UKC

"Our" NHS

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 Greenbanks 03 Sep 2021

A lovely, heartwarming indication of the good things brought by the NHS...worth remembering as the free-enterprise vultures and political chancers hover over its depleting infrastucture...

https://www.bbc.co.uk/news/newsbeat-58418427

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In reply to Greenbanks:

Although I hugely admire the NHS and what it does, and also Macy's incredible bravery and spirit, I can't help thinking "If that was me, I wouldn't want to survive those injuries and go through all that".

Sorry to put a bit of a dampener on a very positive story.

11
In reply to Greenbanks:

On a US-based forum I'm on, there is currently a banner asking for donations to a gofundme appeal for one of the forum founders, to pay for treatment for a brain aneurism. Why does the richest country in the world need to resort to this sort of thing to pay for medical care for its  citizens?

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 guffers_hump 03 Sep 2021
In reply to captain paranoia:

The US is and always has been about free market capitalism. Any mention of free (at the point of use) healthcare or any free social benefits is deemed as communism and is immediately shut down by most of the electorate. It also helps that the general populace are taught/brainwashed to believe that they to are/can be a millionaire but just aren't there yet e.g. The American Dream. This stops the government increasing tax rates on the rich and big business etc.

Post edited at 15:06
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In reply to captain paranoia:

> Why does the richest country in the world need to resort to this sort of thing to pay for medical care for its  citizens?

That's probably why it's the richest country in the world, it doesn't spend money on medical care for its citizens, they're there to produce profits for private companies.

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 Stichtplate 03 Sep 2021
In reply to Ridge:

> Although I hugely admire the NHS and what it does, and also Macy's incredible bravery and spirit, I can't help thinking "If that was me, I wouldn't want to survive those injuries and go through all that".

> Sorry to put a bit of a dampener on a very positive story.

On reading this I’m just massively grateful my own daughter would have the choice without having to consider treatment would necessitate her parents remortgaging the family home.

1
In reply to Stichtplate:

> On reading this I’m just massively grateful my own daughter would have the choice without having to consider treatment would necessitate her parents remortgaging the family home.

Good point well made.

1
 Greenbanks 03 Sep 2021
In reply to Greenbanks:

Good grief. Three dislikes already. What a wonderful world

6
 elsewhere 03 Sep 2021
In reply to guffers_hump:

> The US is and always has been about free market capitalism.

Strangely enough I think the origins of employers linked health insurance are an historical accident from the time that the USA was a command economy or as far as it possible in a democracy to be the opposite of a free market economy.

In the WW2 arsenal of democracy there were all sorts of price controls including wages to rein in profiteering by the lucky ones at home (profiteering seen as unfair whilst others were conscripted to fight & die overseas). The only way employers could compete to attract workers for war production was to offer health insurance. 

Roosevelt's fireside chats about directing the reopening banks during great depression are another funny one. They'd be condemned as communist government interference if spoken by a US president now, but it worked.

https://millercenter.org/the-presidency/presidential-speeches/march-12-1933-fireside-chat-1-banking-crisis

Post edited at 16:15
1
 Lankyman 03 Sep 2021
In reply to Greenbanks:

> Good grief. Three dislikes already. What a wonderful world

I gave you a dislike on this as I'm not that keen on jazz

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 Greenbanks 03 Sep 2021
In reply to Lankyman:

Pity - I was simply trumpeting the merits of the NHS

4
In reply to Greenbanks:

Though it's hugely wasteful and over burdened with management it's a brilliant organisation.

I know too many people who wouldn't be here now to think otherwise. 

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 Marcelmutt 03 Sep 2021
In reply to Dax H:

> Though it's hugely wasteful and over burdened with management it's a brilliant organisation.

It certainly is brilliant value for money.
Not always the best in terms of health outcomes though.

3
In reply to captain paranoia:

> ... Why does the richest country in the world need to resort to this sort of thing to pay for medical care for its  citizens?

It's a peculiarity of the US political Psyche (which makes no sense to us Brits) that public healthcare is the thin end of the wedge and is a trick of socialism to justify communism and so is anti American.

If you think I've made up some ridiculous twaddle I assure you that this view is taken in complete seriousness and has been for years, a particularly eloquent explanation of this was given by Ronald Reagan many years back, warning of the danger of socialised medicine as a way to undermine liberty

youtube.com/watch?v=AYrlDlrLDSQ&

I'm not for a moment agreeing with one fragment of what he said, but listen to this speech for a short while and you'll hear the (bizzare) viewpoint clearly stated that explains why the US is how it is for healthcare

In reply to guffers_hump:

The majority of the US population are in favour of an NHS style healthcare system, the electoral / governance system just doesn’t work in a way that can make this a reality.

The US health system is just incredibly bad value, they actually already spend more per capita on “socialised” medicine than we do, they just don’t get very much for it.

In reply to Stichtplate:

My step-daughter is a happy, healthy 20 year old undergrad. She has also had open heart surgery four times, the last an eight hour operation as a 16 year old and has been under the care of world leading surgeons all her life (no exaggeration). I’m just glad it hasn’t racked up a bill of more than £1m with no chance of insurance after the first operation.

 Basil 03 Sep 2021
In reply to The New NickB:

Brilliant .....the NHS at its best.
Best wishes to your step-daughter.

 abr1966 03 Sep 2021
In reply to Dax H:

> Though it's hugely wasteful and over burdened with management it's a brilliant organisation.

This is not my experience....the Trust I work in has nowhere near enough operational managers....there are a lot of 'managers' in the world of commissioning as far as I can see which is very different from operational management. 

