UKC

http://www.thecanary.co/2016/02/11/exposed-nhs-bosses-backing-jeremy-hunts-...

Interesting reading, re the figures involved.

In reply to Timmd:

I said from Day One, that when the Tories got in, you could kiss the NHS good bye.

In reply to Timmd:



Can you please give the figures for private provision under the NHS umbrella in 2000, 2010 and 2015?

And can you explain why this article is an "expose" when it has been openly declared that private provision of some services is considered the best way forward to provide a cost effective health service as it is, to a much greater extent, across such well know neoliberal economies as France, Germany and Scandinavia?

In reply to Timmd:
http://www.bbc.co.uk/news/health-35557135

Which rather spoils your conspiracy, even if it supports Hunt's mendacity.

In reply to Postmanpat:


That would be those well known rather more expensive health care services in France, German and Scandinavia.

In reply to KevinD:

Scandanavia appear cheaper in GDP terms ,while the French spend more they waste money on homeopathy and are hypochondriacs! Overall there isn't that much difference, however, which suggest the form of provision isn't really the issue (other than the US system being crap). However, generally rising healthcare costs have to be addressed somehow. If we can use hospital equipment better by seven day operation that is good, but just having doctors working more at weekends isn't going to do it

In reply to MG:

Do you think French hypochondria might be in part down to knowing they're personally insured rather than it being a tax-funded service?

In reply to The Lemming:



The NHS is a behemoth. Personally I think it would be a good thing to break it up to get some (self) control back into its organisation.

(Like questioning man-made climate change, I accept this could be considered heresy)

In reply to MG:


What do you mean by that? They spend a small percentage of GDP in healthcare than the UK?

The metric I think is more informative is the amount spent per capita in which Scandinavian countries do indeed spend more than the UK

In reply to blurty:

What do you mean by "break it up"? Wasn't that what the PCTs/Care Commisions/whatever they are currently called were meant to do?

Do you mean it shouldn't be centrally funded? Do you mean it should be broken down and run by private sector chelate care providers? Your statement doesn't mean anything?

In reply to galpinos:


Yes


Yes, I see your point
http://www.google.co.uk/publicdata/explore?ds=d5bncppjof8f9_&ctype=b&am...

In reply to MonkeyPuzzle:
French hypochondria? Definitely that and commercial greed. While my son languished for five days in the clinic in Moutiers with a compressed vertabra the admin. manager came up several times with her clipboard and told us: "Don't be in a hurry to leave!" I'm not surprised; the clinic is used for dementia patients in summer and during the ski season the owners open another wing and transform it into a lucrative orthopedic hospital, which receives the broken skiers from all the surrounding resorts and keeps them while their insurers slowly work out how to get them home.

They insisted on making a special plastic corset for our son to wear, thus trapping us in the clinic for five days. On returning home we went straight to see an orthopedic consultant who said: "With a compressed vertebra, here in the UK he'd have been sent straight home with instructions to take it easy for a few weeks!"

In reply to KevinD:


But also the ones with generally better outcomes. And don't, please, quote the Commonwealth Fund report back to me like everyone does. It doesn't measure outcomes.

In reply to Postmanpat:


So you're saying we spend less per capita and have worse outcomes. Unless Hunt thinks that his plan can achieve better outcomes without committing more money, in which case he should explain how, it's still going to take more money to improve outcomes. This government is being judged by many on its record rather than its rhetoric, it has done everything it can to reduce or limit spending, and services have invariably been reduced because it hasn't been possible to offset the reduction with 'efficiency savings' (higher class sizes, reduction in children's services, a crisis in psychiatric provision, etc.)
One either has to take the view that more people will fall through the net, or redefine the scope of the net to say it is no longer designed to catch them. The majority of the population don't want to see the scope of the healthcare the state provides reduced, but the Government removed its legal obligation to provide a National Health Service, and Hunt has consistently claimed doctors will not be worse off, leading to the inescapable conclusion that the existing resources must be spread more thinly during the week.

There has been no evidence of a holistic strategy, which leaves the question: Are the driving forces behind this following a path proscribed by their political dogma without thinking it through, or have they got a plan that they aren't letting the rest of us in on? And if the latter, what are they hiding?

