[News] Is the NHS Fit For Purpose

[dstanman]

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

A typical problem is they use more than one system, i get infomation on the NHS app (which contains some good information when you look through it), then i get test results on Patients Know Best, then I have a login for Patient Hub. I just want all my information in the same app

 

[Guinness Boy]

Why does the increase in population automatically make it the wrong model? That's a bizarre suggestion. What it does highlight is the fact funding has not kept pace with population increase nor with the increased costs involved with more technology and more complex procedures. Unfortunately, for 18 years under the Thatcher era it was starved of funding and then again over the last 14 years. You've had as one health secretary someone who has written a book about privatising the NHS. How is he going to be objective about funding?

Where have I mentioned increasing population in that post you quoted, specifically?

The world has changed dramatically since the NHS came into being. There were no computers or internet, we didn't have an aging population, less drug and alcohol dependency, less immigration, less pollution, less freedom of global movement and the population was distributed differently. It's the wrong model for all of those reasons.

Those are all factors in why the model needed to evolve and they're just the ones I can think of off the top of my head.

It's been starved of funding, agreed, and it will be again, because British people don't want to pay tax. It's a pretty stark choice because with the funding gaps, with all those extra things to pay for that I listed we will need to pay LOADS more tax. Or, it needs a root and branch overhaul to remove inefficiencies. You can't buy a Ferrari with pocket change.

 

[Harry Wilson's tackle]

Separately today I have heard one analyst saying that for its size and the amount of moving parts, the NHS is incredibly well run.

Another analyst reckons it’s down the toilet.

When independent advisors cannot agree what the issues are, we are frankly, f***ed.

Interesting points. I wonder whether we have become functionally stupid due to the degradation of politics over the last 15 years.

We seem to have to decide whether something is all bad or all good and then decide who to support almost on a whim.

So people say that Labour hasn't explained all their spending or guaranteed everything will be better 'so I am voting Reform'.
And Farage hasn't got all the detail right yet but he's breath of fresh air so I am voting Reform.

The NHS......well, my experience has been brilliant and bad. It isn't all good or all bad. The principle is excellent. The history of delivery and the impact of this are unmeasurably huge. But it has problems. The question is: fix or bin?

My suspicion is it has been encouraged to become dysfunctional by successive Tories who have among their members MPs who are ambivalent or even hostile to 'socialist' health care, and have tried to 'marketize' it. Some with good intentions, some with malice in mind.

The NHS is a socialist entity not a business. Get that back into the ethos and the beurocratization may start to wither, and the medical staff may start to be able to focus on healthcare delivery.

 

[A1X]

I think the model for the NHS is fine but the scope of service it provides should be limited from basically "anything medical" into smaller entities which would put more visibility of things and be able to properly fund itself better. Mental health services, for example.

A healthcare service free at the point of use funded through general taxation is, IMHO, a fundamental principle and anyone who tries to take it away from us should find themselves at the wrong end of a lamppost.

 

[A mex eyecan]

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

Separately today I have heard one analyst saying that for its size and the amount of moving parts, the NHS is incredibly well run.

Another analyst reckons it’s down the toilet.

When independent advisors cannot agree what the issues are, we are frankly, f***ed.

I think things may well be so far gone and muddled, it will be almost an impossibly to untangle it. It must be like a fishing line birds nest 500 miles in radius.

In some ways it would probably be easier to rip it up and start again, and no I am not advocating a private system and I certainly don't have the skills to even begin to know where the new start should be or what it looks like.

 

[nicko31]

Lost one member of family due to negligence and nearly another after their response to a "long lie" was 9 hours wait for an ambulance (thankfully the carer refused to accept that)

We're all vulnerable and private health won't save you in A & E

 

[The Clamp]

I think things may well be so far gone and muddled, it will be almost an impossibly to untangle it. It must be like a fishing line birds nest 500 miles in radius.

In some ways it would probably be easier to rip it up and start again, and no I am not advocating a private system and I certainly don't have the skills to even begin to know where the new start should be or what it looks like.

