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An example of waste in the NHS

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  • JaShea99 said:
    Right. Surely part of it is there not being enough of them though. So how would more funding not solve that problem?
    JaShea99 said:
    Right. Surely part of it is there not being enough of them though. So how would more funding not solve that problem?
    You'd think so. But they'd probably spend the money on extra doctors and discover they need more nurses operating rooms etc. So the doctors would be sitting around doing nothing until extra funding arrived ten years later!

  • You'd think so. But they'd probably spend the money on extra doctors and discover they need more nurses operating rooms etc. So the doctors would be sitting around doing nothing until extra funding arrived ten years later!

    Doctors training is a minimum of five years which then requires another 8 - 10 years to become competent in a specialty. We are currently losing doctors because it’s better for them to take overseas jobs in terms of remuneration and conditions. The recent pay awards might start to stem the losses but we’re still in a desperate state. GP training is at present a completely unattractive proposition for new doctors. This is going to take years to resolve. Other para medical disciplines are mostly equally struggling. The financial rewards versus the responsibility and stresses are very unattractive to someone looking for a vocational degree. Until the NHS can offer competitive packages of salaries and conditions it will continue to struggle to attract staff. Until staffing is resolved it’s hard to see how the NHS can move forward from its dire situation. 
  • edited September 2024
    Don't you? I guess time will tell but, so far, the government hasn't said they intend to change the funding mechanism nor undertake another wholesale restructuring. If that's your definition of reform I fear you're going to be disappointed as there is next to zero chance of this government moving to an insurance based funding system, for example. And I don't see there being much appetite for getting rid of the NHS internal market or shaking up the trust system either. 

    I've set out above their headline priorities for the next decade, they don't, currently anyway, include wholesale structural changes, more a shift in emphasis and a kick up the backside to roll out technology more urgently. 

    Did you have a view on the other aspects impacting on the NHS btw? From what I can see if those other issues are not resolved too, the NHS is still going to struggle, "reformed" or not. 
    Absolutely this. Wes Streeting has said as much about the funding model. They don't believe that is broken so it won't be changing. As for structural changes one of the major points on this in the Lord Darzi review was to paraphrase: "stop fucking around with it". The Andrew Lansley reforms of 2012 come off particularly badly for the desruption they caused to the whole system for multiple years whilst not brining enough in benefits. Yes there will be specific things that need changing to address issues in the system (I'm hoping GP practices as private businesses is top of the list) but it's clear there will not be wholesale structural or organisational change. 
  • The growing use of Physician Associates, who have only 2 years of training, instead of fully qualified doctors, is a worry. How can someone with so little training diagnose conditions to the same standard as someone who has gone through many years of training. 
  • You'd think so. But they'd probably spend the money on extra doctors and discover they need more nurses operating rooms etc. So the doctors would be sitting around doing nothing until extra funding arrived ten years later!

    It happens now without the extra doctors !
  • The growing use of Physician Associates, who have only 2 years of training, instead of fully qualified doctors, is a worry. How can someone with so little training diagnose conditions to the same standard as someone who has gone through many years of training. 
    Surely it depends how they are deployed ?  To me they make sense as part of the triage process.  Like most jobs, knowing what you don’t know is as important, if not more important, than what you know.  My guess is that we will very soon all be using an AI tool at the start of our interactions with GPs.
  • edited September 2024
    The growing use of Physician Associates, who have only 2 years of training, instead of fully qualified doctors, is a worry. How can someone with so little training diagnose conditions to the same standard as someone who has gone through many years of training. 
    AI although not ready yet will no doubt eventually mean that the vast majority of Doctor / Patient initial contact will be done without the presence of a real doctor. It will be a sophisticated triage / screening process that frees up medics to deal with treatment of diagnosed patients. AI will change everything in every aspect of life and medicine is a perfect example of how it will make things more efficient. I was talking with a friend who visited us for the day, yesterday who is a recently retired consultant audiologist. We spoke about this particular aspect of NHS reform and he was fully enthused by it. A lot of a doctors time is taken up with consultations that eventually don’t need interventions or perhaps just need redirection to further investigations. AI when it’s with us will change everything.
  • AI although not ready yet will no doubt eventually mean that the vast majority of Doctor / Patient initial contact will be done without the presence of a real doctor. It will be a sophisticated triage / screening process that frees up medics to deal with treatment of diagnosed patients. AI will change everything in every aspect of life and medicine is a perfect example of how it will make things more efficient. I was talking with a friend who visited us for the day, yesterday who is a recently retired consultant audiologist. We spoke about this particular aspect of NHS reform and he was fully enthused by it. A lot of a doctors time is taken up with consultations that eventually don’t need interventions or perhaps just need redirection to further investigations. AI when it’s with us will change everything.
    The nature of the AI beast means it will be with us quicker than you think, even in the NHS.  AI is a learning engine so can be used in so many situations.  The mammogram AI is a good example where the computer is given digitised images to assess.  During the learning process it is simply told whether or not breast cancer is present.  The AI knows nothing about photos or breast cancer.  It merely looks at the series of pixels (at bit/byte level) and works out for itself how to decide if the mammogram shows signs of cancer.  That’s the clever bit.  It will be here very soon !
  • AI although not ready yet will no doubt eventually mean that the vast majority of Doctor / Patient initial contact will be done without the presence of a real doctor. It will be a sophisticated triage / screening process that frees up medics to deal with treatment of diagnosed patients. AI will change everything in every aspect of life and medicine is a perfect example of how it will make things more efficient. I was talking with a friend who visited us for the day, yesterday who is a recently retired consultant audiologist. We spoke about this particular aspect of NHS reform and he was fully enthused by it. A lot of a doctors time is taken up with consultations that eventually don’t need interventions or perhaps just need redirection to further investigations. AI when it’s with us will change everything.
    I have family that won't use self check-outs as they don't trust 'them bloody machines' the technology is close, as I society I don't think we're even nearly ready to accept it.
  • I have family that won't use self check-outs as they don't trust 'them bloody machines' the technology is close, as I society I don't think we're even nearly ready to accept it.
    It won’t be a leaning curve. It will be a learning cliff but one that’s inevitable and opting out won’t be an option. It will have an effect on every job, ultimately making some completely redundant. One of the big questions will be just how we deal with the people whose jobs are gone. There will be very many.
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  • Hex said:
    Surely it depends how they are deployed ?  To me they make sense as part of the triage process.  Like most jobs, knowing what you don’t know is as important, if not more important, than what you know.  My guess is that we will very soon all be using an AI tool at the start of our interactions with GPs.
    I agree but PA's have been used to cover doctors shifts and run departments which is a scandal waiting to happen imo. They aren't even that cheap as they actually get paid more than junior doctors (or did before this weeks pay agreement).
  • As for AI consultations they cant come soon enough for me. Pretty much everyone I have spoken to about this has had the same experience as me where a GP has simply googled their symptoms in front of them. Its an embarrassment but also a symptom of the GP system where medicine is now both too broad and too in depth for someone to know enough about all illness to make that initial assessment.
  • As for AI consultations they cant come soon enough for me. Pretty much everyone I have spoken to about this has had the same experience as me where a GP has simply googled their symptoms in front of them. It’s an embarrassment but also a symptom of the GP system where medicine is now both too broad and too in depth for someone to know enough about all illness to make that initial assessment.
    I’ve been using AI tools in my business for a couple of years now, and they have transformed the way I work and massively improved the speed of output. 

