UKC

There was an interesting article on the BBC News site where Margaret Thatcher resisted her chancellor's pleas to referb the kitchen in Number 11.

Not very exciting, until you read to the end of the article where Maggie considered scrapping the NHS.

http://www.bbc.co.uk/news/uk-38101020

Is this burying news within non-news?




Another document in the National Archives outlines radical plans to end universal free healthcare.

The document stamped "secret" was called, in keeping with films and books of that era, "The Omega Project".

Civil servants noted that "for the majority it would represent the abolition of the NHS".

But in spite of what was described as the nearest thing to a Cabinet riot in the history of the Thatcher administration, the prime minister secretly pressed ahead with the plans - later backing down.

In reply to The Lemming:

she's not prime minister, or even alive, now, so i don't think there's much risk of her going ahead with it...

In reply to no_more_scotch_eggs:
There's plenty of her followers alive that would.

To quote John Major

"Michael Gove wanted to privatise it, Boris wanted to charge people for using it and Iain Duncan Smith wanted a social insurance system," he said. The NHS is about as safe with them as a pet hamster would be with a hungry python."

https://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantl...

Hunt is trying to dismantle the NHS by ruining it and then claiming it can't be fixed.

In reply to The Lemming:

It does seem to me that the BBC is hiding this. More info here anyway. http://www.independent.co.uk/news/uk/politics/margaret-thatcher-welfare-sta...

In reply to The Lemming:

It is a leviathan rolling uncontrollably down a hill. Until this changes it will never be truly safe from political meddling.

In reply to The Lemming:

The real question is why the NHS, in its current state, is worthy of the sacred cow status it has. Strikes me that other countries manage a far more efficient health service than we manage.

In reply to GrahamD:

Its got nothing to do with efficiency. If it did we would have different models set up on a test bed all over the country to find out which worked best in terms of cost vs outcomes. On the other hand it's ridiculous that you have to accept whatever level of 'service' they offer ( as someone who works all over the country, it truly is a postcode lottery)and are unable to top up or pay for better hotel services, private room, food etc.

D

In reply to GrahamD:

this always gets said, but its just not true. all international comparisons of healthcare systems rank the NHS at or near the top for efficiency, and accessability. its in outcomes that we lag behind.

all other comparable countries also spend considerably more as a proportion of GDP than us.

the unanswered question is, if we put a comparable amount of resource in using the current structures, would we get a high efficiency, good outcome service? Or would it introduce inefficiency?

I'd like to at least see us try that, before deciding to move to some other system, as no other system offers the holy grail of efficient, effective care, and some options we could try are much, much worse.

In reply to GrahamD:

go and actually look in to independent reports comparing different countries' health care systems. Despite current issues the NHS comes out rather superbly.

It falls down in two areas -
1/ when compared to private care in (generally) this country. Well yeah. Because the people lucky enough to afford it are paying considerably more. No one said it was the best care that money could buy, but as a free service on a tight budget it does bloody well and saves a lot of lives.

2/ it's being ****ed over by the tories. Reduce budgets to so low they can't cope, then fine the hospitals out of their budget where they fall down, meaning the next year they more likely to fail. Set up rules that they have to use certain suppliers who line certain people's pockets, who then charge extortionate fees for the drugs and equipment, meaning the NHS is competing in a game where the rules are rigged against it by the people who want it to fail. Prevent them hiring adequate staff so they have to pay much higher costs on agency staff...which again means the system is rigged against them. Yes there are also some other inefficiencies within the NHS - mostly because successive governments (and none worse than the last couple of Tory ones) keep screwing around with it to win a few political points rather than letting the experts work on making it more efficient.

It IS deserving of great respect and gratitude, and if the Tories stop doing their best to sabotage it then it can do even better.

but well done for reading the Tory and right wing media propaganda and believing it

In reply to GrahamD:


'Efficient'? By what measure?

Could you point to one that you think is more efficient?

The NHS has many problems. But many of those problems are the result of piecemeal political 'initiatives' and restructuring. And being forced to waste money on external management consultants who send in children fresh out of college to sit on their arses for weeks, charging £1000 a day, or, at best, repeatedly pester the staff for the same information/suggestions which they parrot back as their 'recommendations'.

In answer to the OP's question: a very firm 'No'.

In reply to captain paranoia:

Well I agree the NHS being used as a political football does not help the operation of the NHS nor does our habit of voting on low taxes. However that still doesn't address the question of why we blindly assume the NHS in its current state is such a sacred cow and no reforms can ever be contemplated.

To reverse the question slightly: who else in Europe, despite them allocating massively more resources to healthcare, chooses to copy the NHS structure ?

In reply to GrahamD:


Clearly that statement is complete bollocks considering every government has been f*cking around with the NHS. The only thing not messed around with (much) is the payment model.


Can we stick with your original claim about more efficient approaches? Given the increasing overall costs I would have thought that would be key.

In reply to GrahamD:

I'd say there's a ratchet effect whereby once organisations are in private hands, under the control of commercial entities, it takes a far greater upheaval to get them back into government control than it does to sell national property to those private commercial interests.

Therefore any country with an insurance system involving private companies is going to have significant difficulty moving to an NHS model, having to work not only against an established orthodoxy that "private is more efficient" but against wealthy companies unsurprisingly reluctant to fold up and go away.

And most importantly, if the UK ever dismantled and privatised the NHS there would be no going back even if it proved an unmitigated disaster.

In reply to GrahamD:

It's the nature of the reforms which are causing people concern, rather than the fact that it's being reformed 'at all' as it were.


I've heard French medical professionals speaking on the record as saying they should have a system like our NHS over in France., for what it's worth, from seeing it as more efficient than their healthcare system.

In reply to cap'nChino:

It is a leviathan rolling uncontrollably down a hill precisely as a result of relentless political meddling.

As an example....the NHS Trust that I work in spent £3.2 million over a 3 1/2 year period relentlessly trying to gain 'foundation' status...it was never going to happen as its too small and in an area where the local health economy was in a financial mess, yet again and again it was tried with a whole department of people trying to make it happen. Years on it never has happened just like anybody with any understanding said it wouldn't! The bulk of the budget for all of this came from clinical budgets!!