 Darron 03 Sep 2021
In reply to Greenbanks:

If anyone gets all Daily Mail with me about the NHS  I tell them it’s worth supporting not only because it will do everything it can to help me and my loved ones through illness and accident it will do the same for theirs.

 FactorXXX 03 Sep 2021
In reply to abr1966:

> This is not my experience....the Trust I work in has nowhere near enough operational managers....there are a lot of 'managers' in the world of commissioning as far as I can see which is very different from operational management. 

Too many managers in a non-frontline role then?
It's the same in the multi-national company that I work for and this explains beautifully how it works:
https://www.bbc.co.uk/news/education-50418317

In reply to abr1966:

My experience supports this, both in terms of working with the CCG and previously PCT, plus the seemingly endless management tiers at my wife's primary care employer. However, when you compare the overhead, the admin or non-operation costs, they are world beating and certainly several factors better than the admittedly famously inefficient US system.

 redjerry 04 Sep 2021
In reply to The New NickB:

"incredibly bad value" drastically understates how shit it is.
11k/year/capita in the US
3k/year/capita in the UK
But you have to bear in mind that a really huge chunk of the population have essentially zero effective access to healthcare, and an even bigger chunk have insurance, but it's so costly to use that they can only use it in the utmost need.
So the 11/3 figure, bad as it is, actually significantly overestimates the value for money of the US system.

 B-team 04 Sep 2021
In reply to Ridge:

> That's probably why it's the richest country in the world, it doesn't spend money on medical care for its citizens, they're there to produce profits for private companies.

In fact, the US spends much more on healthcare, as a percentage of GDP, than do European nations with nationalised healthcare systems.

In reply to B-team:

> In fact, the US spends much more on healthcare, as a percentage of GDP, than do European nations with nationalised healthcare systems.

I had to pay private for root canal treatment in San Francisco: $2,500!!!!  That’s one reason why they spend more, privatised rip off services that the wealthy can afford through insurance.

 Siward 04 Sep 2021
In reply to Bottom Clinger:

Dentistry isn't the NHS's finest achievement. We all know that US teeth are better than our crooked rotten stumps  

Does anyone know how much some root canal treatment would cost in the UK? 

2
 Jenny C 04 Sep 2021
In reply to Siward:

Three price brackets of NHS dentistry charges, root canal would be the middle which is about £65. Even the top one is only around £280.

In reply to Siward:

> Dentistry isn't the NHS's finest achievement. We all know that US teeth are better than our crooked rotten stumps  

> Does anyone know how much some root canal treatment would cost in the UK? 

About a third ish at the most?

It was very high tech. They drilled out the previous root canal, cleaned and filled. I actually fell asleep during the process. The shock of the bill woke me up good and proper !

In reply to Bottom Clinger:

It does look like that is a particularly pricey example mind you - average cost of root canal in the US is apparently $700-1100. 

UK private looks like about £500 (so still a lot less). Hard to work out what the actual cost of NHS treatment is, including cost to the taxpayer. The cost at the point of access isn’t really a fair comparison. 

In reply to Jenny C:

If the question is value for money then the taxpayer contribution in the UK probably needs to be included too. I didn’t have any luck finding numbers for root canal, but it looks like patient charges account for about 25% of the overall NHS dentistry budget. 

So we still almost certainly come out on top in terms of cost. But I’ve never heard anyone say they fell asleep during a root canal before - everyone I know who’s had one says it is absolute torture. So perhaps $2500 does buy you rather more pleasant experience!

Post edited at 10:35
 abr1966 04 Sep 2021
In reply to The New NickB:

Agreed!

I work as a clinical lead/clinician.... so pretty much on the ground. Between me and the chief exec/board are 2 layers of management as in 2 people....

My immediate manager manages 8 clinical areas....a huge task and probably does well over 50 hours a week plus on call manager commitments....whilst getting paid for 9-5 Mon to Fri.

I went to a meeting for him with the local CCG's and the Local Authority and the layers of staff from both of these organisations was shocking....I think there were 12 or 13 people in the meeting including me. None of the others had clinical or Social Work practice roles....the money in the NHS is disproportionately used in the....in my opinion...ridiculous commissioner provider split established years ago to create an 'internal'  market with all of the financial and performance related paraphernalia that comes with it...

 Rob Exile Ward 04 Sep 2021
In reply to abr1966:

From many meetings that I went to with NHS staff, (mostly bureaucrats), I formulated the idea that everyone should have a big badge saying how much they were costing the tax payer per hour. (Typically at least twice as much as they were get paid, taking into account recruitment and  training costs, cover for holiday etc etc.)

Then everyone would be able to look round the room and tot up how much that particular meeting was costing, and judge themselves whether it was really cost effective.

In reply to Jenny C:

> Three price brackets of NHS dentistry charges, root canal would be the middle which is about £65. Even the top one is only around £280.

If you can get an NHS dentist. My old one dropped the NHS and became private and told me it would be £10 a month to stay on their books including a check up every year then a list of charges for treatment.

It took me 4 years on a waiting list to get in with an NHS dentist in my area. 

 redjerry 04 Sep 2021
In reply to Stuart Williams:

just to be clear...the $700-$1100 is for the root canal procedure by itself. Before you are finished you'll have to build up the tooth, pay for a temporary, buy and insert new crown. Total cost is more like the $2500 as experienced by willgriggsonfire.

In reply to Siward:

> Dentistry isn't the NHS's finest achievement. We all know that US teeth are better than our crooked rotten stumps  

> Does anyone know how much some root canal treatment would cost in the UK? 

A few months ago I was offered root canal treatment for about £400 or getting the tooth out for about £40. Obviously I got the tooth taken out.......

Post edited at 08:01
In reply to Bottom Clinger:

It’s about £850 in the U.K. if you get it done privately.  