    Sooner it comes in the NHS, the better.  
  • A clear example of how things have got much worse over the last ten years and why anyone who thinks they will get better without further investment needs to re think.

     https://www.bbc.co.uk/news/articles/cwy948p4j5wo
  • A clear example of how things have got much worse over the last ten years and why anyone who thinks they will get better without further investment needs to re think.

     https://www.bbc.co.uk/news/articles/cwy948p4j5wo
    Agreed. As does anyone who doesn't think it also needs reform. The two aren't mutually exclusive. I make Starmer right on this.
  • As is always the case, its easy to point in general terms but a lot harder to actually reform anything. 
    An example of real world not Daily Hail huge waste, or not.
    Single use items are on the face of it, a huge cost until you understand the reasons why there is so much of it. As I tried to explain to my mother in law, "would you like a piece of equipment used again if it could save money." Of course she would. And put another way, "would you like a piece of equipment used again, on YOU, if there was the slightest chance of cross contamination" 
    Unfortunately, like most people, my mother in law does not know what is single use and why it exists. Likewise most people can see reform is needed but wouldn't have a scooby of what reform is other than convenient words.
    I work for the NHS, (Medical Physics), not many would know what happens there, I'm certain there are some that would take their ignorance and want to reform my hugely expensive wasteful department.
  •  Within any large complex business the optimal strategic and policy decisions rely on an effective management structure to feed accurate and objective information to decision makers.

    The NHS clearly struggles with this I suspect due to the complexity of the institution with services operating in discreet silos and discreet management with targets to meet, and new targets set, with unforeseen impacts on other departments.

    A TV series some years ago sent high profile successful businessmen into problem businesses to firefight a particular problem. The guy sent into the NHS to look at some specific inefficiences, identified a number of changes to address the problem. But it needed the co-operation of several different departments to achieve the procedural changes needed. They just couldn’t co-operate and wasted days in meaningless meetings discussing why they couldn’t do anything.

    I guess politicians believe there is an internal culture issue which inhibits change
    and why they are driven to impose change from without. The reality is they are the least able to manage anything and think bean counters can solve everything.
  • HexHex
    edited September 2024
     Within any large complex business the optimal strategic and policy decisions rely on an effective management structure to feed accurate and objective information to decision makers.

    The NHS clearly struggles with this I suspect due to the complexity of the institution with services operating in discreet silos and discreet management with targets to meet, and new targets set, with unforeseen impacts on other departments.

    A TV series some years ago sent high profile successful businessmen into problem businesses to firefight a particular problem. The guy sent into the NHS to look at some specific inefficiences, identified a number of changes to address the problem. But it needed the co-operation of several different departments to achieve the procedural changes needed. They just couldn’t co-operate and wasted days in meaningless meetings discussing why they couldn’t do anything.

    I guess politicians believe there is an internal culture issue which inhibits change
    and why they are driven to impose change from without. The reality is they are the least able to manage anything and think bean counters can solve everything.
    I think it's good that we at last have a politician that recognises one of the main problem areas for the NHS.

    I would also like to put on record that I have yet to come across a bean counter who could solve anything !
  • The growing use of Physician Associates, who have only 2 years of training, instead of fully qualified doctors, is a worry. How can someone with so little training diagnose conditions to the same standard as someone who has gone through many years of training. 
    Dr Google is a much safer alternative!
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