Without a legal obligation to provide a National Health Service there is no way to challenge the actions of the Government until an election, a lot of people are worried that by the time that comes round (although with the Labour Party currently failing in their job of mounting an effective opposition, after a probable second term) so much damage will have been done that it will be nigh on impossible to turn it around. It looks remarkably like how PFI was introduced (I am not blaming the Conservatives for this one, just to avoid doubt) a course of action was entered into that even if it was later judged to be poor value for money and a continuing huge drain on the resources of the organisations paying for it, at the time there was no way to refute the claims that it was the best way to pay for big capital projects. By the time the consequences are known, hands are tied and there's no way to escape it, it has been imposed on people who don't want it, didn't support it, and those responsible have moved on to the House of Lords or Directorships or onto the books of lobbing groups, or maybe some combination of the three, and the politicians now leading their respective parties can say, that wasn't us, that was the old guard, we're different.

In reply to EddInaBox:

And yet in all this whenver I or my family uses the NHS I get an excellent service ( that includes my Mum and Dad in their mid 80's). That is measured in using it in the last year. Go figure.

In reply to blurty:

Actually it isn't. For instance, front line care is provided by GPs which are private businesses. This has always been so; they were never nationalised.

The NHS is an overarching brand that covers a lot of separate organisations.

In reply to galpinos:



I'd break the NHS up into autonomous regions, funded by local income tax (on the basis that the rich pay more). I'd end collective bargaining of (over-paid in my opionion) professionals.

Central funding would remain for R&D and specialist/ unprofitable specialist functions.

In reply to blurty:

I wouldn't do that, personally, as the postcode lottery would get worse.

If wanting to change things to a different system, my inclination would be towards National Insurance actually becoming a nationalised insurer (with defined benefits for everyone), but with payments being based on affordability rather than need or risk, then existing hospitals being made into independent charities. This is roughly the German system, and isn't hugely different from the Swiss one.

The commercial sector could, if it wished, and as it does now, provide add-on policies for enhanced services such as your own room when in hospital.

In reply to MG:

Those charts always seem to show me how well we have done in the past and how the methods we may be looking at from other countries in good faith may end up costing us more. I think we need to increase spend to the same level as the main Europeans and be honest about impact of cost inflation for kit and drugs... the basic service cannot be perfect for everyone. I also think the figures are about our current old folk... the future holds the results of a public health disaster in terms of the growth of obesity related illnesses (excuse pun) albeit a reduction in early smoking deaths.

In reply to Timmd:

I don't think we're going to solve our looming health service crisis by tinkering - a little more or less use of private contractors by the NHS here - changes in staff contracts there. The fact is that health costs are far outstripping general economic growth for understandable reasons, largely the development of new and expensive treatments, and people living longer (which doesn't necessarily mean greater costs per person if we stay healthy longer, but does if the NHS expensively cures us of, say, cancer, and we then return 10 - 20 years later with something else).

We need to have a proper debate about whether we continue with the aim of providing the best possible health service to everyone, paid for by taxation (or an "insurance" scheme into which the rich pay more than the poor) , or whether we have to accept that the best possible health service in future will be restricted to those who can afford to pay privately. In principle I'm firmly in favour the former, but we must understand that this implies very serious increases in taxation for middle as well as higher earners, and be prepared to vote for a party that promises this. Are we?

Martin

In reply to Offwidth:

I thought stopping smoking was actually expensive because smokers paid tax all their lives and then dropped dead between 60- and 70, rather then going on and on, causing decades of expense!

But yes I agree. The problems aren't really about the organisation but about rising costs and willingness to pay.

In reply to MG:

Tax input was less than the cost of dealing with the problems. If you stop, health benefits are significant and almost immediate and likely future expenditure is reduced on average. Smoking was never good economics.

In reply to MG:


It is incredibly hard to assign values to the various components that make up the total economic costs and benefits of smoking, it's not possible to state with any certainty what the totals are.

http://fullfact.org/economy/does-smoking-cost-much-it-makes-treasury/

In reply to Martin Hore:

Why shouldn't everyone pay more and take responsibility for their own health? The UK is creating two class society, with it's ever increasing tax threshold etc.. better if everyone pays a share of tax, rather than moving towards a system where the very few, support the masses.

In reply to summo:


??! Do you understand how taxes work? Have you not heard of indirect taxes?

In reply to Gordon Stainforth:


And your point is?

In reply to summo:


Everyone is paying their share of tax. Even those who have virtually no surplus income to spare. The people who are probably paying the smallest proportion of tax are those on very high incomes who can hide most of it away. The brunt of the tax burden is still borne by the middle-income workers, i.e. those who are doing the most work/ generating most wealth for our economy. Where it's all gone wrong (of course, don't want to treat anyone as an idiot for saying it) is in the promotion of the idea that taxes per se are wrong, particularly, fairly balanced income taxes. Most of our present problems, I submit, are a direct result of a crazy idealogy that, at the end of the day, shows a reckless disregard for balancing the books, as well as for the most basic principles of fairness.