In reply to GrahamD:


So allocating massively more resources makes them more efficient than the NHS?

Again, what measure of efficiency are you using? Clearly not financial.

In reply to Scarab9:

Well you managed to get 'Tory' in there four times.

Could it not be that people who have 'paid their taxes' expect to get their money's worth.

People think they can abuse their bodies and turn up with incurable diseases and demand expensive treatments because 'they've paid their taxes'.

We live in an age of entitlement where people don't take responsibility for their actions and expect doctors to be miracle workers.

In reply to DancingOnRock:

I assume that you are a climber, since you're posting on here. I'd also assume that you would like to be patched up by the NHS, should the 5hit hit your personal fan.
Now a simple question: do you feel entitled to fritter away the nation's precious resources simply because you indulge in a high risk activity that went wrong?. Why should the taxpayer foot the bill for your hobby?

In reply to Andy Hardy:

There's a big difference between an unintended accident and sustained repeated self-negligence.

Yes, I would like to be patched up but I wouldn't 'expect' anyone to divert funds from someone who needed care more urgently.

The primary care trusts meet every week to decide who deserves treatment and who doesn't.

In reply to The Lemming:

Bottom line - no, nothing is safe under Teresa May.

In reply to Andy Hardy:

Yes, because if I sat on my arse and became morbidly obese rather than run around climbing lots the NHS would have a big bill to cover my long term health problems. Where as maybe 1:20,000 climbers need the NHS 100% of fat knackers will.

In reply to The Lemming:

You get the health service you pay for. UK funding per capita is very low and won't improve because the current government like all others is continuing the myth that you can keep cutting personal tax contributions and improve services at the same time, oh and clear a trillion plus of debt.

In reply to muppetfilter:


I think you'll find pretty much everyone needs the NHS at some point. I take your point about being active, but you can end up a very fit pensioner with all sorts of health problems including dementia that will cost the NHS a fortune. The fat knackers tend to die off before that point.

In reply to Ridge:

People dying early isn't very good for tax revenue.

In reply to Andy Hardy:

Amateur football injuries etc etc, probably cost far more as a whole than climbing....do we really want people to have to take out insurance for everything outside work and "essential activities"? Would this mean the lower paid couldn't participate? How do employers deal with costs of injury and illness to their workers... increase prices, lower wages, pay for private insurance, thus reducing their competitiveness? Would more people avoid getting medical care until diseases, head injuries etc were exhibiting severe symptoms?

Having spoken to a foreign health worker it seems its in the interests of some health systems to carry out tests that are unlikely to be of value...these won't hurt the patient but more fees are charged. The NHS has no interest in carrying out unnecessary work ie is more efficient in this respect. Many people might not pay for health tests and vaccinations which help keep the population/workforce fit.

As someone said the NHS apparently costs less as a proportion of GDP than in many other countries

In reply to The Lemming:

Nothing is safe in Tory hands.

Undermining the NHS is another method they can use to make their usual mark on the British economy and disable manufacturing output. One of the things the NHS is good at (though always room for improvement) is keeping poor people fit and economically active so that they can provide labour in the economy and pay taxes to pay Mrs May's wages.

The Tories don't really get economics.

In reply to oldie:


I'll raise you horse riding.

In reply to Jim Fraser:

Problems are multiple in the NHS, we don't pay enough tax and the NHS doesn't get enough money. We are living longer, but costing much much more to be kept healthy in that old age. Lifestyles have changed, although smoking is down massively, we are on average much less active and work in mainly desk bound jobs, we've built machines to do the work for us 8hrs a day, so we then pay to go to gym to use other machines to exercise out bodies for an hour or two as day, in society kids are trapped in doors at home more and schools are scared of claims for play ground accidents etc...

The only cure for the NHS is to ditch the national treasure sentiment, be healthier and fund it properly, either through more tax or a modest payment for each visit.

In reply to DancingOnRock:


It is if they're unfit for work and keep getting admitted with smoking/obesity related conditions. A fit, healthy workforce that kicks the bucket before drawing the state pension would be the ideal.

In reply to Jim Fraser:




Neither do you by the looks of it.

In reply to Ridge:


Ideally the state pension would be funded better and people would work longer.

I don't get this retiring at 65. It leads to a lot of people putting things off until they've retired, and for a lot of people it's a bit too late.

I'd prefer a phased retirement where people reduce the number of days and altering the type of work they do.

It's ridiculous that manual labourers should be labouring well into their 60s when there are young people looking for work.

In reply to The Lemming:

No.

I'd rather put my wedding tackle in a crocodiles mouth!

NHSP is a prime example of what the Tories are doing to the NHS.

running it down so they can say, "well it's not working so we HAVE to privatise".

Were sending patient to private practises because they've not replaced staff at out local NHS so the no longer have sufficient staff, so we're now giving money away to private companies.

If there's one reason to hate the Tories it's what they are doing to the NHS.

In reply to krikoman:

does it matter?

If a health services sends patients to a private facility which has good outcomes for patient for a reasonable price? Does it matter if staff there are well paid, NHS hospital consultants aren't exactly working for peanuts. They also don't have responsibility for their buildings, equipment, cleaning contracts, pensions and so forth... so they've reduced some burden within the NHS, whilst using external specialist services.

Many countries send patients to private specialists for certain treatments, but the population isn't claiming their government is dismantling a national treasure. This isn't the 1950s, the world has moved on and so should the NHSs structure. Although I do think there needs to be a few percent thrown on base rate tax if people want to fund it better.

In reply to DancingOnRock:

Either the provision of health care is free for everyone, that's fat knackers with type 2 diabetes, smokers who have got long cancer and adventurous sporty types who have an accident or it is rationed. If you start down that road, the inescapable end point is to privatise the lot and force everyone to buy insurance.
Since we are the (or were) the 5Th biggest economy in the world I'd like to think we can afford the universal model.

In reply to Andy Hardy:

Who mentioned rationing?

Don't try and misinterpret what you think I wrote and lead me down your path to cause an argument.