In reply to abr1966:

There's a good few meeting attenders in any large organisation. What to p#*s me off was those people who are supposed to to clinical spend most of their time in meetings. Okay, they should have some clinical input but it's the way it's concentrated into a few people that isn't narrows the outcomes.

On a different note the lead person for Unison at my last Trust was a Band 2 porter. Absolutely brilliant at upholding members rights and at the same time protect services. There were many times when the actions of the management really didn't add up and they didn't like being proved wrong.

Love the NHS. Okay, it provides me with a reasonable pension but it pretty much burnt me out a few years back. I've benefitted from its services on several significant occasions. Let's make sure it's there for future generations.

 wintertree 05 Sep 2021
In reply to Robert Durran:

> A few months ago I was offered root canal treatment for about £400 or getting the tooth out for about £40. Obviously I got the tooth taken out.......

When suggested a root canal, I had the tooth extracted.  No, I don’t want dead tissue remaining in contact with my blood and my oral microbiome for the rest of my life.

Since I put my teeth in notice that’s it’s “three strikes and you’re out” they have stopped playing up so much.

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 MonkeyPuzzle 05 Sep 2021
In reply to redjerry:

Saw a friend's bill for giving birth. All very insanely ridiculous but peaking at the $40 for being given skin-to-skin contact with her new daughter.

In reply to Rob Exile Ward:

Its all well and good decrying “ managers”.  The other side of the coin is that it is a huge organisation with over a  million people  and therefore you are going to get managers - good and poor. You rarely hear the good storries as they are not newsworthy or great for forums . I suspect like inany organisation 20 % are brilliant , 70 % are ok and 10% should not be there or about that. 

 Stichtplate 05 Sep 2021
In reply to neilh:

> Its all well and good decrying “ managers”.  

Perhaps NHS managers wouldn't be such easy targets if they could get the most basic stuff sorted? I've worked in both public and private sectors, within organisations large and small and I've never worked anywhere that tolerates and supports such a high degree of imbedded dysfunction.

Take payroll for example: 

in order to get paid each month I must sign in and out each shift (noting any overtime) on a big sheet of paper in the station. I also log in and out on the ambulance terminal and my attendance noted and logged by control. I also fill in a separate overtime sheet. I also fill in a separate late/missed meals sheet. I also log meal times on the ambulance terminal. I also submit a vehicle expense claim every time I'm sent to work from an alternate station. I also fill in and submit an excel timesheet at the end of each month.

Unsurprisingly, given the byzantine submission process, the amount paid is almost invariably wrong. Sometimes by a few quid, sometimes by a few hundred and sometimes people aren't paid at all. A state of affairs that could perhaps be forgiven in a new start up with a couple of dozen employees but harder to understand in an organisation with 1.3 million staff that's been rattling along for 70 odd years.

Post edited at 13:16
1
In reply to Stichtplate:

The sort of technology that easily addresses time keeping is now widely available on apps etc and via digital means.  But I would be of the view that equally as many in the nhs - unions etc - would oppose such technology. i would also not be surprised that somebody somewhere uses such technology in the nhs already.

 Stichtplate 05 Sep 2021
In reply to neilh:

> The sort of technology that easily addresses time keeping is now widely available on apps etc and via digital means.  But I would be of the view that equally as many in the nhs - unions etc - would oppose such technology. i would also not be surprised that somebody somewhere uses such technology in the nhs already.

It's up to management to manage and rectify inefficient, outdated and ineffective systems that are increasing both workload and stress on their staff. This is basic stuff management are paid to address.

It's not technology's fault, it's not the staff's fault and it's not the union's fault.

1
In reply to Stichtplate:

It’s never anybody’s fault …..

Technology is moving at such a pace that a huge organisation will never keep abreast of it as a whole.

And do not forget that the method of recording timekeeping etc will have been hard fought with unions etc. Toomany have fingers in the pie for big changes in large  organisations. 

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 peppermill 05 Sep 2021
In reply to neilh:

I think what Stichtplate is getting at is that you log on/off to the electronic terminal when you start and finish. 

There is an electronic log of exactly where he is, exactly which vehicle, jobs attended, how late he's finished a shift, when and where he takes meal breaks, whether they are disturbed from a meal break (or been allowed one at all), whether the shift is overtime etc etc etc but he still has to fill in the paper forms which somebody is paid to trawl through each month. 

In reply to peppermill:

What he had not said is how this was negotiated with all the unions in his trust. It’s equally possible that somebody somewhere with a different view considers this a better way. That could be management or it could be another union with a different perspective. 

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In reply to neilh:

Why would it need to be negotiated? 

Surely you just put in the most cost efficient solution across the entire NHS? Don’t discuss it - just put it in…

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 peppermill 05 Sep 2021
In reply to VSisjustascramble:

> Why would it need to be negotiated? 

> Surely you just put in the most cost efficient solution across the entire NHS? Don’t discuss it - just put it in…

Wow that's a slippery slope from a frontline worker's perspective....

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In reply to peppermill:

Sorry it was a genuine question.

We’ve just put in QR code shift logging in and out for our shift workers in the organisation I work for. We didn’t discuss it with them - we just did it.

Surely a doctor or a nurse doesn’t care how they record the hours they work - as long as it’s works.

Whether it works is a management problem and you just get rid of them if they make the wrong decision?

 peppermill 05 Sep 2021
In reply to VSisjustascramble:

Ah ok- sorry I thought you meant that as a general policy the whole NHS should take. Which would be somewhat frightening.

In reply to peppermill:

> Wow that's a slippery slope from a frontline worker's perspective....