In reply to blurty:


You do realise that virtually all health professions remuneration is negotiated by 'independent' pay review bodies?


Where would you place services like mental health or learning disability acute care?

So many posts on this thread are clearly by people who don't know how the NHS actually works!

In reply to abr1966:

Thanks for your knowledgeable input. Please keep posting ... to correct the armchair experts.

In reply to EddInaBox:

If you add up the figures in the article the top of the range is over double the tax take... you can't pin it exactly but costs due to extra health bills, and economic costs due to lost time at work, early death, fires caused by smokers etc when combined certainly seem to be at least of the order of the tax take and most serious researchers who have looked at the overall picture said billions over. This is before we talk about the morals of an industry that sells things that cause millions of early, often nasty, deaths.

In reply to MG:



I kind of thought I'd just prompt the debate really...

In reply to Gordon Stainforth:
I think you'll find that the richest 5% pay way over 50% of all tax revenue, so your whole anti rich argument is a little flawed.

Without everyone paying more tax, the UK isn't going to get better publics services it wants, simple, there is't a country in Europe or the world that has better for less.

In reply to summo:

Isn't it the amount of tax paid as a proportion of income which is/ are the (most) relevant or important figures?


I agree.

In reply to summo:

So, in our economy 5% of the population are earning way over half the taxable income of that total population? That can't be good for anyone in the long term.

In reply to Timmd:


Yes, and if you are a higher earner you already pay more? So perhaps a few percent add at all levels?

In reply to summo:


That's exactly my position. Plus the additional point that taxes should never have been brought to such a foolishly low level in the first place. Only a complete idiot and/or a politically irresponsible power-mongering maniac would ever do such a thing.

In reply to summo:


A few per cent would not have been necessary. Just one per cent, or even half a per cent, higher over the last 35 years would, I suspect, have been sufficient for us now to be laughing, relatively speaking. (35 years is not a vague time span, btw.)

In reply to Gordon Stainforth:

It's the same age as me and the time when the approach to economics and tax was radically changed.

In reply to Timmd:

Can you imagine what it was like to live through it? I was nearly 30 years old when that particular disaster struck. About the biggest national disaster I can recall in my lifetime. It now looks as if we may be heading for an even more disastrous one.

In reply to summo:

In terms of the health service the waste that I see is sickening.....not from clinicians in front line service but in the creation, maintainance and administration of an 'internal market'. The cost of this is multiple billions.
We have clinical commissioning groups 'commissioning' services, ridiculous contracting processes, absurd notions of 'outcome measures' and increasingly 'payment by results'.....all of which has a huge beurocracy and governance costs. The hidden costs are less measurable but probably even higher in clinicians time wasted to produce infinite stats and reports. Having spent most of my working life in the NHS I have never seen it less efficient and overwhelmed by false and unnecessary
In my area....child and adolescent mental health, each clinical contact of 45-60 minutes requires 1 hour of admin time. Around 40 minutes of this hour is not patient care related but all of the other rubbish we are required to complete. We are being bombarded by excess demands from commissioners for outcomes with simplistic models that do not reflect any complexity of real world issues.
People such as myself, as senior clinicians spend most of our time in non clinical tasks to mitigate and mediate the connection between clinical and non clinical issues with commissioners and so on. It's a bloody shambles.
There is huge money to be saved in irradiating a false 'market' and having a public health system understanding local health demographics and dividing the funds according to this and not a false market concept.

In reply to abr1966:

'irradiating'? Did you mean that?

In reply to Gordon Stainforth:

would be one solution to it!

not sure it would go down well with the CCG staff though...

In reply to Gordon Stainforth:

Irradicating!! Typing on my phone!

In reply to Gordon Stainforth:


I think it would need more, NHS with a million employees, modern equipment, drugs, it is a potentially bottomless pit with an ageing population, drink, diabetes, obesity... All of which will still need to tackled, only with insufficient funds.

In reply to abr1966:

I agree it is probably because much of the NHS is run by people who see themselves as astute business managers, but don't have the skills to operate as such in the private sector, making careers out of hiding and promoting each other in the public sector. Without a cull, I see no improvement.

In reply to summo:

I agree with you partly, however, the NHS is crippled by ideological political restructuring every few years and the current system supporting 'business' orientated dogma is a political issue which I can't see any resolution to at the moment unless Corbyn gets elected (which I don't think he will) and gets rid of the 'market' in the NHS.

In reply to Timmd:

http://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantli...