I replied to your question. Maybe try reading it again. I thought I was fairly clear.

Treatment is already 'rationed' in that the PCT determines which patients will be most cost effective to treat. As I wrote above.

In reply to DancingOnRock:




Agree completely. It's 67/68 now, never mind 65. There really needs to be a sensible discussion about how we fund retirement, plus getting the young into work and allowing older people to reduce their hours.

Who the hell wants a 67 year old firefighter or a 68 year old copper turning up when the proverbial hits the fan?

In reply to Ridge:

Ironic that you picked two professions where the retirement age is lower than the normal age... (likely for the reason you have implied)

In reply to Alasdair Fulton:

Fair enough. Lets take plumber, electrician or joiner. All trades where you end up with worn out joints from the work and don't get early retirement.

In reply to summo:




If it were true that it was only for specialist treatment, but it isn't, it routine treatments that the NHS would have done a couple of years ago, so we're now paying private companies to do work which would have been done by the NHS.

Like privatising NHSP, it means money which would at one time be retained within the NHS is now flowing out of it and into private hands.

By running the NHS down the road to privatisation is paved with lies and deceit. I'm all for paying a bit more tax, but I'd resent paying a bit more tax so we could spend it with private companies.

There's no reason why we should have to, but that's the slope we're currently sliding down and the Tories are busy greasing it up.

In reply to The Lemming:


No.

In reply to krikoman:

I don't understand this. If it is cheaper and more efficient for someone else to do it, why spend extra and waste money just so that people feel all cuddly and warm about public/private money.

Once you pay a nurse that money goes into their private bank account doesn't it?

In reply to Ridge:


But quite a lot of people like older people in customer service roles, as the maturity makes them often do them quite well. B&Q are quite well known for employing older staff.

Who says you have to do the same job your whole life?

In reply to DancingOnRock:

Private companies supply the NHS lots of things. Or should the NHS manufacture its own bog roll?

In all seriousness, provided the principle of free-at-the-point-of-use, and payment on affordability not need, remain in place I don't care what the system itself is, and I do think there is a lot going for some of the European mandatory social insurance approaches (there are only two countries with a "monolithic"[1] NHS, us and Cuba, but most European countries have a very good insurance based system, Germany's is particularly good in my experience). One thing social insurance would sort out is the postcode lottery - as it would result in clearly defined benefits for everyone with a "policy".

The other thing of note that many people don't know is that GPs and most dentist surgeries are (mostly for-profit) private businesses. They were never nationalised. So most peoples' main interaction with the NHS is, er, privatised and always was.

[1] I know it's not really monolithic but more a group of trusts and commissioning groups, but to all intents and purposes it's one big thing.

In reply to krikoman:



This is classic one eyed thinking. The cost of providing the healthcare has also been eliminated.

In this example the NHS functions as a clearing house for identifying the best solution, a bit like the triage you undergo on arrival at A&E. It's legitimate and efficient and promotes specialist outcomes at reasonable cost to the taxpayer.

In theory at least. I'm not ignoring the British capacity for screwing it all up. But your concept of the sanctity of the NHS spending only on itself is wildly naive. As someone else pointed out, nurses' wages go straight into the private sector.

In reply to krikoman:


What matters most, who does the work, or the outcome. If the outcome is comparable, for similar price, what difference does it make?


See above. Does it matter if the NHS has 1million employees, or just 100,000 where it directs the care to 900,000 private care workers? It's the treatment that matters.


Not if those private companies tender? Or there is some price control etc.. It is all a question of how it's managed.

I've used outsourced or private healthcare in Sweden, skincare for example. I made an appointment direct with the 2 person show in the city for them to look at suspect mole, seen within a week. Paid my 300kr (£25) which is the same fee as a hospital specialist, mole removed, biopsy and a happy letter to the house all done in under 3 weeks. No need for doctors visit first, the private practise will claim the extra from the state. I didn't waste a normal surgery doctor's time for a referral and I got fast treatment. What's not to like. You can apply the same model to many other small treatments.

It seems to me that people are obsessing over the NHS treating everyone for everything, over and above the fact that it should be about getting the best healthcare in a timely manner, where the badge someone wears to do that treatment shouldn't really matter.

In reply to DancingOnRock:



But you don't pay the nurse do you, you pay the agency, who take there cut and then they pay the nurse!!

It's not hard to understand, I've had agencies trying to offer me staff and their fees are unbelievable. They usually get 100% of the supplied persons first years wage, if you take them on as permanent you pay for the privilege.

The beauty of NHSP is the reduce their commission rates paid for staff, therefore outside agencies appear more expensive, the profits they make go into the NHS! So it's a win win situation for the NHS.

Put it this way would YOU rather pay extra for the same thing?

In reply to krikoman:
It feels like that to me too. Give a little rope and big business does take too much in fees etc. The Tories obscure this tendency with words about efficiency. I had post code lottery problems with my breast cancer diagnosis and saw for myself the disparity in different areas of the availabilty of a certain diagnostic technique - that part of the diagnosis that determines if you have the potential of having gone to secondary cancer and therefore need Chemo. No light problem then!! So that disparity annnoyed the shit out of me. I have no real idea of budget allocation , however a principle seems to raise its ugly head- give big business a road in and it takes too much- I'm seeing it with Community Trusts which have had great good effects but "consultancy " vultures convince the majority of their expertise and people can't see it is money for old rope. I'd pay more in tax and hope to keep altruism/clinical requirements rather than greed as the primary motive in the NHS.

In reply to captain paranoia:


No, being run in a more modern manner better suited to the 21st century is what makes it so efficient.

There are two seperate issues here: lack of funding (which is something we vote for because we vote for low taxes) and whether the NHS structure (unreformed) is the best way to delibver the health care. Don't you find it even slightly odd that just about noone chooses to copy the NHS model ?

In reply to GrahamD:


there in lies the problem, it's almost too big an organisation.

A central HQ leading the whole country and it become big, slow with some many layers of management or regional management, within national guidelines and some will perform better than others, thus postcode lotteries.

For better healthcare nationally, the only solution is to over fund it and accept some inefficiency and waste, which comes back to taxes and voters.

