The Economy and NHS

[Ms B]

Perhaps the recovery is apparrent in London and some other southern counties but I see very little of it up north, this is reflected in the housing market. As for spending cut backs, the nhs could benefit by not employing staff from private agencies paying mega bucks per hour.
MsB

[Kendhni]

4 months into this year and there is definitely a recovery under way. If you have the right skills then the current job market is very lucrative ... but we still need to see more jobs and work towards full employment (probably an unachievable goal .. but still a worthwhile aspiration).

MSB, on the NHS front I am in 2 minds about that ... either the NHS managers have done the sums correctly and are correct when they say agency staff provide the best value for money or they are crassly incompetent and lazy and we should not be using agency staff ... your guess is as good as mine in determining which is correct.

[david63]

Not sure that hypothesis is necessarily correct Ken.

My view would be that moral, for various reasons, in the NHS is so low that staff have left and as there is a requirement to have certain staffing levels then the agency staff have got the NHS "over a barrel" - however reports, if they are true, of agency doctors being paid over £1k a shift are totally unacceptable.

[Kendhni]

What is the answer then, David? For the past 15-20 years the government has been throwing money at the NHS ... without doubt it has got better, but nowhere near as good as the amount of money would suggest (that goes beyond the NHS and applies equally to other health systems worldwide) ... the implication is that they are throwing money in all the wrong directions.

In the last 10 years
- net expenditure on the NHS has almost doubled ... and despite what some may think it has risen in the last 4 years.
- amount spent per capita has risen by about 50% (in England)
- the number of doctors is up by over one third although the number of nurses has only risen by about 7% and other clinical staff by about 18%
- It now employs nearly 1.4 million people ... maybe the problem is that only about half of these are qualified clinical staff.
In the last 15 years medical school intake has risen by nearly 60%, so surely it can not be a shortage of qualified people?
Either the managers in position to make decisions are getting them right or they are getting them wrong . which includes the use of agency staff ... although I am inclined to think that the media is doing its usual spin and implying a small number of 'worst possible case' is the norm .. I read an article a while back that suggested many agency staff, recruited from overseas, cost less than UK staff.

Since we are now in a recovery I am sure they will start throwing more money at the NHS ... however unless the underlying problems are fixed and money is targeted to the correct services then it is nothing more than papering over the cracks ... or, as some would say, 'polishing a turd'.

[david63]

I am not sure that there is one answer Ken - the situation is highly complex. Just "throwing money" at the NHS is not the answer until some of the basic issues are sorted out as it will not be of any benefit.

- In my opinion the NHS is too big and, in its present structure, probably unmanageable - it is in need of splitting into several smaller manageable units.

- The biggest and most urgent change that is needed is that the NHS needs to move away from being target centred and return to what it used to be and that is patient centred. If you visit any hospital, or doctor's surgery, you are bombarded by a plethora of statistics - the majority of which are meaningless. Last year when taking my mother to hospital one of the charts on the wall was "how long it took a porter to answer a call" - I really cannot believe that somebody is recording that information and what difference does it make?

The problem is that these statistics in general have nothing to do with medical care but are political tools created by successive governments to try and demonstrate that they are "doing a good job with the NHS" whereas in fact they prove nothing as they are comparing chalk and cheese due to the fact that no two hospitals are the same.

Another example of "box ticking" was again when I took my mother to hospital and she had to sit in a corridor for three hours whilst the doctor discharged other patients so as to reduce bed times and then he could spend, literally, three minutes telling her that there was nothing wrong and all the tests were clear - which we told three hours earlier.

- There needs to be a major change in the culture/attitude within the NHS. People are ill 24/7 therefore it is unacceptable that some areas of the NHS operate a "9 - 5 Monday to Friday" approach. If you visit any hospital after 18:00 or at a weekend then significant resources are not being utilised. For example outpatients departments should be operating until nine or ten at night and at weekends. I am not suggesting that there should be more clinics but that they should be "time shifted". This could also have a benefit on the general economy with people not having to take time off work.

It is also unacceptable that many support departments do not operate "out of hours" and tests cannot be done at a weekend - again use time shift. When was the last time you saw a consultant on the wards after midday on a Friday until Monday morning?