Jeremy Hunt was a co-author of a book called Direct Democracy calling for denationalisation of the NHS

In reply to Timmd:

"Mitchell is also furious with Hunt’s suggestion that the new contract will introduce a sense of vocation for medical staff. “That is the most inflammatory and appalling thing to say as a health secretary about junior doctors,” she said."

That's Andrew Mitchell's daughter talking. "Introduce a sense of vocation"!!! I'd like to stamp on the cnut's throat.

In reply to Yanis Nayu:

Yes, why the hell else would they train for 7 years if it wasn't a vocation?

In reply to Timmd:

That's precisely why they're so angry. Being told that the new contract will 'introduce a sense of vocation', when of course their whole career is already a vocation. And this comes from Jeremy Cnut, who has no sense of vocation whatever, except perhaps to be a time-historical cnut. His behaviour is so perverse that future historians and psychiatrists will, I'm sure, find him a quite extraordinary case study.

In reply to abr1966:


Sorry to tell you this, but 'irradicating' isn't an English word either. Or in any language, afaik.

In reply to Gordon Stainforth:
it used to be, but it was eradicated...

In reply to Yanis Nayu:



No it didn't. The book had one line "We should fund patients, either through the tax system or by way of universal insurance, to purchase health care from the provider of their choice." which may have hinted at an alternative funding mechanism-presumably a return to a hypothecated national insurance.
There is no evidence Hunt wrote it. The most likely writer was Hannan. In any event Cameron has slapped it down.
To regard this as evidence of a secret plot to dismantle the NHS is conspiracist nonsense. By the way, at this stage you're supposed to mention the American health insurers lapping at the door of Westminster

In reply to Postmanpat:

Dare I suggest you're treading in v dangerous waters now, that may come back to haunt you if you're proved wrong? You talk as if 'Cameron has slapped it down' still has some kind of shred of credibility.

In reply to Gordon Stainforth:

Well, I think I burnt my bridges on this one some time ago!!

The trouble is that the evidence doesn't support the concerted campaign to accuse the Conservatives of privatising the NHS. The official figures show that 2005-2010 Labour outsourced 0.5% per annum to the private sector. Up to 2014 the coalition outsourced 0.25% per year. So the Tory led coalition did less than Labour.Even now the % is only about 6%. Hardly a headlong rush. (To put that in context, in socialist France it is about 35%.)

Interesting that, despite being asked, none of the scaremongers ever come up with numbers on this.

I don't think there is any doubt that outsourcing to the private sector will the evidence suggests it will be on a gradual and pragmatic basis.
As for changing the funding structure, personally I think it will have to happen eventually and the it would be ludicrous for it not to be publicly discussed, but so are lots of things that don't become government policy.

In reply to Postmanpat:

OK. I'm fascinated by the way many of our European neighbours manage to do it, particularly Norway and Sweden, for example. But the present source of the problem in the UK now is the impression given by successive Tory governments that we shouldn't be contributing so much, fiscally, to our health service, i.e. that it should be privatised a lot more. What everyone is asking and wondering is where JC and JH are actually taking us. Just what might our health service look like in a decade's time, if they have their way? Most sane human beings have absolutely no faith in their pronouncements. All the signs suggest that they have a deeper, less benign plan. (See various other threads above re. Hunt's other interests and involvements on this subject.)

In reply to Gordon Stainforth:

JC?

In reply to Gordon Stainforth:


by paying much more in tax. Sweden, everyone pays 30% and beyond on all their wages. Tax free threshold is about £1.5k. Then for a nurse or doctor surgery it's about £12 a visit, hospital/A&E/Specialist around £25 a time, with an annual cap of roughly £160. Prescriptions they cost more too, but also with an annual cap. It doesn't matter rich, poor, young or pensioner you pay for prescriptions, only kids doctor visits are free. Overall I would say I get a better service though, in the nearest big city there is an out of hours doctor surgery until 9pm every day, so A&E doesn't get swamped. Specialist referrals are very quick in my experience.

Also for the staff the idea of working 40 plus hours doesn't happen, free time and family time rules in the health sector just as much as anywhere else, the solution is they simply employ more staff. But, a doctor / consultant won't be paid as much here, the untrained nursing assistants and cleaners will certainly be paid more than the UK.

In reply to summo:

We pay around 30% income tax in the u.K. many of us much more.

D

In reply to Gordon Stainforth:
>
Is that really what they have been saying? All major parties have agreed that there are limits to fiscal spending and since healthcare is one of the biggest budget items there must be a limit to that. Th challenge is therefore to get the maximum bang for the buck out of a finite amount of bucks. ie.maximise productivity.
Some argue that this can be done just by better planning and cost controls within a top down, or entirely public system.So limited spending doesn't, of its own, imply privatisation.