In reply to GrahamD:


Once again. The NHS structure has been continually messed around with over the course of several governments.

In reply to summo:
Sure some inefficiency and waste and despite massive political meddling (eg forcing an artificial market, unwanted political structures etc) still overall a system that is at least as efficient and nearly always more efficient than all other major western systems (more efficient than the US system per capita on the state before a cent of insurance is paid).

For Graham.. you cant copy it, it takes too much cost to buy everyone else out... we did it after a war when health measures in society were blatantly unfair and the people had had enough and voted in a democracy alongside various nationalisations and accepted pretty hard costs like continued rationing in return.

In reply to Offwidth:

Think it's wiser to ignore the US model, I don't think any country wants to copy that system.

I think measuring efficiency and outcomes, across different systems, must be near impossible. All the UK can do is look at the bits that aren't acceptable, like waiting times and outcomes and target those areas individually, as you say wholesale change across an organisation as big as the NHS has been tried and hasn't worked, multiple times. Creeping change is better.

In reply to summo:

Its not that difficult as its done: our efficiency is excellent but as we spend much less per capita our outcomes are below par for the EU.

There is a real crisis approaching as the latest sticking plaster plans don't seem to be working well on the ground (at commissioning level... funding is too short, important system details like contract lengths don't match etc) and the pressures from the gap in social care funding have never been worse. When Landsley and Crisp are sending out warnings the government should be listening but Brexit has them like rabbits in car headlights.

In reply to krikoman:





This is how it should be done if it really has to be done. The agencies only take a commission so that they can pay their staff overhead. NHSP will still have to take a commission and why do we need a separate agency to manage labour within the organisation?

The whole way rotas and shifts are organised is archaic. I've had many arguments with my friend who is a mid wife. "You get 6-9 months notice of busy periods plan ahead, it's not hard." They have a shift rota that is released on a monthly basis. I work in engineering I already know whether I am working Chrismas Day 2017. Apparently "That's not the way it's done." And "I wouldn't understand"

Personally I think there's a massive overtime fiddle going on where people are being called in on their rest days to cover when really it's an inefficient rota system. I'm guessing this is echoed all across the NHS in all departments.

No wonder morale is low and it's difficult to get nurse cover.

The unions and nurses are making it hard on themselves.

In reply to DancingOnRock:

Do you have any evidence for this or do you just THINK that's what's happening.
My sister is an A&E nurse and they're working 13 hour shifts, what your suggestion that'll make the rota system more eefficient.


I don't think it has anything to do with the unions and even less to do with the nurses, what say do they have no what shifts they work and the rotas (if that's the problem)?

Morale is low because they can see how underfunded everything is and they then get the blame for the system falling apart.

If someone kept telling you, "you're not working hard enough" or "they're closing this hospital and moving everyone to XXX", how would you morale be?

In reply to krikoman:
The rotas need to be published well in advance so that Nurses can gain control of their lives outside of work. Working 13 hour shifts is wrong. What is happening is they're going off sick die to stress and this has a knock on effect where someone else has to cover them (and get paid overtime) or you bring in agency staff.

Give nurses a fixed rota and help them find cover when they need it and it leads to nurses who have more control over their lives.

It happened in a job I did where morale was low, sickness high, the manager was fire fighting and pulling people off one job to do another. Nothing actually got done and everything just got worse.

New manager stopped people being pulled off jobs and made a plan up which detailed who was going where in the next month and told the customers when to expect an engineer.

Now obviously you can't tell patients that they'll have to wait all the time, and wards are probably crazy at times but part of the problem is organisation and the thought that you're only going to get 10 hours break before the next 13 and you're not going to get any breaks in your 13 hour shift.

That has to be addressed and is a two part thing. Nurses have to take their breaks and managers have to support them and enforce them having breaks.

In reply to DancingOnRock:


Long gone are the days when managers were there to support staff. Now it's the staff's job to ensure the managers get their statistics and quotas filled.

In reply to Andy Hardy:



Myself personally would be prepared to pay for insurance as it's my hobby and it seems unreasonable that someone else should pay

In reply to Andy Hardy:

If you find rock climbing a "high risk activity" then I suggest that you're doing it wrong, and I'd rather not be at any crag that you're visiting.

The overwhelming problem for the NHS is NOT people taking part in physical activities, it's people who do b*gger all except sit in front of their tellies eating drinking and smoking, plus the aged.

Then of course there's the drinking (and the fighting that follows it) on a Friday/Saturday - again not something regularly involving sporty types, who are usually a little tired to get involved in such shenanigans.

And if you really do want to list sporting activities in order of NHS usage, then I suggest that you start with the likes of squash and badminton (twisted ankles/knees) and lower level football.

In reply to krikoman:





I've recently started working Bank within my original NHS Trust and Agency in a different one (in order to get part time/ reduced night shifts which I couldn't get any other way).

The problem i see from this is that the NHS is so mismanaged that they are prepared to pay an excessive amount to an agency to provide flexible staff at the same time as "punishing" their own flexible bank workers by giving them lesser pay and poorer terms and conditions than their contracted employees.

For example:
In many trusts bank staff get put on the bottom point (or one point up) in there pay band meaning a Band 5 nurse with 7+ years experience getting £11.49 an hour compared to all her equally experience colleagues doing the same job for £14.56 per hour.
I get statutory annual leave (5.6 weeks per year) compared to the NHS standard of 27+8 days at the start of the career or 33+8 days per year after 10 years service.
I am only eligible for statutory sick pay/ maternity pay etc.

So if the NHS wants it's staff to stop jumping ship to agencies they need to value the staff they have already and pay the ones who provide the flexibility they require properly.

In reply to SAF:

Yes. I knew I heard about the overtime fiddle/workaround.

Essentially nurses are working in different trusts on agencies to make up their money.

The costs to the NHS are wage bills not fancy treatments or people neglecting their health, playing dangerous sports etc. Those people only add to a system that's already mismanaged.

Pay people what they're worth, give them breaks, explain what you want out of them and they'll work properly. Stress and sickness will vanish overnight.

