[Politics] The state of things

[Paulie Gualtieri]

My experience of management in the NHS is somewhat similar. Generalising somewhat, I’ve found 2 types.
1: Managers sourced from the private sector, often with no experience in healthcare. They make the majority of decisions in line with budget restrictions with absolutely no idea on how that would affect patient care. Their decisions can be short sighted (eg this dressing is £1 cheaper, failing to understand that it could lead to longer healing times and increased nursing input in the longer term) a very short sighted approach.

2: managers who have been promoted from clinical positions. This type have often lack any sort of management skills and have often been promoted to the role without any management training and struggle with the day to day management due to this.

Personally I’ve found that management don’t last very long and are often moved between positions, incompetence is rife between both types and is often excused.
There is no long term approach to anything at present and the service is a reactive service with no long term strategy in place.
I’ve often discussed this with managers of both types and they know they won’t be in the role long enough for it to matter.
It’s often very frustrating when you identify long term problems and you’re ignored/palmed off by managers.
Obviously healthcare is difficult as any decision will impact patients at the point of service, which makes comparisons to other industries difficult.

Interesting, thanks

With the health of the patient being the primary purpose of the service it would naturally make sense to invest in those with a clinical background who understand the nuances, some of which would be critical.

It would the investment in management / strategic education isn’t sufficient but then I guess this depends on whether the NHS is being run as a business or a health service, the cycle continues

 

[Ooh it’s a corner]

The first rule of Life Club - Do not under any circumstances listen to Radio 2.

You wag - the prog HWT was listening to will have been on 5live!

 

[The Clamp]

Key facts and figures about the NHS

What's the NHS annual budget? How many doctors and nurses are there? What's the cost of an operation? We answer some of the most frequently asked questions we receive about health and social care.

www.kingsfund.org.uk

Quite interesting.

 

[Thunder Bolt]

Is it your firm opinion that pouring more money into the NHS will make it better? Because the NHS budget has risen by 32% after adjusting for inflation (from actual spend £94 billion in 2013-14 to budget £152 billion in 2022-23) and the improvement hasn't started to show yet. Evidence suggests we need another solution.

£152billion which includes PPE and storage of useless PPE waiting to be desposed of. Baroness Mone bought a £10million yacht out of her £29million
There are 47,000 vacancies for nurses, so agency nurses are brought in at double the price.
Despite the protestations of the politicians, the money isn't the issue but the implementation of it is.

Nurses are leaving because they won't see patients only half treated so work extra hours without overtime to make sure their patients are ok.

 

[The Clamp]

I am constantly receiving phone calls from women’s refuges and other similar places begging me to come in and cover shifts so their day-staff can go home. The pay is so bad people are leaving in droves, they simply don’t have enough staff.

Out of the managers, who do actually get paid okay, one has taken annual leave in December (ridiculous), one works from home (how is this possible) and another can’t organise rotas and calls staff bullies when they ask for more money to come in and do a 16 hour night shift. And another refuses to work anything else but 9-5 Mon-Fri (in a 24 hr operation) because and I quote “it’s managers’ privilege”!!

That manager, thankfully now binned off, tried to get me sacked when she made a potentially life threatening decision and got it wrong. She tried to throw my colleague under the bus and I stepped in and wrote a statement in his defence and highlighted what a fuckwit she was.

No wonder people are jacking it in.

And how do they fill the gap? They hire agency staff who are not trained up to standard and charge 2/3 more than a regular staff member costs. And they often just don’t turn up because they have a better offer elsewhere. When they do turn up they just see themselves as “bums on seats” and sit and play on their phones all shift.

And few come back for a second shift because they’ve been paid quite poorly to deal with insane abuse and violence from service users.

Forget trying to fix all the other issues, if you don’t pay staff fairly, you don’t have staff.

 

[maltaseagull]

I have been listening to Nicky Campbell this morning, with the phone-in on the nurses' strike. I am not sure we are close to a tipping point yet because it seems clear that most of us don't understand the big picture.

I may be wrong but it has always seemed to me that if you have a State, and charge the State with provision of key services, then this has to be paid for from tax. With, indeed, a contribution from the return on investment of some of the money raised in tax.

It seems that the people expect certain core services to be managed by the State. The police. The military. The national health system. Education. Border control. The fire sevice. Social services. (Have I missed anything?). This is essentially 'one nationism'.

