…..but do you want to pay 7% of your income with the employer making up the other 7%? Probably not.

we already do in theory, NI is 8% employee and 13% employer. but then again no we wont, everyone shat the bed over 2% for social care, got dropped and NI cut further since.

 

[Herr Tubthumper]

we already do in theory, NI is 8% employee and 13% employer. but then again no we wont, everyone shat the bed over 2% for social care, got dropped and NI cut further since.

NI isn’t ring fenced for health care though. Far from it. What I talk about is.

 

[wellquickwoody]

Part public funding, part private. Emergency and life saving care free for all at point of delivery. No queue jumping for this care. Other care (hips, gynacology, minor surgery and plenty more) can also be free but a a waiting list. Alternatively private health care can be purchased to speed up the non urgent system. Tax breaks for the young to take health insurance from an early age, tax penalties for the wealthy that do not. This is by no means perfect or exhaustive, but a starting point for discussion perhaps. Ambulance services could also be privatised. GP care could also run in a similar way to the above.

 

[Springal]

Pretty good for an actual emergency, cancer treatment & pregnancy. Shite for anything else - thank god for my work BUPA in the last 5 years helped me get a couple of fairly major health issues sorted quickly rather than the 12 month+ wait on the NHS

 

[Harry Wilson's tackle]

The thing is, it is worse in Labour led Wales and SNP led Scotland.

We need an independent system away from and political input.

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

 

[Tom Hark Preston Park]

The NHS is 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

 

[Bry Nylon]

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.

 

[Mellor 3 Ward 4]

A few points.
We do have an insurance based model. It's called national insurance. Any other system has far higher admin costs.
The problems with departmentalisation and arse covering have been exacerbated by the part privatisation of the NHS, I don't see how further privatisation is going to magically make people think more holistically and help other departments out.
Vast sums are extracted from the NHS as profit, it seems odd that eliminating this is not seen as an option to increase efficiency.
Many workers are low waged in the NHS. Many of them go above and beyond because they see themselves as a public service in the national interest. Profit taking and executive pay only erode this motivation.
The restructuring by Cameron to allow private companies to further benefit from NHS contracts cost around £6 billion to implement and raised admin costs by £2 billion per annum.
Water and Railways are a good indicator of what privatisation actually means for public services. I.e. higher costs, poorer service, more debts to service and less resilience in return for shareholder profits.

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