The NHS is like a lot of public companies completely inefficiently managed.

In reply to Big Ger:


Exactly. And unless this changes then the NHS will continue to collapse under the strain of mismanagement.

This isn't a Tory thing, this is a historic thing where managers aren't trained in management properly.

Labour just poured money into the bucket and never fixed the hole.

Tories will stop pouring the money in and get a new bucket.

In reply to DancingOnRock:


The NHS is unlike most public companies because it is absolutely vast (5th biggest employer in the world to run the health service of a single middling European country)

In reply to SAF:

My big concern is the unions and the nurses don't want change. They just want what they've always done, to work properly.

Things change and unless people adapt to change (as Darwin says) they won't survive.

People don't like change.

In reply to GrahamD:


Quite. Even more important that the managers know how to manage.

In reply to DancingOnRock:


I think people need a bit of perspective on the sickness rate thing...

I am currently sick (on my day off) with a hell of a cold (hoping I will be well enough to work my shift tomorrow). Last week I went to a least 2 patients with symptoms of colds (999 calls), so I can guess where i picked it up from! Add Norovirus to all the colds and flus we get exposed to and then have to transport a patient in an enclosed environment with those symptoms and is it any wonder we get sick. Then add night shifts which are proven to suppress the immune system and it's a double whammy. And then there is the fact that night shifts increase your risk of developing all sorts of long term health problems (type 2 diabetes, certain cancers etc).

In the ambulance service we are also expected to lift patients in circumstances where everyone else would be stopped from doing so due to health and safety...one of the biggest causes of sickness/ early retirement is back injuries, you try lifting a wet naked person out of the bath after they have had a stroke!
We are also exposed to traumatic events that are clear indicators for developing PTSD... critically sick/injured/ dying kids, dead colleagues, mass casualty incidents etc. which most people would hopefully never encounter in their working life.

Low morale within the NHS is a problem for increasing sickness but it is also the attitude from the public that NHS staff are soft and pulling sickie's simply due to stress that pushes our morale down further.

In reply to DancingOnRock:


The problem with the NHS is its such a political football that getting sensibly planned reform (which would take multiple terms of government office) just doesn't happen - or if it does it happens in a rushed way

In reply to SAF:


Its unfortunate that for as long as I can remember, reports of the morale in the NHS is "at an all time low" or the NHS is at "breaking point" have been rife so the public to a large degree see it as just crying wolf.

In reply to SAF:

Totally agree. Plus you can't work with vulnerable immune suppressed patients if you are ill.

That also raises the issue of whoever is dispatching ambulances to persons in awkward positions requiring to be moved should also maybe dispatching porters. Nurses shouldn't be doing heavy lifting. Maybe something to consider? I don't know how viable that is but seems wrong to be expecting valuable medical staff to do heavy lifting.

In reply to SAF:




If ever there was a time that I wanted tio hit the "Like" button then this would be it.

People also don't realise that if ambulance staff go off sick then their employer actively and enthusiastically follows their sickness/disciplinary policy which then lowers staff morale because they are afraid to get disciplined for genuinely being sick.

In reply to GrahamD:


So doesn't semi-privatising it and taking it away from government control make some kind of sense on that level?

In reply to DancingOnRock:

With all respect I don't think you quite realise how bad it is out there...
They often don't even have ambulances available to send out to critically ill patients, let alone sending multiple resources to patients who have fallen. They send rapid response cars (single manned) to falls where patients are known to still be on the floor. I have had to wait over 6 hours to then be backed up by more staff to be able to lift the patient off the floor. We now have volunteer community first responders acting as falls teams, in there own time, and they are often older people...so how long that will last, who knows. There simply aren't enough ambulance for the call volume and for the hours lost waiting outside A&E, the system is broken!!

In reply to fred99:


Next time you're planning a trip somewhere, ping me an email, and you can go elsewhere if you find I'm also going.




The point is as soon as you start down the "well they deserve it (because of their lifestyle) so we shouldn't treat them" line, the logical end point is private insurance for everything.

In reply to DancingOnRock:


It could do, but it seems to purely depend on how that is done, and how the incentives could be structured. As we've learnt from PFI, there is a huge risk in outsourcing on longer term public projects as the costs are then set for a longer period of time and either what appears reasonable at the outset isn't, or more cynically, people make it look good in the short term and worry about the longer term later.

The typical experience in the commercial sector isn't that the kind of timescales we are talking about here (decades, rather than years) for successful outcomes / remuneration would necessarily work - in almost every sector, targets are set in the shorter term than that. And a further risk of outsourcing on a longer term is that if it goes well, the rewards go out, but if it goes badly wrong, the costs are socialised anyway (we would have to step in and fix it). The NHS is definitely in the "too big to fail" category!

In reply to SAF:

Which side is broken?

Lack of rescourses due to sickness?

Too many people calling ambulances when they could find their own way to a doctors?

Too many sick people for the funding available.

Funding being mismanaged.

There's a massive picture to all of this and there has to be a multi pronged approach to bring it under control.

In reply to DancingOnRock:


Its almost certainly more complex than just privatising bits of the NHS but an institution that big trying to do something that complex has to be bad, I'd have thought. Why does little old UK need a health service vastly bigger than anyone else's in the world when we aren't even particularly high spenders on health ?

In reply to DancingOnRock:

Every

You seem to have an obsession with it being the fault of the sick staff...It is insulting!!

Yes, we are frequently called to "check people over" people think we are here to assess in the community to see if they need to be seen at A&E/GP.
We need an education campaign backed up by some sort of punitive action when the NHS services are misused/abused....how you do that I have no idea. Some on here would say privatisation, then the punishment would come in the form of paying out excesses/ increased premiums. I'd prefer to see someone devise a way to do it within the NHS.

Yep, too many elderly sick people. Some very sick, with lives artificially prolonged...but that's a whole other debate that parliament and the house of lords are not prepared to have.

Yep, but how do you manage a sinking ship?!

Also:
Fear within the NHS of litigation, leading to over caution, over investigation, over treatment!