Of course, a union would claim it's some right or invasion of privacy installing a system where they could check folk had arrived for work on time! 

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 Ian W 05 Sep 2021
In reply to summo:

> Of course, a union would claim it's some right or invasion of privacy installing a system where they could check folk had arrived for work on time! 


They never have in any of the cases I've been involved in.....obviously your experiences have been different.

In reply to Ian W:

> They never have in any of the cases I've been involved in.....obviously your experiences have been different.

I was just speculating. You'd think modern fire regs would prescribe a system that can provide an accurate head count in a large building. 

 Ian W 05 Sep 2021
In reply to summo:

> I was just speculating. You'd think modern fire regs would prescribe a system that can provide an accurate head count in a large building. 


I know that. And exhibiting an irrational prejudice against unions. You've been reading too many Neilh posts.

And to fire regs add security, access control, insurance etc. All quite easy these days via SIM cards.

In reply to VSisjustascramble:

There must be at least 10 unions ranging from BMA, nurses, unite, unison etc all of which any such scheme on payroll will need to be negotiated and agreed.

 Stichtplate 05 Sep 2021
In reply to neilh:

> It’s never anybody’s fault …..

> Technology is moving at such a pace that a huge organisation will never keep abreast of it as a whole.

I’d a 30 year history of working for various employers before the NHS and the most onerous stipulation placed upon me was to clock on and clock off. With the NHS it’s beyond parody, overtime alone has to be recorded in four different formats.

> And do not forget that the method of recording timekeeping etc will have been hard fought with unions etc. Toomany have fingers in the pie for big changes in large  organisations. 

Ditto every other business in the land and they all seem to manage it with zero fuss and bother. It’s not rocket science.

In reply to VSisjustascramble:

> Surely a doctor or a nurse doesn’t care how they record the hours they work - as long as it’s works.>

Indeed. But it might actually cost the NHS more money. I've worked hundreds of hours for nothing. Breaks not taken. Not finishing any like on time. It all adds up.

In reply to Stichtplate:

I would question that assumption. Running payroll and expenses for large organisations with different requirements across multiple locations with different agreements is never  simple and that includes having the right technology and infrastructure behind it. 

In reply to neilh:

But it wouldn’t be a change to payroll - It doesn’t change how much people are paid.

It’s just how hours worked would be recorded…

Are you seriously saying that you’d have union involvement to change a time sheet system?

 Stichtplate 05 Sep 2021
In reply to neilh:

> I would question that assumption. Running payroll and expenses for large organisations with different requirements across multiple locations with different agreements is never  simple and that includes having the right technology and infrastructure behind it. 

You’ve spent considerable time excusing and defending and I’ve repeatedly pointed out that no other organisation does it like this, so either provide an example or acknowledge what I’ve been saying all along: the NHS is uniquely cackhanded in these matters.

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In reply to summo:

> Of course, a union would claim it's some right or invasion of privacy installing a system where they could check folk had arrived for work on time! 

That might be a valid point if it weren't for the fact that Stichtplate is already using such a system...

2
In reply to Stichtplate:

Cackhanded in these maters just means drilling down and figuring out why and then coming up with the solutions.Its not offering an excuse.There could be a logical explanation, its just that you do not know or maybe are not prepared to acknowledge. I would suspect its as equally a frustration in management( what look like simple things usually are often incredibly difficult issues to resolve in big organsiations).

2
In reply to neilh:

what look like simple things usually are often incredibly difficult issues to resolve in big organsiations).

I used to think that breaking up the NHS into smaller operational chunks, with vertical integration might be the solution; the continuing poor performance of NHS Scotland gives lie to that though.

I don't have a solution other than keep sending ever increasing amounts of treasure the NHS' way until a Hercules appears - to clean the stable.

Post edited at 10:32
In reply to captain paranoia:

> > Of course, a union would claim it's some right or invasion of privacy installing a system where they could check folk had arrived for work on time! 

> That might be a valid point if it weren't for the fact that Stichtplate is already using such a system...

There is, of course, the existing deterrent that if you're late for handover the night staff actually might kill you.

 mondite 06 Sep 2021
In reply to Stichtplate:

> Ditto every other business in the land and they all seem to manage it with zero fuss and bother. It’s not rocket science.

I work in the private sector with a US managed firm and I think the most time recording systems we got up to was four. Currently in theory it is two but my team stopped filling one out a year or so back and no one has complained yet.

 Stichtplate 06 Sep 2021
In reply to neilh:

> Cackhanded in these maters just means drilling down and figuring out why and then coming up with the solutions.Its not offering an excuse.There could be a logical explanation, its just that you do not know or maybe are not prepared to acknowledge. I would suspect its as equally a frustration in management( what look like simple things usually are often incredibly difficult issues to resolve in big organsiations).

To cut through the waffle then...you're continuing to defend a ridiculous system without offering logical explanations or (as I've asked) evidencing any employer with similarly byzantine payroll protocols.

There's nothing inherently wrong with continually identifying with and defending the current government or upper management in general, but when it's continually done from an evidence free position along the lines of "we can't know why/who/what, but there must be a good reason" it starts to seem a bit pointless discussing it with you.

Post edited at 10:58
 Stichtplate 06 Sep 2021
In reply to mondite:

> I work in the private sector with a US managed firm and I think the most time recording systems we got up to was four. Currently in theory it is two but my team stopped filling one out a year or so back and no one has complained yet.

So that’s one then?

I actually undersold how dire our own system is, it’s not four, it’s five. I also carry a little black diary in the left breast pocket of my uniform to record shift times, meal breaks, overtime and stations worked from. This is used to fill in all the other formats and also as an easily accessible master copy to identify when payments have been missed. This is something we all do, whether it’s a notebook or on a smartphone.