Something like this hopefully

 

[A mex eyecan]

Something like this hopefully

View attachment 184252

you know, it would be like a dream wouldn't it. Oh Babs

 

[BLOCK F]

Interesting points. I wonder whether we have become functionally stupid due to the degradation of politics over the last 15 years.

We seem to have to decide whether something is all bad or all good and then decide who to support almost on a whim.

So people say that Labour hasn't explained all their spending or guaranteed everything will be better 'so I am voting Reform'.
And Farage hasn't got all the detail right yet but he's breath of fresh air so I am voting Reform.

The NHS......well, my experience has been brilliant and bad. It isn't all good or all bad. The principle is excellent. The history of delivery and the impact of this are unmeasurably huge. But it has problems. The question is: fix or bin?

My suspicion is it has been encouraged to become dysfunctional by successive Tories who have among their members MPs who are ambivalent or even hostile to 'socialist' health care, and have tried to 'marketize' it. Some with good intentions, some with malice in mind.

The NHS is a socialist entity not a business. Get that back into the ethos and the beurocratization may start to wither, and the medical staff may start to be able to focus on healthcare delivery.

1.) Fix or bin?
Yes, fix.
2.) Some Tories hostile to socialist health care.
Hmm, a very small minority, I would reckon and they haven’t got very far in having their voices heard. A contribution towards some people paying a subsidised fee for certain treatments, for instance, if it were to happen , wouldn’t constitute much hostility in my humble view.
3.) A socialist entity not a business.
Yes, I largely agree with this, however, it doesn’t mean to say that this socialist entity wouldn’t benefit from becoming more business like though. After all, socialists are rather fond of bureaucracy so I believe!

 

[drew]

Where have I mentioned increasing population in that post you quoted, specifically?

The world has changed dramatically since the NHS came into being. There were no computers or internet, we didn't have an aging population, less drug and alcohol dependency, less immigration, less pollution, less freedom of global movement and the population was distributed differently. It's the wrong model for all of those reasons.

Those are all factors in why the model needed to evolve and they're just the ones I can think of off the top of my head.

It's been starved of funding, agreed, and it will be again, because British people don't want to pay tax. It's a pretty stark choice because with the funding gaps, with all those extra things to pay for that I listed we will need to pay LOADS more tax. Or, it needs a root and branch overhaul to remove inefficiencies. You can't buy a Ferrari with pocket change.

Apologies, I did post my comment on the other thread in response to Commander's post where he did mention the size of the population but I removed it out of respect to post on here. It's been continually starved of funding and therefore has been falling further and further behind. Covid has pretty much done for the NHS because, despite the clapping and the plaudits from the Tories, they still, in the main, would like it gone. We hear the mantra that they are putting in records levels of funding but that is just semantics. If the Tories put an extra £1 in each year they can claim to be putting in a record level of funding but that doesn't mean it is keeping up in real terms.

We often hear the mantra 'too many managers' but that has previously been proven not to be the case (see The Kings Fund ,The NHS Confederation , The Nuffield Trust).

We know staffing levels are low and there is about 100k vacancies. Pay will be a big factor in that. If you have enough staff then that takes the pressure of everyone which in turn leads to less turnover.

That said, I agree that it isn't a case of a blank cheque and things like procurement, digitalisation etc need a review to ensure value for money. However, with reference to the factors you raise, I don't really accept that that means the model required drastic overhall. Are you saying it shouldn't be free at the point of delivery? People don't like paying tax but they also don't like paying insurance and/or an excess each time they visit!

 

[Harry Wilson's tackle]

1.) Fix or bin?
Yes, fix.
2.) Some Tories hostile to socialist health care.
Hmm, a very small minority, I would reckon and they haven’t got very far in having their voices heard. A contribution towards some people paying a subsidised fee for certain treatments, for instance, if it were to happen , wouldn’t constitute much hostility in my humble view.
3.) A socialist entity not a business.
Yes, I largely agree with this, however, it doesn’t mean to say that this socialist entity wouldn’t benefit from becoming more business like though. After all, socialists are rather fond of bureaucracy so I believe!