Misuse by other care settings, largely due to fear of litigation, e.g care homes calling every time a resident falls, just in case they have hurt themselves...Schools calling ambulances when they should be calling mum and dad.

First Aid Training having been over zealous and misinterpreted, leading to a culture where people "see" injuries that aren't even their, and think that you must not move any body under any circumstance....common sense needs to prevail, particularly amongst the younger generation.

In reply to SAF:

Sorry. It's not an obsession. If staff are going sick I appreciate it's not their fault but if there is high levels of genuine sick, it's still a major problem.

In reply to SAF:

So we need some heavy education and publicity into wasting ambulance and A&E time if the message is still not getting through.

There's a balance though between charging people for misuse and creating a problem where people won't call ambulances for fear of being charged.

Also there needs to be something put in place (if it's not already) where ambulance staff can decide not to carry or treat patients. My friend called an ambulance, by the time it had arrived, the baby was born but they insisted in taking them both to the hospital purely because the ambulance had been called. That was a few years ago and may have changed.

In reply to GrahamD:


I think there is a hint in that sentence. Possibly the claim that the health service is vastly bigger might be wrong and just a case of piss poor statistics and comparisons.

In reply to DancingOnRock:


Have you got any evidence for this? Perhaps they object to what they can see are failed attempts at change.

In reply to DancingOnRock:


You would not believe how much "Wasting ambulance and A&E time" goes on by people genuinely believing that they are legitimately asking for an ambulance. Its no fault of theirs, because they are acting in good faith.

And then there are those that call for a Big Yellow Taxi simply because that is what they think ambulances are used for.
I've even been told that it was cheaper to use the diesel of the ambulance than the caller's car.

You try working a set of 12 hour shifts with what is now becoming the norm to have a single 30 minute meal break, somewhere between seven and nine hours in, and then have your second refreshment break tagged onto the last few minutes of your shift so as to be made futile by the time you arrive back on station to be relieved by the crew working after you.

I pity the police, because at least ambulance crews get a 30 minute break. Many of the police near me miss out completely during their shift.

I should have joined the Fire Service.

In reply to KevinD:


Its a long standing statistic which I haven't seen debunked (it being third biggest has been though)

http://www.telegraph.co.uk/news/uknews/9155130/NHS-is-fifth-biggest-employe...

That isn't claiming that we have more people in healthcare obviously - we almost certainly don't - just that every other country in the world has partitioned the functions rather than try to bring them under one umbrella.

In reply to The Lemming:

I think this has become a really interesting thread now that the petty party politics encouraged by your OP has been sidelined. Keep up the flow of experiences and ideas everyone. As someone who has run a monolithic organisation, broken up into operationally and legally separated, autonomous entities, I'm all ears.

In reply to GrahamD:

Yet it rarely has a good source attached and mixes up very different business types. Macdonalds for example is heavily franchised. Are they counting those employees as Macdonald workers.


The NHS has, of course, been partitioned and messed around with to politicians hearts content for years. Its probably one of the organisations that has undergone the most change.

In reply to SAF:


I couldn't agree more it's the use of agencies that I have a problem with, and the fact they're going to privatise NHSP. When that's gone who do the NHS have left?

I can see agencies have their place, I've worked in companies which have used agencies before, and sometimes, you can cut through a load of chaff and get a decent person who doesn't need much time getting up to speed. Other times we'd have been better dragging people in off the street.

It was only until I was directly involved i.e. agencies offering me staff that I realised just how much these staff cost.

It's relatively easy for the agencies to pay over the NHS rate when they're getting double the rate for supplying someone. This is what needs to be managed, it could be done by the government by capping the amount that can be charged on top of their costs, say 15% on what they pay their staff. This would be easy to enforce but a lot of MPs are involved with private health care companies so it might be difficult for them to help the situation.

In reply to BnB:
I think its a pretty poor thread with a few on the ground reports of home truths (especially from SAF) scattered among a good deal of plain ignorant commentary. UKB have had a really good thread running for years on the woes of the NHS if you want to see what a climbing forum can do on the subject.

For starters, the NHS is no larger than other health services it just has a legal umbrella that makes it look so big. People are employed by seperate units from the huge trust to the small single-handed GP practice. Its size is only an issue in that its less independant from government.

I think the management is pretty good on average but under ridiculous pressure to follow almost impossible processes passed down from their political masters, that for the last two goverments have involved austerity budgets alongside the generation of an internal market (with little independant research showing any success in this for the massive costs of change and system maintenance) and an expectation to maintain quality (as measured by the idiotic CQC) in the face of the fact our spending is well behind and reducing compared to other major economies (labour did at least increase spending to close the gap albeit alongside a PFI disaster).

Important local services will be earmarked for closure under the current plans this winter. Social Care, A&E, and the Ambulance service are on the edge of collapse (black alerts in many areas) with the main annual extra winter pressures still on the way.

If people want an NHS they have to become political to stop it going down the pan: its easy to do this now through the likes of 38 Degrees. The service would be OK currently if funded at an average EU level and sure the internal inflation is higher in health and we are living longer so some form of fairly rationing against demand 'is neccesary at some point'. Yet the NHS does this already in many little ways from your granny spending 6 hours on a trolly outside A&E to physio support post climbing injury that anyone interested in recovery would bypass by paying. Any alternative to the NHS would be at least as expensive and probably more so (albeit privatisation and release of public assets is a clear glint in most tory free market thinker's eyes).

In reply to Offwidth:


I don't particularly want an 'NHS'. I want a modern, European style and properly funded health system. "NHS" carries too much emmotive baggage with it and I have no evidence that just puouring money into the current system doesn't just add more middle management and little in terms of real improvement.

In reply to KevinD:

Either that article or another, maybe BBC one, discusses the validity of McDonalds franchises and yes, there is a case that McDonalds should not be on the list and the NHS is 4th. But still, why isn't any other health service anywhere on the list ?

In reply to Offwidth:


You do not nececcessarily get the best overall perspective from ground level, but if you want to start a thread for NHS employees or disgruntled NHS users only go ahead. Personally I think its ignorant to blindly assert that our healthcare model and way of manageing healthcare is better than anyone elses in Europe.