I dread to think how many millions of hours NHS staff have been forced to waste doing this crap.

Post edited at 11:12

1
In reply to Stichtplate:

> I dread to think how many millions of hours NHS staff have been forced to waste doing this crap

Ask for a booking code for completing timesheets. Then someone can measure how much time is being wasted...

The commercial world isn't exempt from such stupidities. What often happens is some manager wants to make a name for themselves with a 'money saving initiative', which removes some central, efficient service, and passes the responsibility down to individual staff, who, not being familiar with the task, take longer. But, as they don't have a booking code for that task, it gets subsumed into other codes. The actual cost goes up, but it is lost in the accounting. So the 'initiative' is deemed a cost-saving success, and the manager climbs up the greasy pole...

I think I have only ever had to complete two timesheet systems concurrently, and that was for one particular project. We do have to book leave in a separate system, even though we book leave in our timesheets, so it could easily be automatically extracted.

In reply to neilh:

All of the different formats for all of the different agreements would be different reports generated from the same database, provided the database records everything required. It's not rocket science, although public services love to get utterly ripped off by IT consultancies, so it would probably cost approximately 1000x the amount it should...

 mondite 06 Sep 2021
In reply to Stichtplate:

> So that’s one then?

Well you have mentioned a single case as well so I am not sure why your one wins out?

Large organisations often have lots of siloed areas which dont necessarily play well with each other either due to empire building or just lack of investment. Whilst sticking in an auto feed from the ambulance terminal to payroll could be feasible it depends on who owns each system and how antiquated they are.  Even just printing it out in a usable format for that person to input into the time system could be an arse.

Something that investment could probably solve but its getting the upfront money to spend.

1
 wbo2 06 Sep 2021
In reply to Greenbanks:  Not so very long ago the US were very close to adopting a single payer sysem .. the medical insurance industry were terrified so employed people to lie about how bad that would be , with the horrors of the Canadian system held up as an example (Canadians thought it was fine, as it was, and didn't know what the US was talking about).

Look for interviews by Wendell Potter https://en.wikipedia.org/wiki/Wendell_Potter 

 Stichtplate 06 Sep 2021
In reply to captain paranoia:

If I asked for a booking code they’d look at me like I had two heads. It’d probably take months to even identify who would be responsible for such a thing, if indeed such a thing exists.
Even the simplest of requests can turn into a titanic struggle. Swapping my car on vehicle expenses took 3 months, something like 10 emails, 3 phone calls and two face to faces with my operations manager.

Worth bearing in mind that nothing has been done to address such time wasting inefficiency during a period of emergency measures that’s seen army personnel and students drafted into frontline roles in an effort to relieve crippling service pressure. In fact more bureaucracy has been introduced which has further reduced time crews can spend on patient care.

1
 Stichtplate 06 Sep 2021
In reply to mondite:

> Well you have mentioned a single case as well so I am not sure why your one wins out?

Not a single case, a single recording system. You stated that you currently record one set of timekeeping data (though you're supposed to produce a duplicate). At our end we're currently duplicating the same information five times.

> Large organisations often have lots of siloed areas which dont necessarily play well with each other either due to empire building or just lack of investment. Whilst sticking in an auto feed from the ambulance terminal to payroll could be feasible it depends on who owns each system and how antiquated they are.  Even just printing it out in a usable format for that person to input into the time system could be an arse.

> Something that investment could probably solve but its getting the upfront money to spend.

At a time of immense service pressure that has necessitated drafting in the army, students and non clinical staff, not to mention leaving pensioners with broken hips lying on floors for 12 hours plus, instigating the sort of rational time saving, payroll system that works just fine for every other large employer and can even be bought off the shelf from multiple suppliers, would seem like a ridiculously easy win. No?

In reply to Stichtplate:

My take and I will caveat that I have never worked for the NHS. Is that the NHS often suffers from the problem of if you were to build it again you wouldn't start from here. As Stitchplate is pointing out there are many process inefficiencies (not some are not unique to the NHS some probably are) but often those who have the power and responsibility to change these things are so busy fire fighting that they never get sorted. I see exactly the same type of things happen in the private sector where you find people running mission critical IT systems on an old xp laptop, as an example. When asked why the response is usually that no one will sign off on the possible downtime to change it so better to keep going with a system that they know kind of works most of the time than invest the time and energy in sorting it out properly. I think the NHS can be particularly handicapped here as successive governments have stripped it of layers of non-clinical staff who would be able to do this work. Their argument is always cost saving by removing management but there does become a point where things actually need managing!

1
 mondite 06 Sep 2021
In reply to Stichtplate:

> Not a single case, a single recording system. You stated that you currently record one set of timekeeping data (though you're supposed to produce a duplicate)

No I said currently I am down to just one. I was considerably higher and thats without worrying about an expenses system.

> At a time of immense service pressure that has necessitated drafting in the army, students and non clinical staff, not to mention leaving pensioners with broken hips lying on floors for 12 hours plus, instigating the sort of rational time saving, payroll system that works just fine for every other large employer and can even be bought off the shelf from multiple suppliers, would seem like a ridiculously easy win.

The problem there is whilst you are drafting in all those people you then need to draft in a bunch of professionals to do a system replacement which, generally speaking, requires quite a lot of face to face time not just in specifying the system which would involve pulling front line workers off for several chats but also in staff training.

I would expect there would be plenty of outliers for the NHS eg getting it speaking to the system you use for control and seem to want to use universally so it wouldnt just be plug and play.

If you glance through theregister and similar sites there is no shortage of cases where those upgrades went badly over budget and failed to do minor things like pay employees.