Socialists obsessed with bureaucracy . . . like the local leader of my former union. "Respect the committee process". Far cough.

Yes. Any organization must be fit for purpose. But....I can't help thinking that Douglas Adams may have had his finger on the pulse...the people most suitable for high office are those least inclined to want it. And vice versa. Mix in the Peter Principle, and that fact that we "always get the governments we deserve", it is sometimes hard to work out quite how we created civilization at all.

Perhaps we need constant conflict and crises to manage for our advancement, with too much stability leading to inertia and corruption. But how do we manage disruptive change and avoid making catastrophic errors? Johnson's disruptive mate didn't last long, but his Brexit vision has prevailed (that is 'no plan needed - f*** it - it will sort itself out').

None of our disruptive inventions have done for us yet:

Agriculture
Industrialization
Nuclear power
Fascism
Communism
Post war consensus

Every one was opposed. When it was time to move on we moved on. Perhaps we have nothing to fear from the EU, Brexit and global warming after all, and when disruptive change is needed, it happens.

But Farage though? Christ, no. None of the above were nostalgic steps backwards. Farage is reactionary and retrospective. I think even his admirers realize, and know he won't prevail. No wonder they are always so angry

 

[Harry Wilson's tackle]

To add, you can have socialist structure in a capitalist world, Not everything has to be the same. I love a socialist NHS but I don't want a socialist BHA.

 

[One Teddy Maybank]

Completely agree. We have a completely outdated model that isn't used anywhere else on the planet. It's ridiculous.

It's taboo to say it, but part of the problem is a lot of the people who work in it! When you pay minimum wage you get minimum wage quality. The administration side of it is so appalling bad, with constant mistakes costing it millions and millions of pounds. If they paid people better then you'd generally get much better people, which would minimise the mistakes and surely minimise the money lost- paying people more and hiring better people would actually save it money. But it's so departmentalised that they don't seem to be able to look at the bigger picture.

Good luck to any politician suggesting anything other than a completely free service though, especially if they are a Tory. "YOU WANT TO PRIVATISE THE WHOLE NHS AND HAVE PEOPLE DIE BECAUSE THEY CAN'T AFFORD MEDICATION!!!??"

Usual nonsense from people who have no idea about the NHS, which actually has the leanest management costs.

I could say so much to the absolute bollocks being spouted but I can’t, so it’s going on ignore.

Suffice to say every department in the NHS is under severe pressure, from clinical teams to managers….

Edit - apologies @Commander as you’re a great poster, but that irritated me….

 

[FamilyGuy]

My experience ….on the whole lovely people trying to work within crap systems

I agree.

I (unfortunately) have needed to use the NHS at many levels in the last 15 months (and counting).
All the people I have had dealings with - incl; emergency teams, intensive care, walk-in dept staff, surgeons, surgical teams, ward admin, nurses, sisters, neurologists, consultants, opthalmologists (sp?), GP's, GP admin/front office, post care teams, etc - have to a woman/man been/are excellent.

The circumstances and systems within which they work are somewhere between archaic and awful.
Their approach to the work they do is to be admired and applauded.

I wouldn't be here today if it were not for these wonderful people.

Does that answer the OP's question?

 

[Cotton Socks]

The NHS seems a completely messed up system now, there is no holistic thinking.

The leading cause for children being admitted to hospital is for teeth extractions under GA. Some of this may be down to too much sugar and poor dental hygiene but it's really difficult to get an NHS dentist, even for children. In lockdown my son missed his yearly check up as it was closed, I didn't feel the need to immediately contact the dentist for 'just a check up' when they reopened as people actually needed treatment as they'd been in pain etc. Then there was another lockdown & emergency treatment only. By the time it came to be fine to make a routine appointment, he'd been taken of their list, as 2 years had passed. They weren't taking on any more NHS patients (even kids), I could only get him a private appointment which was £40 for a check up. That doesn't sound like a lot but I didn't bother to ask for the price list if he needed a filling. 4 hours I spent trying to find him an NHS dentist for a check up. He's a kid, it's supposed to be free. They took away the sweet trolley at the Amex so the blue sweets that dissolved his teeth instantly, were no longer on the radar & I've always been to lazy to walk to the sweet shop with him.