In reply to GrahamD:


Thats the problem isnt it. What is the methodology for this report? There is no point just repeating the claim unless you actually understand how it was achieved and what peer review has been done on it.
If you put mcdonalds on the list because HQ has some control then the question is why isnt the German healthcare system on there since their government commission has a hell of a lot of power over the providers.
Its just meaningless.

In reply to GrahamD:
You are the one with the daft assertions (very unlike you)... the NHS is efficient for a national system, it is not a huge monolithic employer etc.. I'm just dealing with actual costs and outcomes from those organisations (WHO, OECD and numerous UK based health and economics trusts) who monitor and compare international health performance. The NHS is as financially efficient as any major system and in that the outcomes are not unexpected in not being quite as good as our EU neighbours (but not that far behind) as its less well funded. In the system we have there are good bits and bad bits so I don't see any part of the NHS as an ideal. I would happily accept any more efficent alternative that we could transfer to withought breaking the NHS to seemingly prove how bad it is (whilst hiding the real problem is how poorly funded it is for a major economy health system and how much politicians have messed it around). The UKB thread is good for serious 'macroeconomic' health debate as well as on the ground detail. All usually pretty well referenced from those organisations I listed... so where is your data coming from?

In reply to Offwidth:

>
And in most countries the spending differential with the UK is significantly or sometimes even fully accounted co-payment, insurance based, or other non State funding.

These organisations comparing data try as best they can to deal with this if they are being fair... they are publishing in public so are open to scrutiny. The UK has a very significant private health market most of which is already insurance based.

In reply to Offwidth:


Yes and you look across Europe and other OECD countries the percentage of GDP spent on healthcare and percentage of GDP spent the by the State on healthcare and you can see much of the explanation why the UK's spending of the former is lower.

In reply to The Lemming:


Anyone who doesn't believe it would be well advised to watch the likes of "999: What's Your Emergency?" Last night's episode showed just how desperate ambulance control is, and how stupid some of the callers are.

In reply to Postmanpat:

Nothing like all of the gap.

https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/health-care-spendin...

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

UK private spending is not especially efficient and piggy-backs on the NHS (when things go wrong and doesn't really pay its fair share for this or for the training of its staff).

In reply to Offwidth:


Hence I used the term "significantly" or 'much of". The numbers seem to vary between the World bank and the OECD but for one or two (eg.Canada,Portugal and Australia) private spending accounts for pretty much all the difference For others such as Switzerland , France and Germany (on OECD table) it's approaching half .

Indeed, if it understand the World Bank numbers correctly (which don't always tally with the OECD numbers) it suggests that for Europe and central Asia as a whole private spending accounts for all the difference (albeit distorted by some poor countries). For high income countries it accounts for half the difference, albeit distorted by the US.

Either way, it surely represents a significant part of the difference and therefore deserves attention.

In reply to Postmanpat:
These percentage differences by GDP can look small but as a for instance if we increased our percentage GDP total expenditure on health (including the UK private spending) to the level of Germany we would be looking at spending more than £40 billion extra annually (over a fifth extra). If people want to quote German health outcomes thats what we need to take into account. If they wanted to compare with Portugese outcomes that would be different.

There are lots of things that are as significant as the effect as UK private healthcare... the changes in GDP, the different age distributions (some countries with faster population growth have a significantly lower % of more expensive in health terms old people) and how health and social care is divided. In the latter case we are especially dishonest in this respect in the UK. We had to fight fir over a year for a older relative who is cared for at home, barely mobile, peg fed and catheterised to be regarded as requiring daily health as well as general care needs and we are determined middle class people with expertise. Back to my main point though, the NHS is efficent as a main health system in comparative peer terms and we fund health in the UK at below the peer average and well below the levels usually quoted from countries as having preferred health systems. It we want a better health system funding the NHS better would be a pretty good way in financial effciency terms to achieve it.

In reply to Offwidth:


But that is really my point. That £40bn would represent a 23% rise in income tax or a 7% rise overall tax. This in itself would move the UK from being a mid range tax country to a high tax country with all the downsides that implies. And that is excluding all the other increases in State spending that people argue for.

It seems reasonable to suggest exploring how some of the difference could be made up through alternative sources.

In reply to Postmanpat:

The money needed is roughly the same whether the funding is through tax or insurance. If we want to move away from the public's beloved NHS we need to convince the population it is a good idea and where the efficiency gains are (with an NHS system that is efficent). I currently don't see a chance of this from a political or a health economics perspective.

In reply to Offwidth:


And therein lies the problem!

It would actually be interesting to see an analysis of the inefficiencies of different systems . One has a suspicion that German inefficiencies may be different to British inefficiencies.

In reply to Postmanpat:

As always you make very good points on what is a very complex issue which also feeds into people's own personal experiences of the NHS. Personally I have regular shall we say interactions with the NHS ( local GP'sand visiting A&E( for my immediate family), and looking after a dementia father at home and a mother who has nursing needs at a care home.Its about 1 a week all told( this week its been 3 times so far, my dad's dementia has deteriorated.)

Maybe I am lucky, I just do not recognise the NHS collapsing all around it's ears as portrayed in the media.

In reply to Offwidth:

All big organisations, especially delivering complex and shifting services, will atrophy if they are not allowed to evolve and, if need be fragment. The reason the NHS morale is always reported as low and the NHS is always reported as being at 'breaking point' is because health care in this country just cannot evolve in this country whilst the 'NHS' is such a sacred cow which in turn makes it a perfect political football.

I'd love to see more money on healthcare in this country, but not if it just leaks into middle management and agencies and nothing actually happens.

In reply to GrahamD:

Again you spout platitudes and rhetoric based seemingly on no data or evidence; has someone stolen your UKC login??. All the evidence is that the NHS has almost certainly had too much evolution not too little; it is certainly efficient. Most of the thousands of organisations that make up the NHS are still mainly functional and have loads of good management practice despite operating under very difficult current circumstances (and funding management good practice is sensible as it improves front line efficiency) The seams are starting to pop in places due to the lack of response to clear local funding difficulties and dumb and expensive past political priorities (like the internal market and PFIs) under tight overall budgets.