There is a reason why companies often stick with antiquated systems until they have no choice but to upgrade. It is a risky business.

 OrangeBob 06 Sep 2021
In reply to Deleated bagger:

We all know, if it wasn't for the Band 2 porters the whole thing would fall apart

 Andy Gamisou 06 Sep 2021
In reply to Stichtplate:

You get meal breaks?   NHS has clearly changed since my wife used to work for it.

 Stichtplate 06 Sep 2021
In reply to mondite:

> No I said currently I am down to just one. I was considerably higher and thats without worrying about an expenses system.

What you said is that you were on four, then two but for the last year you've just been on one. Perhaps I'm being dense but I'm struggling to see the equivalency with my current five?

> The problem there is whilst you are drafting in all those people you then need to draft in a bunch of professionals to do a system replacement which, generally speaking, requires quite a lot of face to face time not just in specifying the system which would involve pulling front line workers off for several chats but also in staff training.

Errr, No. The last change occurred about 18 months ago when all staff on the new contract were instructed to start filling in a monthly excel timesheet. No frontline workers were pulled in for chats. No training was given. We were sent an email with the attached spreadsheet and instructed to start filling it in every month if we wanted to get paid. This was on top of all the existing duplicate systems.

Interestingly, staff on the old contract continue to be paid without this added burden.

> I would expect there would be plenty of outliers for the NHS eg getting it speaking to the system you use for control and seem to want to use universally so it wouldnt just be plug and play.

> If you glance through the register and similar sites there is no shortage of cases where those upgrades went badly over budget and failed to do minor things like pay employees.

and yet in your own case you've gone from four duplicate systems to one but haven't mentioned any issues at all.

> There is a reason why companies often stick with antiquated systems until they have no choice but to upgrade. It is a risky business.

Did you miss the bit where I pointed out that crews are under so much pressure that we've been drafting in soldiers and students to do the jobs normally performed by qualified clinicians? Did you miss the bit where I pointed out patients were being left unattended?

So tell me about that "risky business" stuff again?

1
 peppermill 06 Sep 2021
In reply to OrangeBob:

> We all know, if it wasn't for the Band 2 porters the whole thing would fall apart

Add to that Band 3 Care Support Workers in most hospital departments. 

1
In reply to Stichtplate:

> If I asked for a booking code they’d look at me like I had two heads

My tongue was firmly in my cheek...

 OrangeBob 07 Sep 2021
In reply to peppermill:

I write down when I start and finish work on one sheet of paper and what vehicles I use on another. The records are for different purposes. 

1
 OrangeBob 07 Sep 2021
In reply to OrangeBob:

If I had an expenses claim I wouldn't put it on my timesheet, or on the vehicle log, but I would fill in an expenses form. Crazy world.

2
 elliot.baker 08 Sep 2021

In reply to HVS Leader:

This is the exact same post that Morgan put in the politics forum... like copy and pasted wording. 🤔 

In reply to elliot.baker:

It's another spam new member, they are getting cleverer with their screen names though. 

In reply to wintertree:

> When suggested a root canal, I had the tooth extracted.  No, I don’t want dead tissue remaining in contact with my blood and my oral microbiome for the rest of my life.

The bit of your tooth in contact with your ‘blood and microbiome’ is no more dead after RCT than it was before.  The whole point of the process is to remove dead tissue and infection from inside the tooth and permanently seal it off.

 wintertree 08 Sep 2021
In reply to Dave Garnett:

That depends on how porous the tooth becomes.  If it gets to root canal stage, it's already become porous enough to get infected three times.  After an RCT, the ability to repair dentin is gone, and so whilst the tissue of the remain tooth is "no more dead", it is less maintained than it was before.  Re-infection after a root canal can still happen.  

 Lankyman 08 Sep 2021
In reply to summo:

> It's another spam new member, they are getting cleverer with their screen names though. 

Suspended already. They need to up their game.

In reply to wintertree:

> That depends on how porous the tooth becomes.  If it gets to root canal stage, it's already become porous enough to get infected three times. 

 

But the infection must be coming from your mouth originally, via dental caries if that’s what has damaged the tooth.

A lot depends on what state the tooth is in, but in a heathy tooth the point of contact is the cementum surface of the root and the periodontal ligament.  Dentine certainly become more brittle in a non-vital tooth (no longer being maintained by odontoblasts) but I don’t know about porosity and, usually, little or no dentine is in direct contact with tissue anyway.

Recurrent infection can also spread down the outside of the root from deep pocketing, of course, but that’s a different thing and unrelated to RCT.

 timjones 08 Sep 2021
In reply to Stichtplate:

> On reading this I’m just massively grateful my own daughter would have the choice without having to consider treatment would necessitate her parents remortgaging the family home.

Do we have a choice or are others going to decide that we have to survive regardless of the extent of our injuries?

In reply to Stichtplate:

Your frustration is more with a government not managers ( they are after all just administrators of the system)who are not prepared to give the NHS  an unlimited budget to sort things out like this.

Tarring your managers with that brush seems to me to be just wrong.They will find it as equally frustrating.

4
In reply to timjones:

If you're an adult and conscious, and considered compos mentis, then, yes, you have a choice.

I'm not really sure how your comment relates to Stichtplate's, though; how did you get from the benefits of universal healthcare to enforced treatment...?

 Offwidth 08 Sep 2021
In reply to neilh:

Yes in the end the NHS is severely underfunded compared to the best systems in Europe. Yet we do burn way too much money on the idiotic purchaser provider system, from the Lansley 'reforms' that weren't in any manifesto that we voted for.

In reply to Offwidth:

> that weren't in any manifesto that we voted for.