Mental Health is another mess up. You're not feeling great so you manage to get an appointment with a GP which involves ringing them up at 8am & finding all appointments for non urgent are booked up for the next month & to ring back tomorrow and hope you get one when the 'calendar' rolls over (I seem to be very lucky with my practice & don't have that?). I said on another post that I haven't seen my GP for years but I have remembered I did contact them as I had an infected finger. I sent them pics they sent me a prescription. Going back to MH, the GP will give you the questionnaire, prescribe meds & tell you to self refer to the 'Wellbeing Clinic'. You self refer to the clinic, they'll help in about a year with a short course of CBT & hope you don't darken their doorstep again. If you have severe depression aside from meds, you're on your own, unless you can afford private therapy which I'd give an average cost of £60 an hour. You end up in crisis, try to take your own life and end up in A&E, wait for psychiatrist to come round, who basically decides you haven't tried hard enough to be admitted to Millview & sends you home with more meds.

I know a 60ish year old lady that has tried to take her own life twice this year, 1st time she was in AAU for 3-4 weeks, this time she's had to be resuscitated & I can't remember the wards she's been in but she should be in Millview. She knows she can't keep herself safe & wants to go there, no beds. She has carers for physical needs and twice they've now gone in to her home to find her nearly dead. That isn't fair on them, they're there to help with physical care needs & perhaps a bit of general cleaning they're being paid the same rate as someone who works in McDonalds. How cheerful would you be going to work hoping that your client hasn't taken their own life? They do it though & don't get enough money or credit for doing it, even private companies pay their carers s**t money.

People are living longer, there's huge amounts of waste. My mum has just been for a pre-op, for an op that should've been done years ago, they've done a different op that hasn't worked 3x now. She's had an op for something else in between & she didn't come out of the anesthetic very well. She's waited so long to be out of pain that even though the risk is now really high for loads of things, she's just said f**k it she'd prefer to be dead, than live how she is. I get that, but I'd be lying if there's not most of me wanting to beg her not to do it, as now the risks are so much higher than they were 4 years ago. If the anesthetic affects her long term mental state, ie brings on dementia, I know we're stuffed getting help with her care.

Joined up services are needed, treat the whole person rather than going from one dept to another & the previous dept not knowing who to send notes to. The last time I saw my hospital notes on paper stacked up, they were a foot high with different colour folders meaning diff departments. I have since actively disagreed to my record being shared digitally between departments though, because in the small print they say they're going to share it with outside agencies and the list was so long that I just thought 'Nah, I don't know who these people are'. If they'd said 'within the NHS only' then yes they could share my height, weight & infected finger with the rest of the NHS, I just don't want any Tom, Dick or Harry knowing my med history. If we went US style of insurance, my premium would be similar to a 17 year old's car insurance cost after buying a Ferrari!

 

[Cotton Socks]

Double post...

 

[Cotton Socks]

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.

The published peer reviewed paper, that said peer reviewers were absolute shite, will probably make me chuckle forever, because it's true. Not many people would've done that!!

 

[Harry Wilson's tackle]

Something like this hopefully

View attachment 184252

Or like this:

 

[um bongo molongo]

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.

That’s pretty much what many of us pay in NI

 

[um bongo molongo]

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.

I’ve spent my whole career in the private sector, and from my experience, the bigger and more bureaucratic the organisation the more it’s like this. The point being that I agree with you that the funding model is irrelevant - the best businesses even if their big have small teams focused on specific parts of the business, managed by leaders with autonomy.