However, all the major parties have acknowledged that improving productivity might be best achieved by enabling external. ie.private, entities be paid to provide some services, just as they are paid to provide equipment.

Any discussion of alternative funding schemes for healthcare has basically remained off limits. Of course many European countries have different funding schemes-either co-payments or public sector insurance, or compulsory private sector insurance. My expectation is that eventually the UK will have to acknowledge that however services are provided-private, public, non profit or whatever, we will eventually have recourse to alternative funding.

The Swiss system of compulsory minimum health insurance, subsidised for the poor, which can be topped up for those who wish, produces excellent outcomes. Overall the Swiss spend more (% of GDP) on healthcare but the State pays less, whilst ensuring everyone has access to high quality healthcare.

In reply to Postmanpat:

https://en.m.wikipedia.org/wiki/Healthcare_in_Switzerland

Several factors make it unlikely to be adopted in the UK perhaps the biggest being the suprisingly low pay differentials between the lowest and highest paid. The cost per capita is a good bit higher than the UK

In reply to Dauphin:


That's not the base rate in the UK though and the UK zero tax threshold is five times higher than Sweden. Base rate varies regionally, 30-32%, most pay a few percent unemployment insurance scheme tax too so generally everyone loses around 35% of ALL their income on tax.
Then those over roughly £50k lose an additional 30% of any income over £50k and if you are really doing well that extra take increases. So if you earn 100k plus then you will be saying goodbye to over 60% of ALL your income.

Edit, I should add, whatever an employee pays in tax, their employer must match.

In reply to Postmanpat:


What makes you think that if we simply upped our GDP spend to Swiss levels with the existing system, we wouldn't get similar outcomes? Given the variety of systems and very close "outcome/pound" in each, I can't see the system is really the issue (USA aside, of course)

In reply to MG:

We might,we might not,although evidence tends to suggest that productivity doesn't increase in line with spending. But we'd definitely have a substantially higher budget deficit .

Why should it not be explored as one possible option that we can learn from?

In reply to summo:

It really is extremely difficult and potentially misleading to compare tax rates in different countries. For example, as mentioned above, the Swiss pay a substantial compulsory health insurance whereas in Britain that is funded from tax. Different income tax thresholds make a significant difference to the amount of tax an individual pays. And any comparison of national income tax rates ignores consumptions taxes like VAT and local government taxes.

There are two major components to tax - payment for the services government provides, and re-distribution of wealth from rich to poor. In countries with a larger discrepancy between top and bottom earnings, like the UK, the above averagely rich should IMO expect to pay a higher rate of tax to compensate.

Martin

In reply to Postmanpat:

Exploring is fine but changing to a new system will be very expensive, so before doing so there needs to be good reasons and strong evidence to suggest it is better. That doesn't seem to be there with the Swiss or other systems, which mostly have slightly better outcomes for somewhat greater expenditure (who'd have thunk it!?)

In reply to Postmanpat:

I would suggest it's the desire for a surplice which is putting screws on spending on public services, providing lenders to the uk are happy enough with our ability to repay - which they have been in times without there being a surplice, then these straightened times are (partly) a political choice rather than one of necessity.

PS. The Conservatives have been giving extra funding to Conservative councils like in Oxford to keep them sweet - so they don't have to make the same levels of cuts as if they weren't getting the money, which means people who live in these areas are more likely to vote Conservative again, through being less effected. How fucking immoral is that?

I don't usually swear....but that's 'sneaky'.

A very dear family friend is a tory by the way, so I don't dislike Conservatives on sight...

In reply to Timmd:


I agree. Naked priests are a terrible thing.

More seriously, is running up more and more debt really wise? (I know it's not quite that simple, but a "let's keep spending money until we can't" is hardly a wise policy.)


Have you got a link for this claim?

In reply to Timmd:
>
If you think that governments favouring councils of their own persuasion is either new or unique to the Tories then I think you need to catch up with the real world a bit!!!

http://uk.environment.conservation.narkive.com/dBKlvajW/nulabour-diverts-bi...

In reply to Postmanpat:

Yep, unfortunately instead of adopting a mix of private and public healthcare paid by patients but insured by the state, which is the system that seem to offer the best outcomes, the plan seems to simply be for the NHS to pay private companies to deliver healthcare on its behalf.
That is compeltely bonkers. It won't deliver better outcomes, and the state will get scammed, like they they get massively scammed by Serco, G4S, Atos and the likes.

In reply to RomTheBear:

And the MPs with interests in the private companies will be rubbing their hands together.