It seems that manifesto 'promises' can be broken...

 timjones 08 Sep 2021
In reply to captain paranoia:

> If you're an adult and conscious, and considered compos mentis, then, yes, you have a choice.

> I'm not really sure how your comment relates to Stichtplate's, though; how did you get from the benefits of universal healthcare to enforced treatment...?

Was the patient in the article was unable to communicate any form of choice.

How do we handle it when we have revived an unconcious and severely injured casualty that would sooner have accepted the inevitable and died rather than living with serious lifelong disabilities?
 

In reply to Offwidth:

Lansley reform would be probably ok if it was funded properly and as you say its been underfunded.You are still going to get admin and management burning through money whichever system you use. Good funding is always the key.

1
 Stichtplate 08 Sep 2021
In reply to timjones:

> Do we have a choice or are others going to decide that we have to survive regardless of the extent of our injuries?

If you have mental capacity and can communicate your decision then you’re fully entitled to refuse treatment.

 Stichtplate 08 Sep 2021
In reply to neilh:

> Your frustration is more with a government not managers ( they are after all just administrators of the system)who are not prepared to give the NHS  an unlimited budget to sort things out like this.

> Tarring your managers with that brush seems to me to be just wrong.They will find it as equally frustrating.

As I noted already, across a multitude of threads you’ve displayed a propensity to defend management to the hilt, regardless of the fact that you present no evidence and claim no experience of the matter under discussion. Bit odd really.

2
In reply to Stichtplate:

Just a different view to you. No different form any other discussion on a forum.Why not just respect it.

I see it all the time when managing my employees, its hardly novel.Sometimes they are right and sometimes they are wrong...just the same with me.

Post edited at 12:21
 Stichtplate 08 Sep 2021
In reply to timjones:

> Was the patient in the article was unable to communicate any form of choice.

She certainly was during the course of her 400 day hospital treatment.

> How do we handle it when we have revived an unconcious and severely injured casualty that would sooner have accepted the inevitable and died rather than living with serious lifelong disabilities?

How are we supposed to determine what an unconscious patient’s wishes would be? People aren’t horses, we can’t just look at them and go “Nah, paraplegic after that lot” and reach for the bolt gun.

Injuries that might mean a life not worth living for one person simply present as a life affirming challenge for someone else.

In reply to

I think I should jump in here as tim probably picked up on my earlier (2nd post in the thread) comment that although it was a 'good news' story my initial thought was “I really wouldn't have wanted to survive with those sorts of injuries”

> She certainly was during the course of her 400 day hospital treatment.

Bit late at that point, but as you say:

> How are we supposed to determine what an unconscious patient’s wishes would be? People aren’t horses, we can’t just look at them and go “Nah, paraplegic after that lot” and reach for the bolt gun.

Exactly(though in the not too distant past medics might well have made the decision not to proceed with heroic attempts to save a live at all costs). When it comes to emergency care there isn't any other option than to assume the patient should be given the chance to live.

> Injuries that might mean a life not worth living for one person simply present as a life affirming challenge for someone else.

True, but I suspect we only get to see the life affirming stories. However we're now in danger of straying into what choices elderly or severely disabled patients have when they feel life is no longer worth living, and slowly starving/dehydrating yourself to death is the only option, which isn't what this thread was about.

Post edited at 13:27
 timjones 08 Sep 2021
In reply to Stichtplate:

I would agree with that but if we must revive everybody just in case we should maybe have an option that allows those who do not find that a severe disability is a "life affirming challenge" to reverse our well intentioned efforts to save them at all costs.

Personally speaking if I ever get to the point where I have  serious inuries and a mere 2% chance of survival with medical intervention then I would be happier to let nature take it's course than to gamble on a miraculous recovery versus a lifetime as a burden to my faily and society.

In reply to Stichtplate:

> Injuries that might mean a life not worth living for one person simply present as a life affirming challenge for someone else.

I did note the irony of the discussion, coming just days after the end of the Paralympics...

 wintertree 08 Sep 2021
In reply to timjones:

https://www.ageuk.org.uk/information-advice/money-legal/legal-issues/advance-decisions/

No idea if anyone has ever done one covering eventualities such a "injuries sustained in a climbing accident" or the like; usually used more in relation to ageing.

 Stichtplate 08 Sep 2021
In reply to timjones:

> I would agree with that but if we must revive everybody just in case we should maybe have an option that allows those who do not find that a severe disability is a "life affirming challenge" to reverse our well intentioned efforts to save them at all costs.

You can put in place a DNACPR and you can mandate a ceiling of care. You can make your wishes known to your next of kin and you can arrange for a living will. But if you haven't put those things in place why on Earth do you expect some poor medic, who knows nothing of you or your views, to put aside their training, natural inclination to help others and moral duty to do their best for their patients to just shrug and walk away?

Medics already have to make tough decisions about if it would be futile to initiate or continue treatment in the elderly and chronically ill. It's always tough and it always takes it's toll ,but the severely injured? Try to place yourself in a medics shoes, you turn up to someone hideously injured in an RTC and you seriously expect to be able to instantly assess what the patient's future quality of life is going to look like? We can't Xray, cat scan or MRI them. We don't have their medical records and we don't know their personal opinions on what constitutes a life worth living and we don't have time anyway because we're far too busy trying to stop them dying. In all honesty there's f*ck all time for anything else.

What exactly do you want from clinicians?

> Personally speaking if I ever get to the point where I have  serious inuries and a mere 2% chance of survival with medical intervention then I would be happier to let nature take it's course than to gamble on a miraculous recovery versus a lifetime as a burden to my faily and society.