Not everyone agrees with this. There has always been an element among the right that the State should not provide any service other than the military to protect us from invaders. Possibly a police service, but that could be set up as a local militia. This is a common view in America. The rest of 'services? - well if you want health or education, just earn money and pay for it. It is a viewpoint, and it is coherent.

On the other hand, there is an element on the left who consider that not only key services, but most economic activity should be state owned and regulated. 'Top' salaries should not exist and we should all earn a 'living wage'. No profiteering, and a regulated economy. To keep all this together, tax should be high.

Here is the rub. What happens, here, now is somewhere in between. There is a large proportion of the electorate who consider that low tax, and systems that facilitate individual men and women accumulating wealth, should be the national priority. There is another large proportion, with considerable overlap between the two populations ironically, that expect a decent health service, short waiting lists, and excellent reliable public transport.

Neither labour nor conservative have hugely wavered from a policy of attempting to keep tax low while keeping essential services running, since the war (WWII). Neither party has said either "we MUST tax people more to keep the ship afloat" or "we must privatize everything to keep tax low". Some goverments have got close, but these goals have never been explicit or the main policy.

So we have a mess. This has managed to rumble on with 'one nationism' practiced by both parties, but Thatcher ended all that. Thatcher did not change society, but she changed the direction of travel. This was not reversed by Blair (I was hoping it would be, but instead he embraced public/private ownership - a horrible hybrid).

Now, the hard right among the tories have seized a series opportunity offered first by 'The crash', then Covid and Putin, to bring in austerity. What is this supposed to achieve? Shrinkage of the state, a shift in power from state owned enterprises to private. It has been a continuous sequence that involves underfunding state owned enterprises so people criticise them. So what is the end game? It has to be no state ownership and low taxes. But....we have not been told this, have we.

Listening to the 'national conversation' the sense seems to be that the NHS is ruined. And yet the nation is not screaming at the government, demanding money be made available (by increasing tax) to fix it. The understaffing is barely mentioned 'at large', and has been absorbed into the general 'woe is the NHS' narrative. Why is nobody demanding that we swap some Albanians with some Rwandan nurses (fair exchange is no robbery etc). I am being facetious of course. My point is that no solutions are being offered. Think of that!

There is one, of course. Put up tax, pump money into the NHS, and make it much easier for the stream of overseas nurses that used to supplement the workforce to settle in the UK.

Oh, but that means higher taxes and more foreigners.

We have not reached tipping point yet, but it may be just over the horizon. Perhaps if Labour grasp the nettle and offer a clear alternative, a brave one (it will require higher taxes, and also some 'redistribution' of wealth, windfall taxes etc.) there may be some hope. Labour are nailed on to form the next government so I can understand that, if they have a clear plan, they are keeping their powder dry. Any detailed policy announcement will be mocked and ridiculed by those willing to rush to the bottom and pedal any lie to keep the Tories in power. So I don't expect Starmer to reveal any detail till after he's in number ten. Risky.

But if there is a plan, a radical left plan, I shall rejoice. Because we cannot carry on like this, with the impossible fudge where tax is kept low and our institutions collapse. That is a hard right agenda, and one that has astonishingly been accepted as the only way of doing things. That (not cheese imports) is a disgrace.

Some excellent points. At the risk of upsetting @Nobby I think that a lot of people who express opinions of about what is needed would possibly change their opinion if it would cost them extra taxes however good the idea.

Great if they can afford to pay more, but there are probably a lot more who cannot afford to.

 

[beorhthelm]

i thought this was about general economics, since it wants to be about NHS, here's some great data.

The NHS workforce in numbers

Facts on staffing and staff shortages in England.

www.nuffieldtrust.org.uk

source data on total staffing

Microsoft Power BI

app.powerbi.com

 

[The Clamp]

Pay demanded by striking nurses is unaffordable - health secretary

MPs' expenses: The most outrageous responses – so far | MPs' expenses | The Guardian

<p><strong>Paul Owen:</strong> How some MPs have chosen to defend themselves in the wake of the expenses scandal.</p>

amp.theguardian.com

 

[Tom Hark Preston Park]

I have been listening to Nicky Campbell this morning, with the phone-in on the nurses' strike. I am not sure we are close to a tipping point yet because it seems clear that most of us don't understand the big picture.

