An example of waste in the NHS

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

ShootersHillGuru said:

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

Doesn't matter how you fund the NHS, it'll still be f***ing inefficient ! Lovely and competent people running around like headless chickens!

stevexreeve said:

ShootersHillGuru said:

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

Doesn't matter how you fund the NHS, it'll still be f***ing inefficient ! Lovely and competent people running around like headless chickens!

What?

ShootersHillGuru said:

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

I'm afraid I don't agree. 

I don't think the funding model is fundamentally broken. In the short term we are gonna have to pay more to fix the mess and in the medium term we will pay more than we should have to because 14 years of cuts largely focused on the prevention side mean we are a sicker population and so will have to pay for that while we wait for prevention on the next generation to catch up. 

But, I still believe this should be funded through general taxation. I don't want to get into the realms of the politics thread but I believe there are ways to raise extra for this if needed and other European countries are starting to do so. The analysis is clear that even the smallest surcharge on these things will cause people to delay investigations and treatment and end up with adverse effects likely only getting treatment later which means its more expensive, more invasive  longer recovery times, more ongoing care, longer out of work etc etc. This would have a much much worse effect on population health and the state of our NHS than the generation of missed prevention I mention above. It will only assure that costs are higher in the medium term.

You only have to look at the state of dentistry to see why keeping health free at the point of use is essential.

Chippycafc said:

A friend of mine is a self employed package and parcel delivery driver who delivers those articles anywhere in the UK and charges £1  mile. He lives in Hull.

When the pandemic was on he took up the challenge of delivering covid samples to London from Hull airport that was mainly business flights from Amsterdam,

On his first job he had to take 10 samples to the lab. He quoted £300 round trip

The NHS thought he was quoting £300 each and paid him £3000. When he discovered the mistake he told them and they said dont worry thats what we agreed.

He told me he made£70k over the period on that agreement. Thats not forgetting  picking up return packages on his way back.

That's nuts, I would have thought with the NHS in crisis, they'd want to ensure they weren't spaffing away £2,700 per round trip 

JaShea99 said:

stevexreeve said:

ShootersHillGuru said:

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

Doesn't matter how you fund the NHS, it'll still be f***ing inefficient ! Lovely and competent people running around like headless chickens!

What?

Lions led by donkeys.

Kap10 said:

TellyTubby said:

ShootersHillGuru said:

ShootersHillGuru said: Attendance at A&E for anything other than a real and significant problem should also be stamped out. More than half of all A&E attendees could easily wait to be seen by their GP or Practice Nurse. Few people take advantage of ringing NHS Direct to obtain advice as to the best course of action and consequently the NHS is bogged down and drained of resources quite unnecessarily. People call for an ambulance for all sorts of inappropriate reasons. Of course a lot of this is true SHG but there is always two sides to everything. Our doctors practice has so many patients and that is because it increases their funding allowance, hence when you want to see a doctor you can't. Mrs dave suffers with Sinus problems it's not a serious complaint I admit but when she gets a bad cold it inevitably turns to an infection in the Sinus. Last time she was getting severe nose bleeds and was generally very unwell but despite numerous attempts we struggled to get an appointment to see the doctor. So they ask you to phone up, which we did and despite a history of the same problem the doctor refused to prescribe any medication and told us that my wife had to come to the surgery so we are back on the same treadmill crazy! So what are the alternatives? Certainly not A&E so eventaully we went to a walk in clinic in Crayford and after 2 hours got seen, antibiotics prescribed and after 2 days she was getting better. My point is that after a while people who feel unwell get desperate, sure there are the numpties who call an ambulance because they have a cold, but some of the so called time wasting is created by the system. If you can't see your own doctor then what else do you do? I know we probably disagree on this mate but there is a problem with the way the NHS allocates it resources.

To my knowledge all GP surgeries are affiliated to an out of hours service that you can attend. You can ring NHS Direct and speak to a nurse to ask advice as to whether you need urgent attention or you can wait. The options are available but few even consider it as an alternative to pitching up at A &E with a bad headache or a case of the trots.

Mrs TT recently retired from a GP surgery. She hated the waste and has always said that the NHS doesn't need more money. It is very badly run. Neither of us would want it scrapped BTW,  just major reforms.

When out of hours was forced on the practice ( which all are effectively private businesses BTW), the practice took a huge amount of money to provide the appointments. I think that I'm right in saying that they never saw any patients during these extra appointment periods, because they never advertised them, would only take advance bookings and because several practices joined together, it was hard to discover which practice's turn it was to do the out of ours stuff.

As for 'Bank staff' system, it's absolutely madness and hospitals will collapse if the current government stop all zero hour contracts as they say they will.

The NHS is a long way from the envy of the world. My experience of health care in New Zealand, Portugal and Italy were all superior to the NHS. 

It was, 14 years ago!!

With regard to GPs.  it has been known for years that there would be a large number of older male GPs retiring in the early 2020's, but there was insufficient planning to replace them.  There is an annual NHS report that does not talk about the number of GPs available but the number of GP hours available which has reduced. 

Overall we are likely to see more private contracts given out by this Government, before it can start to bring things in house, to clear the mess in the short term.

Another area of cost is the locum and agency staff who fill in gaps in staffing. 

It was not the env of the world 14 years ago. If it was other countries would follow the same model - and no one does. It is a very, very long time ago that it was anywhere near the envy of the world

Bournemouth Addick said:

cantersaddick said:

ShootersHillGuru said:

cantersaddick said:

Agree with lots of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence. As a result GP practices have far to much independence in how they operate a large number of things and the NHS cannot tell them  how to operate even if it is better for the patient experience. GP practices also own their own data and can choose what and how much they share with the NHS which prevents analysis into how the system can be improved and how we can better target treatment and most importantly prevention. 