No one sensible claims the NHS is perfect. Roy Lilley regularly suggests several ways of saving serious money in his many health blogs: merge the top end government health structures, dump the internal market or rationalise it to cut the number of CCGs, better fund the dissemination of proven good practice; dump the CQC and focus management and quality priorities on data and support on the front line; and the biggy, better align the NHS with Social Care.

In reply to GrahamD:

offwidth is absolutely correct; repeating these things doesnt make them true.

in fact, its the opposite of what you suggest; in my experience the NHS has too few managers, not too many. We are facing a demographic crisis, driving by aging, frailty, and mutlimorbidities, with a social care system not resourced to meet the challenges this is posing.

we have to do things differently, across the whole health and social care system, and one of the advantages the NHS has is that there is the potential to do this, with collaboration across organisations who are all part of the same system. but pushing through complex, radical reforms needs sufficient senior management and clinician time. if all these people are firefighting the latest bed or staffing crisis, then these reforms will not happen, or will fail to deliver.

In reply to no_more_scotch_eggs:

'in my experience the NHS has too few managers, not too many' - Good luck with that as a political slogan! But in fact, if you'd said 'in my experience the NHS has too few good managers, not too many' then I would have agreed. But the motivation, strategic grasp, integrity and motivational skills of the NHS managers that I have met or worked with has not *always* been the highest.

But I agree. I had reason to visit A & E on a number of occasions a few years ago and it was pretty obvious that a) no-one was in charge, and that b) all the staff seemed to accept that chaos was the natural order of things and was inevitable.

In reply to Rob Exile Ward:

indeed. the 'NHS has too many managers, get rid of more of them and support Front Line Staff' mantra is hard wired into public consciousness, with debilitating results for the system

i accept the point about good managers though- and trying to realign something as complex as delivery of health and social care across a large population without creating serious unforeseen negative consequences is massively difficult; it doesn't just need good managers, it needs exceptional ones; and lots of them

moving to a different funding model wouldn't make that problem go away; it would just create more barriers and complexity in the provider system, and make the cross agency working even more complex

In reply to Offwidth:

I'm not sure how it can so efficient, there must be a fairly lengthy period since these studies were done, height of the New Labour spending etc. We spend X amount and there are less deaths than expected? My experience of a broad range of healthcare environments, mainly acute NHS hospitals critical care facilities and wards but also private homecare in the last 18 months has been instructive.

Obtain private healthcare insurance immediately. At least your relatives have a good chance of winning a litigation if they kill you.

Its a carnival of underfunding and clueless idiocy outside the best centres, the fact that people manage to escape intact is a testament to human hardiness rather than effective clinical intervention.

D

In reply to no_more_scotch_eggs:



Isn't that exactly what I said ?

In reply to GrahamD:


No. You keep making claims about healthcare not changing. Which is clearly wrong.
It has probably had the most changes out of any government organisation over the past few years.

In reply to Offwidth:


You might disagree with my assertion that its hard to believe that a perpetually preserved, monolithic organisation like the NHS is almost certainly not the best way to deliver a 21st century health care system but I'm not sure where you get the rhetoric or platitudes ?

I'm not, by the way, talking about money saving.

In reply to GrahamD:


Why on earth do you keep repeating this bollocks?

In reply to The Lemming:

I suppose its been said already as I'm late into this debate but may I ask:

Is anything safe in Tory hands?

In reply to Valaisan:



Yawn.....

In reply to KevinD:

Its not bollocks. Its my experience of what happens with very big organisations trying to deliver complex requirements.

In reply to Postmanpat:


Sure, it is boring, but is there anything safe in Tory hands?

In reply to GrahamD:

but this is exactly the point - the NHS is not one very big organisation- it is an umbrella within which a myriad of organisations work, each run independent of each other. If it was actually a monolith, it would solve many of the problems (though of course, would create others...)

In reply to Valaisan:


Bank of England's gold?

In reply to KevinD:


Perhaps that isn't the problem. Perhaps it's not changed enough. The world of medical care; costs, funding, medication, equipment, illness and longevity have all changed massively since the NHS was created, but has it evolved enough itself to cope.

In reply to Valaisan:

>
Yes, the habit of people asking cliched unoriginal rhetorical questions

In reply to Postmanpat:


You do take yourself rather too seriously.

In reply to summo:


Thats not the claim GrahamD was making though.
Arguably for at least some of those issues eg longevity and long term illnesses the best approach would actually be to make the overall health system larger and get proper overlap with community care, oap accommodation and so on.

In reply to cap'nChino:


Globally it is a highly efficient system. The uk spends less of its gdp on health than virtually any other developed country in the world, the medical outcomes could be a lot better but considering what we spend they are good.
A recent government statement said they aim to get health spending in the uk UP TO 7% of gdp. That is a laughable amount. Germany pays 12% of gdp on health and the USA 15%. Yet health outcomes in the USA are appalling..If you are poor the healthcare is shocking, but the best in the world if you are rich. The result is the USA has aworse record than some under developed countries.
All thats wrong with the NHS is that is woefully underfunded. It is cheap to operate because they do not need huge beaurocracy to operate a billing system and insurance system, both of which up the costs.

Another advantage of the NHS is when you see someone you know you are not seeing a charlatan. With a private system how do you tell the difference between a genuine practitioner and people selling snake oil and wonder cures. It happens all the time.

In reply to Postmanpat:

It would be an interesting one for you to answer though. The environment? Hardly. State education ? 'Culture'?
What do you think, that you value, IS safe in Theresa's hands?

In reply to Rob Exile Ward:



Silly question. Is anything safe in any government's hands? What does it even imply or mean?
Obviously i think health culture and education are much better served by a market based mixed economy rather than a Statist economy and hence likely better served by a Conservative government. Feel free to disagree.

In reply to Valaisan:


So your question was just a meaningless joke unworthy of response?

In reply to The Lemming:

Ever think its not safe because its the Conservative Clean up crew that has to come and sort the mess out?

Anyway, the Scottish NHS definitely isn't safe in SNP hands. Its already f*cked.