I may be wrong but it has always seemed to me that if you have a State, and charge the State with provision of key services, then this has to be paid for from tax. With, indeed, a contribution from the return on investment of some of the money raised in tax.

It seems that the people expect certain core services to be managed by the State. The police. The military. The national health system. Education. Border control. The fire sevice. Social services. (Have I missed anything?). This is essentially 'one nationism'.

Not everyone agrees with this. There has always been an element among the right that the State should not provide any service other than the military to protect us from invaders. Possibly a police service, but that could be set up as a local militia. This is a common view in America. The rest of 'services? - well if you want health or education, just earn money and pay for it. It is a viewpoint, and it is coherent.

On the other hand, there is an element on the left who consider that not only key services, but most economic activity should be state owned and regulated. 'Top' salaries should not exist and we should all earn a 'living wage'. No profiteering, and a regulated economy. To keep all this together, tax should be high.

Here is the rub. What happens, here, now is somewhere in between. There is a large proportion of the electorate who consider that low tax, and systems that facilitate individual men and women accumulating wealth, should be the national priority. There is another large proportion, with considerable overlap between the two populations ironically, that expect a decent health service, short waiting lists, and excellent reliable public transport.

Neither labour nor conservative have hugely wavered from a policy of attempting to keep tax low while keeping essential services running, since the war (WWII). Neither party has said either "we MUST tax people more to keep the ship afloat" or "we must privatize everything to keep tax low". Some goverments have got close, but these goals have never been explicit or the main policy.

So we have a mess. This has managed to rumble on with 'one nationism' practiced by both parties, but Thatcher ended all that. Thatcher did not change society, but she changed the direction of travel. This was not reversed by Blair (I was hoping it would be, but instead he embraced public/private ownership - a horrible hybrid).

Now, the hard right among the tories have seized a series opportunity offered first by 'The crash', then Covid and Putin, to bring in austerity. What is this supposed to achieve? Shrinkage of the state, a shift in power from state owned enterprises to private. It has been a continuous sequence that involves underfunding state owned enterprises so people criticise them. So what is the end game? It has to be no state ownership and low taxes. But....we have not been told this, have we.

Listening to the 'national conversation' the sense seems to be that the NHS is ruined. And yet the nation is not screaming at the government, demanding money be made available (by increasing tax) to fix it. The understaffing is barely mentioned 'at large', and has been absorbed into the general 'woe is the NHS' narrative. Why is nobody demanding that we swap some Albanians with some Rwandan nurses (fair exchange is no robbery etc). I am being facetious of course. My point is that no solutions are being offered. Think of that!

There is one, of course. Put up tax, pump money into the NHS, and make it much easier for the stream of overseas nurses that used to supplement the workforce to settle in the UK.

Oh, but that means higher taxes and more foreigners.

We have not reached tipping point yet, but it may be just over the horizon. Perhaps if Labour grasp the nettle and offer a clear alternative, a brave one (it will require higher taxes, and also some 'redistribution' of wealth, windfall taxes etc.) there may be some hope. Labour are nailed on to form the next government so I can understand that, if they have a clear plan, they are keeping their powder dry. Any detailed policy announcement will be mocked and ridiculed by those willing to rush to the bottom and pedal any lie to keep the Tories in power. So I don't expect Starmer to reveal any detail till after he's in number ten. Risky.

But if there is a plan, a radical left plan, I shall rejoice. Because we cannot carry on like this, with the impossible fudge where tax is kept low and our institutions collapse. That is a hard right agenda, and one that has astonishingly been accepted as the only way of doing things. That (not cheese imports) is a disgrace.

TL;DR

 

[raymondo]

I was more interested in the 'being kept low'... which doesn't seem to be the case. it looks more like a steady rising trend to me.

Probably inflation in there too

 

[raymondo]

Pay demanded by striking nurses is unaffordable - health secretary

MPs' expenses: The most outrageous responses – so far | MPs' expenses | The Guardian

<p><strong>Paul Owen:</strong> How some MPs have chosen to defend themselves in the wake of the expenses scandal.</p>

amp.theguardian.com

Thanks for the link @The Clamp . It's painful reading their self-serving nonsense. And I believe they have a restaurant in parliament which is heavily subsudised (by us) whereas nurses pay full whack for pretty low level cafeteria food (just one example).

 

[BLOCK F]

probably all off shore.