Changing the GP model and phasing out the private GP practice model would be top of my list if I was in charge of reforming the NHS. It’s the most important factor in the Moving from hospital to community care - one of the 3 pillars of their 10 year plan for the NHS. It will be a difficult legal battle but we have a top lawyer for PM so if there is a time to tackle this it’s now. In my view this is the biggest blocker to the NHS performing well.

The NHS does need reform and I worked in it for thirty years. The real problem is that it’s not just about reforming the management structures or even funding. That’s been tried by practically every government since year dot. The whole ethos of the NHS needs a rethink. Everyone wants an NHS but nobody wants to actually pay what’s required to make it function well. That’s not just about throwing money at it but fundamentally changing how we fund and view our healthcare. For me, I would suggest that all accessed services come at a small individual cost. Means tested certainly but if you need a blood test then it’s £10:00. A general x-Ray £20:00 and so on. You get the drift. People have to feel that they are invested in the service and their own health. I think this is even more important than collecting the fees. At present too many people treat their health and those that provide their health services as some sort of god given right. Pitch up and it all falls into place like magic. I can tell you there isn’t much magic. People are fully prepared to spend a lot on all sorts of things yet ask them to invest a small amount in their own health and they object. I know that’s not everyone but it’s a majority I feel. Health technology and pharmacology changes at a breathtaking pace and it’s bloody expensive. Nobody should be expected to or need to go into debt or struggle with medical bills but I think the time has come where big decisions need to be made. An insurance based system would be a disaster but asking people to pay a little towards and take some responsibility for their own health is I think the only way to keep the NHS in a form we would still recognise and want. It’s going to be a long haul because getting the staffing issues sorted is a mountain in itself. 

I'm afraid I don't agree. 

I don't think the funding model is fundamentally broken. In the short term we are gonna have to pay more to fix the mess and in the medium term we will pay more than we should have to because 14 years of cuts largely focused on the prevention side mean we are a sicker population and so will have to pay for that while we wait for prevention on the next generation to catch up. 

But, I still believe this should be funded through general taxation. I don't want to get into the realms of the politics thread but I believe there are ways to raise extra for this if needed and other European countries are starting to do so. The analysis is clear that even the smallest surcharge on these things will cause people to delay investigations and treatment and end up with adverse effects likely only getting treatment later which means its more expensive, more invasive  longer recovery times, more ongoing care, longer out of work etc etc. This would have a much much worse effect on population health and the state of our NHS than the generation of missed prevention I mention above. It will only assure that costs are higher in the medium term.

You only have to look at the state of dentistry to see why keeping health free at the point of use is essential.

I agree. That's not to say there's not significant improvement in tackling waste and fraud within the NHS. Just like there is with any organisation, let alone one as complicated as the NHS.

I think it's convenient and natural for many to look at what's happening within the NHS in isolation and come to conclusions without taking the necessary holistic approach. Whether that's throwing more money at it or fundamentally changing the funding formula.

But what about the impact of cuts to social care? Or moving Public Health into the local government budgets? Or cutting access to community mental health services? Or drug and alcohol rehab projects? Or cutting community groups for the elderly or socially isolated? Or reductions in warmer homes grant funding? Or closing Sure Start centres?

None of these, or dozens of others, may be within the control of the NHS but sure as hell impact on it and the service we receive. I don't know how we begin to fix all these factors, good luck Wed Streeting, but I do know the solution isn't moving to an insurance based system that sure as eggs is eggs will end up being like the US system and not like the French system its proponents like to pretend it will. 

Bang on. And the paragraph in bold is just some of what I was referring to when I said a whole generation of missed prevention work. It's actually broader than prevention strictly as many of then aren't about preventing sickness per se but they all prevent someone from showing up at hospital and needing a bed whether that's through more effective social care  better primary or community care, better education around health, healthier eating, exercise etc. It all makes a huge difference.

Upwards of 400 men pay (£15 I think) to a charity to have a PSA blood test at Charlton with the results conveyed by email within 24 hours so people are willing to pay for a specific service. I have a PSA blood test on the NHS yearly via my GP the results take up to 2 weeks. To get these results I have to ring the Surgery.        

shine166 said:

DPFC said:

shine166 said:

I'm 99% sure I've got a hernia, doctors suggestion was a appointment in 4 weeks, ring up tomorrow at 8am for one of 6 appointments on the day or go to A&E. How the hell has it ended up like this, there really does seem to be zero Improvement on medical times and if nothing it's still getting worse 

Does your surgery not have an e consultation service?  Here in Whitstable you can fill in an online form . I did this at 7 am last week and exaggerated the symptoms.  I had a phone call at 10.15 and a face to face at 11.30

Yeah it opens up at 12.30 each day, it's a new version of said system. By the time I'd worked out how to get into it at 12.40 it had reached max allocation for the day !. Anyone that works or has commitments that makes it tricky to be available bang on that time has no chance.

I find that appalling ours runs 24 hours a day though you omly get a response during surgery hours

PrincessFiona said:

The NHS has had record funding. even Labour are saying vehemently, 'no extra funding without reform. And reform or die. It is NOT about additional funding but about reform and reducing astronomical waste

I'm not sure when Starmer says "reform" it means what you want it to mean. The recent announcement of the 10 year plan was around, "shifting the NHS from analogue to digital, putting more care in the community, and a focus on preventing people getting sick."

https://www.reuters.com/world/uk/uk-pm-starmer-promises-10-year-plan-fix-health-service-crisis-2024-09-11/

That's not the same as yet another restructure of the NHS or changing the funding model.

No details yet granted, but I can't see too much to object to in there and it clearly recognises some of the factors external to the NHS that myself and Canters mentioned above.

Out of interest are you in agreement or not that there are a lot of other factors outside the NHS control that also require urgent attention?