In reply to RomTheBear:


Well don't tell me about it! Tell those who think that any private involvement, either provision or funding, is the work of the devil and thus suppress sensible debate on the topic.
Presumably you think it axiomatic that the State sector is so useless that it is unable to negotiate a decent contract with the private sector?

In reply to Yanis Nayu:


Ive been trying ro get some details on this. Can u help?

In reply to Martin Hore:

Don't think it matters how you compare, national, local, high or low earner, Indirect or direct tax in the nordics it is higher, if you want better public services etc.. state funded it needs paying for, and not just by the rich elite.

In reply to summo:

There are other ways the NHS could be improved, or helped, but funding is always going to be the main problem. A top heavy management structure doesn't help the NHS one bit. Neither does the inability t get rid of ineffectual staff. Also the remit of the NHS should be looked at, could services such as diabetes care, and cancer care be outsourced .

In reply to: BigGer


http://www.kingsfund.org.uk/projects/general-election-2010/key-election-que...


The nhs doesn't have a top heavy management structure- see link. Though numbers have increased they still make up less than 4% of the workforce.

My experience is that there are in fact too few managers, trying to push through too many 'transformation agendas'...

In reply to no_more_scotch_eggs:

Reasonable, my views on it are coloured by my experience working in NHS mental health.

In reply to Timmd:

Worth a read

http://www.theguardian.com/society/2016/feb/09/which-country-has-worlds-bes...

In reply to Postmanpat:



There is little competition and the companies involved are connected to the highest level of power. This tend to make it impossible to deliver a good deal.

But that was not even my point, what makes private / public mix such as what there is in Germany and France so good is the fact that the patient is a paying customer, and therefore the care becomes organised around him/her and not around a set of targets recommendations set at national level.

With the form of privatisation the NHS uses you don't get any of that, instead chunks of the care delivery are simply contracted out to private companies. It's a worst of both world solution really.

In reply to Big Ger:

I agree entirely on your thoughts of the management structure and sorting the wheat from the chaff.

Private clinics, yes, small independent specialist units. I had a mole removed here by one. You make your own appointment direct, no referrals, you pay the same fee up front when you attend and I presume they claim the rest back from the state. From my first phone call, suspect mole removed that week. Results from lab in two. It's a very small show, that is all he does, no management structure, everyone there is customer facing.

In reply to summo:

Re management structures- did you read the link I posted in reply to Big Ger? The nhs is overall undermanaged not over managed. Your one man band dermatology clinic sounds great; and in fact that is similar to how most health care is delivered in the UK (by gps, with very little management input). But it would not be suitable for managing a large acute hospital , with dozens of departments, and thousands of staff. Nor can you provide comprehensive and coordinated urgent care across the range of clinical need from lots of loosely connected one man bands.

The nhs needs to change, and find better ways of providing integrated and effective care to a growing population of people with complex multiple long term conditions and frailty; or else it will not survive. Working out what that integrated care model, or models, should be, and changing organisations to deliver it, won't happen by magic; it will take managers. My fear is that we don't have enough, and enough good, managers to do this

In reply to RomTheBear:




I agree with this last point.

Don't dismiss the benefits of national evidence based guidelines and quality standards though- these are powerful tools to improve standards. It's impossible to independently keep up to the cutting edge across all the areas that a practitioner is likely to deal with- national guidelines ensure that the best practice is set out in a way that is easy to access. These developments are ones that the nhs is internationally recognised for.

In reply to no_more_scotch_eggs:


Guidelines and quality standard set at national level are important and do exist in a semi private system like the French or German one.
But the main thing with the NHS is that inevitably guidelines are set to offer the best health outcomes on average for a given budget, when in fact the goal should be to offer the very best care for each individual patient.

Now I am pretty convinced that the same kind of patient-centred care could be delivered by a socialised healthcare provider such as the NHS, with proper management, funding, well designed incentives, and a strong political will.
But this government has set out to do exactly the opposite, so it's kind of doomed at this point.

In reply to Postmanpat:


http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lans...

http://socialinvestigations.blogspot.co.uk/2014/03/compilation-of-parliamen...

In reply to Yanis Nayu:


To put this in context, I think the whole system of electoral funding and lobbying etc needs to be re-examined, although I don't see an easy solution, especially in the Lords, the whole point of which is to contain people who are experts on their subject.
Lansley's donation from Nash was actually a private donation to CCCHQ. I agree it's not great but I'm not sure how the system should work.