Oh, The sinner.

 

[Machiavelli]

a while back i accepted there needs to be more taxes if we are to maintain or have more services. i was surprised when a Tory government introduced tax rises they had often opposed. imagine the confusion when Labour rejected this. then further confusion as they complained we had the highest ever taxes (true), made up of rises to NI corporation tax and fiscal drag on higher rate earners.

Labour wont make a clear case for broad tax rises. they are so scared of reaction to that they wont, they will instead rely on minor taxes around the margins, leaving them wide open unfunded spending promises.

I'm with you on this. Labour need to:
-- put up taxes
-- be honest of the need to put up taxes
-- while much of this can come from the sort of sources that I've advocated all along (eg windfall taxes -- I know they tend to be one-offs; closing tax loopholes for MNCs, eg Amazon; raising inheritance tax and CGT; other asset taxes, etc), this will need to be supplemented by rises in either the basic rate of income tax or NI
The more interesting question, however, is why won't Labour come out and make the case for higher taxes?

 

[Machiavelli]

Tax as a share of nominal GDP in the UK... after the latest Tory budget...

View attachment 154735

Yes, it may well be low compared to others, but it is rising, and on current budget will continue to do so in the near future.

I appreciate that this is a swerve from where you're on, but I'd add that, within that, the burden of taxation has shifted quite substantially from the rich to the poor since 1979. If you don't believe me, check out the rates then (and now) of:
-- VAT
-- highest rate of income tax
-- basic rate of income tax

 

[LamieRobertson]

Away at Chalrton next wednesday…yippee….then Boxing Day away at Southampton……then New Years Eve at home to the leaders Arsenal..so looking forward to it.

Oops wrong thread

 

[Machiavelli]

I sometimes listen to Radio 4 comedy programmes as well.

Can you share with us the following information please:
1, what proportion of GDP does the US spend on healthcare?
2, what proportion of GDP does the UK spend on healthcare?

 

[KZNSeagull]

I'm with you on this. Labour need to:
-- put up taxes
-- be honest of the need to put up taxes
-- while much of this can come from the sort of sources that I've advocated all along (eg windfall taxes -- I know they tend to be one-offs; closing tax loopholes for MNCs, eg Amazon; raising inheritance tax and CGT; other asset taxes, etc), this will need to be supplemented by rises in either the basic rate of income tax or NI
The more interesting question, however, is why won't Labour come out and make the case for higher taxes?

Because they have been consistently complaining about the high tax burden ever since the NI rate was upped to pay for social care.

 

[Knocky's Nose]

Government wants to privatise the NHS. They know we wouldn't accept that.

So, create a problem - provoke a reaction - offer a solution.

That's the playbook.

 

[newhaven seagull 85]

There are so many issues within the NHS, it needs a radical rethink.
1, we all need to pay more for the services we expect, this could be 1% increase on income tax for all. NI should be paid at the same rate for all with no threshold, why should the poorest in society pay the greatest percentage of income?.
2, The NHS needs to radically rethink its staffing structure, more front line staff less management.
3, The Government needs to allow free movement of Potential employees from anywhere in the world as long as they are trained to NHS standards, and if not train them up.
4, There needs to be suitable availability of Half way houses/ residential short term homes for patients who have been treated, but are too frail to look after themselves and need to build up their strength. This would stop the log jam in A&E allowing the great staff in the NHS to get on and do the job they want to do. It would also relieve the problem of Ambulances sitting in A&E bays waiting to hand over patients.
5, the NHS should have its own Staffing Agency to supply short term cover staff, and it should be mandated that no other agency could employ medical staff on its books.
6, Do not Privatise anymore of the NHS, it was devised as a free service.

I'm sure there are many other ideas people would have for the NHS, These ideas are just as seen from the outside looking in. They may not be right but the current arrangements are only getting worse.

 

[vegster]

My gut feel is that most people are broadly supportive of things like "pay more tax to improve the NHS and provide better schools etc" until it actually comes to the bit where they are asked to pay more tax. At that point, tax isn't anyone's friend, and no-one wants to hang out with it.

I think the overall stagnation of wages over the last 10 years or so has led to a lower tax revenue. So many employers look to employ workers at a few pence over the minimum wage that subsequently they are paying minimal tax..... and then personal allowances slowly rise taking people out of tax altogether.