Cool, have a think about what the people who love you would want, have a think about what you'd want for the people you love and then do what you think is best, but don't think you can just shrug those responsibilities off onto someone else's shoulder and expect them to deal with the aftermath of not doing everything in their power to save a life.

 spenser 08 Sep 2021
In reply to captain paranoia:

Expenses, used to be a form we filled in and stapled receipts to, now a web based system which takes a noticeable period to respond to each instruction.

Financial reporting of projects, used to be done by finance with PMs having lots of analysis functionality available to support, they took this away and gave us some nonsense thing called JD Edwards which is completed by PMs but removed most of the functionality of the old system. I despised the new system so much that I packed in being a PM and went back to purely technical which is where I wanted to be anyway. 

In reply to Stichtplate:

100% agree with that.

 timjones 09 Sep 2021
In reply to Stichtplate:

> You can put in place a DNACPR and you can mandate a ceiling of care. You can make your wishes known to your next of kin and you can arrange for a living will. But if you haven't put those things in place why on Earth do you expect some poor medic, who knows nothing of you or your views, to put aside their training, natural inclination to help others and moral duty to do their best for their patients to just shrug and walk away?

Because whilst it is likely to be possible to foresee most health problems and make the judgement at the time there does not appear to be any mechanism which would reliably allow me to have any input if I was unconcious and at deaths door at the scene of an accident.

> Medics already have to make tough decisions about if it would be futile to initiate or continue treatment in the elderly and chronically ill. It's always tough and it always takes it's toll ,but the severely injured? Try to place yourself in a medics shoes, you turn up to someone hideously injured in an RTC and you seriously expect to be able to instantly assess what the patient's future quality of life is going to look like? We can't Xray, cat scan or MRI them. We don't have their medical records and we don't know their personal opinions on what constitutes a life worth living and we don't have time anyway because we're far too busy trying to stop them dying. In all honesty there's f*ck all time for anything else.

And that is exactly the problem that concerns me, modern medecine is wonderful but the presumption that it should always be used is not always going to lead to the outcome that the patient might have desired.

Should the need for the medics to feel that they have done all that they can to help trump the patients wishes?

> What exactly do you want from clinicians?

To be left alone to die when the time comes rather than revived because a clinician has the power to do so?

> Cool, have a think about what the people who love you would want, have a think about what you'd want for the people you love and then do what you think is best, but don't think you can just shrug those responsibilities off onto someone else's shoulder and expect them to deal with the aftermath of not doing everything in their power to save a life.

Isn't it rather selfish to wish to keep a loved one alive for your own purposes?

I have no wish to shrug the responsibilities onto anyone elses shoulders BUT if they choose to intervene then they have taken those responsibilities upon themselves whether I like it or not.

Is it any better to condemn someone to a lifetime of unwanted disability than it is to let them die?

2
 timjones 09 Sep 2021
In reply to wintertree:

> No idea if anyone has ever done one covering eventualities such a "injuries sustained in a climbing accident" or the like; usually used more in relation to ageing.

Thanks, that provides some good information but I think it indicates that it would be quite tricky to produce one for injuries sustained in an accident an it certainly seems clear that it cannot be used to ask for your life to be ended.

 Stichtplate 09 Sep 2021
In reply to timjones:

> Because whilst it is likely to be possible to foresee most health problems and make the judgement at the time there does not appear to be any mechanism which would reliably allow me to have any input if I was unconcious and at deaths door at the scene of an accident.

How would you envisage such a mechanism actually functioning in the real World? If I turn up at 2 in the morning to find an upside down Fiesta in a ditch with four teenagers dead or dying, do you first want me to try and ID the kids (how exactly?) and then access some (non-existent) data base to ascertain if they've made clear their wishes in such a situation? Or do you want me to go to work immediately?

Say the (non-existent) data base had been set up and one of the teenagers identified and confirmed as having said he didn't want medical treatment in the event of serious brain injury or permanent paralysis, how exactly am I supposed to ascertain that'll be the outcome while crawling about in a ditch with a torch, trying to assess said teenager in his upside down Fiesta?

> And that is exactly the problem that concerns me, modern medecine is wonderful but the presumption that it should always be used is not always going to lead to the outcome that the patient might have desired.

You're comprehensively demonstrating that you have very little understanding of the problem that you think concerns you.

> Should the need for the medics to feel that they have done all that they can to help trump the patients wishes?

It doesn't. Medics can't force treatment on anyone with mental capacity (as already stated).

> To be left alone to die when the time comes rather than revived because a clinician has the power to do so?

That's not how it works.

> Isn't it rather selfish to wish to keep a loved one alive for your own purposes?

That's not how it works, as a multitude of very well publicised cases have demonstrated.

> I have no wish to shrug the responsibilities onto anyone elses shoulders BUT if they choose to intervene then they have taken those responsibilities upon themselves whether I like it or not.

See above. What exactly do you expect the emergency services to do in time critical situations?

> Is it any better to condemn someone to a lifetime of unwanted disability than it is to let them die?

It's better to do all you can to save a life, absent of contrary instruction, than to condemn them to death cos there's absolutely no coming back from that decision. On the other hand, suicide has been legal since 1961.

You seem to be determined to demand the impossible, unless you have some solution in mind?

 peppermill 09 Sep 2021
In reply to timjones:

I can't add any more than Stichtplate other than to ask:

You're the Dr, Paramedic, [Insert appropriate medical professional]. What would you do if it was your patient?

Post edited at 16:59
1
In reply to timjones:

> there does not appear to be any mechanism which would reliably allow me to have any input if I was unconcious and at deaths door at the scene of an accident.

I think you're asking a bit much from the NHS there, crystal balls and ouija boards might get in the way a bit at an accident scene.


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