Have you actually looked at the list? If Jeremy Hunt had produced it you'd dismiss it as a tissue of mendacious propaganda. Most of it barely rises above "I danced with a man who danced with a girl who danced with the Prince of Wales". Hunt received £3k (wow, game changer) from Caxton, a US hedge with $217mn invested in healthcare. Funnily enough it neglects to note that Caxton has over $8bn not invested in healthcare and that most of the healthcare investments are probably not in the UK. So the helthcare "connection" is basically non existent.
Or, to pick another high profile one:
50. Jacob Rees-Mogg: MP for North-East Somerset: Partner of Somerset Capital Management LLP, who have Redwood Emerging Markets Dividend Income Fund as a client, which invests in Healthcare. MP for North-East Somerset, has shares in Lloyd George Management Ltd; investment management, who invest in Healthcare. According to the electoral Commission, he received £2,000 to his constituency office on the 14th April, 2010 from Mr Robin Crispin Odey, a hedge funder who has invested in Circle healthcare.
The clue is in the name for "Redwood emerging market dividend fund". It invests in emerging markets, not the UK! (as, so it happens, does Llyood George)
So all JRM has is a has a directorship of a company that has fund management companies as clients that may (but probably don't) have a few shares in health care companies which may (but probably don't) benefit from a private NHS provision.

In reply to The Lemming:


People have been say that since the day the NHS was created.

Oddly or not as the case may be Labour politicians are raking in millions from private healthcare.

In reply to no_more_scotch_eggs:

Do you really think the NHS is under managed and needs more managers? Of all the problems it has, I struggle to believe that anyone other than an NHS manager would agree with you.

Why do several small clinics have to be disjointed or badly connected, it is about how you set up the system. Problems occur when a massive organisation tries to operate like it did in the 50s when it first evolved. A business that started as a corner shop, then developed into a global chain, would not retain the same structure etc.. the NHS needs to evolve.

In reply to summo:
Whilst there may be resources wasted in the enforced chasing of top-down targets, the NHS is under-managed. Massively so.

Average % of workforce employed in management in top FTSE-100 companies? About 10%. In the NHS it is between 2.1-3%.

Away from the clinical side a lack of managers is incredibly evident in the poorly implemented IT-infrastructure projects that plague many Trusts (see, for example, Addenbrooke's Hospital, NPfIT or the story of Lorenzo) and procurement.

Good management is also about providing providing service co-ordination. GIven that 70% of the NHS' resources go on about 15% of the population with Long Term Conditions, this is crucial to stop people becoming acute / improve their quality of lives / save us money.

I don't deny that there is some wastage in the current design of the system, with the multiplicity of Trusts + the CCGs, NHS England, CSUs, Providers and other organisations. However, that doesn't make the NHS over-managed, just overcomplicated. Fundamentally the NHS could do with more managers.

"Why do several small clinics have to be disjointed or badly connected, it is about how you set up the system. Problems occur when a massive organisation tries to operate like it did in the 50s when it first evolved. A business that started as a corner shop, then developed into a global chain, would not retain the same structure etc.. the NHS needs to evolve."

You underestimate the complexity of Healthcare. A mole being removed is no way representative of the majority of healthcare provision. LTCs dominate the budgets of the NHS and no-one's going to die or be seriously injured if the clinic mislays the file on your mole.

In reply to summo:



Problem is the I.T. capability it 'utilizes' is lamentable, certainly at the clinical end.

D

In reply to BenFitzG:

Management of LTC is compromised every day by inadequate handover, limited information sharing capability between clinicians and illegibility of written medical notes. All for want of a simple to use universal medical records system. Its 2016 and I still have to wade through pages and pages of poorly scrawled notes to get what I need to know about a patient, assuming I can translate non standard abbreviations and the actual handwriting. Doesn't even begin to include the dangers and inefficiencies created by different results systems between hospital and general practice.

D

In reply to Dauphin:

Completely agree. I work in a Mental Health Trust - the lack of systems built to provide integrated care for people is utterly ridiculous.

To go back to the point above though; you're going to need leaders, people to drive the change, some of whom will occupy management positions, if things are going to be different.

In reply to BenFitzG:
I don't have a paper file on my mole, any doctor, hospital.... Can log into my health record using only my personal number, information sharing is instant. Although I should point out people do die from illnesses started from moles, so not losing any file is important.
I imagine another manager Is just what nurses and doctors think about at the end of a tough shift.

In reply to BenFitzG:
It's not going to happen. Trusts get all horny about management consultancies who come in and tell them how to do it - supposed to be the other way around, no?

We seem to have a different records and results system (maybe, doesn't exist in every) in each acute trust, community trusts and general practice. Billions spunked away in I.T. infrastructure. You kind of start to think it's all this way by design.