- There needs to be a degree of deregulation within the NHS. There are far too may "rules and regulations" introduced for a myriad of reasons - political, H&S, working practices, union influence, management (good and bad). Most of these introduce systems that create inefficiencies - for example, again when with my mother, there suddenly appeared two women with clipboards who were there check on the cleaning of the department. Now I fully understand the need to keep on top of the cleaning in a hospital but why two? For whatever reason it is inefficient and one could do the job.

- The problems in the NHS cannot be fixed with a "one size fits all" policy imposed from the top - it can only work from the "bottom up"

[Kendhni]

I agree totally David .. I have often said that they need to dismantle the NHS and rebuild it around a set of 'fully funded' core services and subsidised 'ancillary' services. I agree there is far too much paperwork and regulation .. but much of that is to placate the demands of very vocal minorities who know what they want but never concern themselves about how it will be paid for. They have to stop tinkering around the edges and throwing good-money-after-bad.

Like many I have experienced both the excellence and the mediocrity that the NHS provides.

I know some people will complain that that could create a two tier system but they are only fooling themselves if they think it not already a two tier system ... money talks in the NHS just as much as anywhere else.

[ITWA Travel Writer]

The NHS will continue to require more and more funding as the population base grows older and as medical research advances. With this medical advancement, once untreatable illness which controlled population is no longer a factor. If we continue to seek longer and better lives then we must be prepared to pay more for the service.

To be quite frank, in this day and age ‘Great Britain and the United Kingdoms’ is no longer the dominant force that it once was and the sooner we realise this the better. We are not the world’s police force. I would rather we scrapped ‘Trident’ and spent the money on the NHS. Imposed a banker’s levy, revised the insurance system and spent the money generated on the NHS as well.

Bring back ship building to the Tyne and Clyde and restart building our own cruise ships!! My God if the Italians can do it surely we can as well?

[Mervyn and Trish]

What we also need to do is stop abuse of the NHS. Anyone who turns up in A&E with a drinking related problem (whether due to accident, fighting, alcoholic poisoning or whatever) for example, should pay for the service, as should anyone who turns up with something trivial they could have treated themselves. Our local A&E sees more than three times the number of patients it did when it opened in the 60s and the local population hasn't risen in that time. Some people attend so often the staff don't even need to ask their name!

[david63]

Whilst I would agree that there needs to be some deterrent for the "minor" cases, as there does for those not turning up for appointments, it becomes a very difficult area to deal with.

Do you charge, or try to charge, before treatment? If they cannot, or will not, pay do you then not treat them? And what happens when you don't treat someone who then develops complications, or possibly dies? The media would have a field day.

If you charge after treatment then you start to introduce a level of administration that would incur additional costs so you would, in effect, be back at square one. And then what happens if they do not pay? No treatment next time? Media field day again.

[towny44]

I wonder, looking at poster boy and smurfys last posts, if we are in danger of believing too many anecdotal reports about problems in the NHS. I agree that sorting out trivial attendance at A&E should be a high priority, but I wonder if all these "We will not tolerate abuse to our staff" posters on notice boards might not be making some staff forget that they are in a caring profession and should be looking to give top class customer service to worried and nervous patients who are understandably agitated at times.
I, like Ken, wonder sometimes where all the increased spending on the NHS has gone, it is better than it was and certainly in our hospitals there has been substantial refurbishment, but there still seem to be too many admin staff and not enough medical staff.

[Mervyn and Trish]

I wonder, looking at poster boy and smurfys last posts, if we are in danger of believing too many anecdotal reports about problems in the NHS.

Not anecdotal Towny. I worked in a major NHS hospital and spent a lot of time in A&E. I personally witnessed the sort of people they have to deal with. For example the chap who turned up with a hurting arm. Turns out he'd fractured it on the beach on the first day of his holiday two weeks before and it hadn't been a problem until he faced the prospect of going back to work, by which time it was well on the way to healing. Or the person who was so ill they dialled 999 for an ambulance to bring them to A&E, then when they found there was a 2 hour wait went shopping to pass the time. Or the times I've been to help friends and relatives as the result of real accidents and the place has been awash with drunks. Not anecdote, real cases.

And it's not the caring staff who would ever dream of discriminating among patients.

It's us as taxpayers who foot the bill and whinge if the price goes up or the service goes down. If we're prepared to put up with the lowlife who abuse the NHS then we just need to shut up or pay up.

For my money I personally resent those who will spend a fortune every week binge drinking but then expect me to pay to pick up the pieces.

As David says, however, it would probably be impossible to administrate. Though they do manage it in other countries.