An example of waste in the NHS

ShootersHillGuru 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of whats been said but lets remember GP practices are private businesses and the contract that they operate under is outdated and in place long before most modern technology was in existence.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 can’t say that I disagree with you but for me there does need to be a sea change in how the nation feels about the NHS and in particular the need to take more responsibility for its own health. The NHS is loved by nearly all and nearly all take it completely for granted. I’m of the opinion that people are more connected to and feel invested in something when they are required to pay, even in some small part towards it. I’m talking small fees that are capped regardless of amount of useage. Every hospital has a cashiers office to take payment and let’s be honest a card payment machine could do 99% of the task. General taxation has to be the main and maintained funding model but I think people will have a little more respect and interest in their own health if they have to think about paying a small fee for accessed services. I’m always amazed that ask the average Joe where and what their pancreas is and 95% won’t have a clue. You get one body to see you through yet people are mostly blasé about why and how it works. When there’s a problem there are people who quite unbelievably rock up at A&E and have a headache or bruised toe. There’s no respect for the service by too many. It’s free and taken for granted. I worked sharp end for years and the amount of people who attend with a really shitty, unpleasant and arrogant attitude is astonishing. 

shine166 said:

stonemuse said:

shine166 said:

Managed to blag a appointment, hernia confirmed. Apparently there is quite the waiting for the OP, so if I want it done soon I was recommended to go private... 

That’s what I was told and did so … fixed in a few weeks rather than 12-18 months which I was told to expect with NHS

I am fortunate I could afford it … not good for those who can’t.  

Unfortunately thats not an option for me, the thought of being like this (and it getting worse) for that amount of time is incredibly depressing and worrying.

shine166 said:

stonemuse said:

shine166 said:

stonemuse said:

shine166 said:

Managed to blag a appointment, hernia confirmed. Apparently there is quite the waiting for the OP, so if I want it done soon I was recommended to go private... 

That’s what I was told and did so … fixed in a few weeks rather than 12-18 months which I was told to expect with NHS

I am fortunate I could afford it … not good for those who can’t.  

Unfortunately thats not an option for me, the thought of being like this (and it getting worse) for that amount of time is incredibly depressing and worrying.

I can understand that … would below be an option (available at Blackheath Hospital)?

https://www.circlehealthgroup.co.uk/paying-for-treatment/flexible-finance

Not really, after everything else that's gone up the last few years, another £400+ per month is just not an option. 

Friend Or Defoe said:

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.

PrincessFiona said:

cantersaddick said:

PrincessFiona said:

ShootersHillGuru said:

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

Of course there’s record funding. Just like the cost of your shopping basket at home has to reflect the increases in prices. It goes up week on week year on year. Even then the funding on the NHS has been squeezed year on year since 2010. Every metric you can name has got worse over the last fourteen years. Finally we’ve reached or very close to rock bottom and there is no quick fix to reverse fourteen years of decline. You’ve only got to look at the doctors pay disputes which showed how far behind they’d fallen behind as a window to the bigger picture. I totally agree that waste and inefficiency has to be rooted out but I’m sorry to say that if you think waiting lists, cancer outcomes and staffing issues are not going to need at least for the medium term additional and significant funding then you’ve not understood the problem.

I wouldn't worry about whether I think significant funding is required or not, but what the current government think - NO additional funding without reform. They do not think it is a case of just more (and more) funding - if it was just insufficient funding, then additional funding would be the solution. 

30 July 2024: 'Overall NHS spending has increased in real terms since 2015/16. This has been driven by a £14.3 billion increase in spending on acute care, which accounts for over half of the overall increase in spending (£25.4 billion) over this time period.'

To put those figures into context they include all additional funding for covid including the initial response, purchasing enough vaccines for the whole population to have multiple doses, PPE waste, Test and trace billions. Despite that funding growth per head has been at its lowest level since the NHS's inception in the time the Tories were in charge. 

So hardly like it's been thrown more than it needs and failed. It's actually been given much less than it needs with massive chunks of thatvsiphoned off for covid whether wasted or actually useful.

Starmer says no additional funding without reform and reform or die. Unusually, I agree with him. And I think Labour have a mandate to do something the Tories wouldn't have in the identical circumstances. He doesn't think the solution is more funding. If it was underfunded, the solution would be 'merely' be more funding

PrincessFiona said:

ShootersHillGuru said:

PrincessFiona said:

cantersaddick said:

PrincessFiona said:

ShootersHillGuru said:

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

Of course there’s record funding. Just like the cost of your shopping basket at home has to reflect the increases in prices. It goes up week on week year on year. Even then the funding on the NHS has been squeezed year on year since 2010. Every metric you can name has got worse over the last fourteen years. Finally we’ve reached or very close to rock bottom and there is no quick fix to reverse fourteen years of decline. You’ve only got to look at the doctors pay disputes which showed how far behind they’d fallen behind as a window to the bigger picture. I totally agree that waste and inefficiency has to be rooted out but I’m sorry to say that if you think waiting lists, cancer outcomes and staffing issues are not going to need at least for the medium term additional and significant funding then you’ve not understood the problem.

I wouldn't worry about whether I think significant funding is required or not, but what the current government think - NO additional funding without reform. They do not think it is a case of just more (and more) funding - if it was just insufficient funding, then additional funding would be the solution. 

30 July 2024: 'Overall NHS spending has increased in real terms since 2015/16. This has been driven by a £14.3 billion increase in spending on acute care, which accounts for over half of the overall increase in spending (£25.4 billion) over this time period.'

To put those figures into context they include all additional funding for covid including the initial response, purchasing enough vaccines for the whole population to have multiple doses, PPE waste, Test and trace billions. Despite that funding growth per head has been at its lowest level since the NHS's inception in the time the Tories were in charge. 

So hardly like it's been thrown more than it needs and failed. It's actually been given much less than it needs with massive chunks of thatvsiphoned off for covid whether wasted or actually useful.

Starmer says no additional funding without reform and reform or die. Unusually, I agree with him. And I think Labour have a mandate to do something the Tories wouldn't have in the identical circumstances. He doesn't think the solution is more funding. If it was underfunded, the solution would be 'merely' be more funding

There is absolutely no question that the NHS is and has been underfunded for years. Wages for the work and responsibilities are insulting and if you want proof of that one aspect of the NHS then look at why experienced and dedicated staff are leaving and a new generation of staff can’t be recruited. It’s just not an attractive career which is bonkers because there is so much that the various disciplines offer. If anyone has an answer to the recruitment problem that doesn’t include more funding I’m dying to hear it. Staffing is just one problem the NHS faces. Not enough specialised equipment per head of population another that simply demands extra funding. It’s actually so complex that I have no clue what will happen. Not much if there isn’t more money is my guess.

By way of example. This nursing example can be repeated in many other specialisms.

https://www.nurses.co.uk/blog/stats-and-facts-uk-nursing-social-care-and-healthcare/#:~:text=There%20are%2046%2C828%20NHS%20nursing%20vacancies%20according%20to%20the%20most%20recent%20data.&text=If%20we%20add%20the%20number,a%20record%20high%20of%2011.8%25.

Better tell Starmer then (not me) as he's said no more funding without reform and reform or die