Oh yeah, the result beinng dead, injured and badly managed patients as a result of the lack of effective national leadership in this area.

Personally I think we should down tools over this as much as any current or forthcoming pay and conditions deals.

Personal interest - I'm a intensive care nurse by trade, I've moved home to look after my Dad for the past few months, his care in both hospital and community compromised again and again by ineffective I.T. "Playing at hospital" as my Dad phrased it. Embarrassed to a part of it to be frank.

D

In reply to BenFitzG: .


So perhaps sack some ineffective lifer managers who are just coasting, replace with better paid managers who might only stay for a decade before moving to another challenge?

In reply to summo:

If you could back up your opinions with evidence as opposed to insults and meaningless comments I would be more minded to give them some credence. "This is the last thing NHS nurses think about" and "coasting" managers - I think the intensive care nurse posting above you shows the ignorance of your first point and, yeah, the NHS is burdened by some shit employees, as is every big organisation. There aren't many though, and there especially aren't many in management as they keep getting sacked - we're at the lowest number of managers ever in the NHS right now.

In reply to Dauphin:


Not the way it should be done. My trust employs business analysts and developed its own electronic health record - the individual modules were designed by clinicians who have continual input into their development. It can be done.


Not design, stupidity, a proliferation of politicians who don't understand IT . My city has three Trusts + GPs, at least 5 different record systems being used (that's ignoring ICE, pharmacy management systems etc - The teaching hospitals had 15 or so electronic systems at last count). Now we're doing interoperability projects trying to get systems to talk.





So much is done badly, it's embarrassing and it's handicapping clinicians. If we don't start doing something about it it's only going to get worse.

In reply to BenFitzG:

Evidence, I can only base my opinion on my own experience of the health service and of friends who are doctors, managers and other staff in the profession. I can't fault your loyalty, but I don't think the managerial competence is anywhere near as high as you think. I don't think the management competency is any higher here in Sweden, only that because of the tax regime and the fact you pay per visit they can throw more money at the coal face.
If a health professional was regularly working 50hr weeks, then they would just employ more staff etc.. junior doctors doing 70hrs a week etc is just madness.

In reply to summo:



perhaps not at the end of the shift, no.

but at other points yes. our trust, like probably all others, has a continual stream of 'transformation projects' on the go. i have no doubt these are necessary; with 3% of the budget cut every year, year on year, funded by 'cash releasing efficiency schemes', we have to do things differently or services get cut.

these are complex projects which if done badly will literally kill people. they need managed, and managed well. i think trying to implement these while also carrying out all the 'routine' management activity, on 3.5% of the total staff numbers, when business works on treble that proportion, is asking a lot.

so yes, i do think another manager, or in fact significantly more managers, would be helpful

In reply to summo:



how many NHS senior managers do you know?

i know quite a few, and i dont think any of them are chumps.

and anyway, basing a plan on people being better than they are in reality is a making a plan thats doomed to failure. they are on average competent in my eyes; we just need more of them if we are really going to get the service changes that we need to avoid the perfect storm of demographics, frailty and multiple long term conditions sinking the NHS

In reply to no_more_scotch_eggs:

2, my whole life and various others I've encountered, obviously anyone work in the NHS will know many many more.

I doubt many are chumps, but they can be a really nice person and still be completely useless at their job.


Perhaps the NHS doesn't need 'average' managers, it is an organisation of a million people, it's annual spend is more than many countries total annual budget, I would suggest it needs some outstanding people?

how many NHS senior managers do you know?

My Trust claims that the clinical/non-clinical staff mix is 52/48. Obviously many of are support services. However, many of the middle management are former nurses. These people manage to maintain their professional registration despite not having regular patient contact. It's a play on the numbers to make things look better than they are. Still I wouldn't any of these people looking after my family.

In reply to summo:



Not necessarily. I went 15 years without meeting one. Im now in a senior enough position in a small enough trust where clinical engagement with senior managers is good enough that I do frequently deal with them.


Outstanding people would be great, and some will be. But for an organisation the size of the nhs to rely on its management cadre being exceptional performers seems risky to me. .. the system and structures should assume that people are competent, and be able to succeed on that basis.

In reply to Removed UserDeleted bagger:

It varies from trust to trust I guess. The lower and middle tier management in my trust are also largely from nursing backgrounds; but the ones I've dealt with tend to be very good experienced clinicians to. At the team leader level, perhaps they aren't all excellent managers; but then it's people we're employing not robots. They aren't all going to be outstanding at everything. Are they 'good enough'? In my experience, yes.

However I fully accept the non-generalisability of my observations. Different trusts in different locations and sectors may well have very different management cultures.