What state is the NHS in? How can we improve it

ToneControl

There's a lot of cliches thrown around about the NHS:

The tories intend to privatise it
It's the best  health service in the world
managers ruin it
it would be best to sack all the managers, and let the doctors run it
nurses can be referred to as "angels"
everyone in it is underpaid
etc


From what I can see, it's something we can be very proud of and  we should feel fortunate, and AFAIK with the most notable exception of the US, the Anglosphere colonies usually have an NHS-like service

From my experiences with the NHS, which have been more than average contact levels, I've formed these opinions:
Vast majority of staff are competent, committed professionals
A few are half-arsed or crappy with patients
Salaries are very good for many, not good enough for some (I'm thinking junior doctors in particular) 
Hospitals  in major cities are  very busy, I try to avoid them
Hospitals in poorer areas  seems to have a much higher proportion of  foreign doctors, including some who were struggling with  communication issues  (Bear in mind I happily work with foreign people all day, so this is  a  measured comment)

I have heard that some of the  procurement for the NHS is poor, and  that they pay too much for some  goods and services 
I have seen first hand some of the IT problems, all the evidence I know of is that  it's IT is way more dysfunctional than other  100k+  employers.
I have seen a lot of waste in other government departments, much less so in the NHS, but  I have only  seen the NHS as a customer

On a political level, I cannot see any  ethical  reason to mandate that all government services be delivered by government employees. I've seen plenty of examples where that approach is highly inefficient and ineffective, but as I  say - with the NHS all I know about is  the  procurement and IT

This story today seems to  confirm that  the NHS can be just as guilty of cronyism as any private firm

So  what I am trying to form an opinion on is:
Could the NHS be better run, and if so, by whom or how?
Is all the  vitriol against  managers in the NHS  mistaken?
What improvements could be made ?

mudslide73

As a frequent service user and spouse of NHS manager I've seen many changes over the years.

They will privatise services with measurable outcomes sooner rather than later. There are moves for Trusts to bid for services in other geographical areas as well as private sector bidders. Services with long term service users (mental health etc.) are not as popular with the private sector - very costly with some service users being on the books for decades. Not long for the current model imo.

I have had incredible care from the hospital with the worst reputation in the UK so standards aren't often reported properly by the media. Hopefully we'll emerge with something that works.

octatonic

Kill all the old people.

strtdv

There are two options for front line services:
Fund it properly (which would mean higher taxes), which would include improving pay for junior doctors but also providing a true 7 day a week service, and generally increasing the number of staff on the ground.

The other option is to run it like a GP practice where it is a private business but with the government as it's sole client. This is similar to the New Zealand system, and would improve efficiency while still remaining free at the point of use.

ESBlonde

My partner is a senior nurse within the NHS, she was for a brief time a Matron a couple of years ago but stepped down because of poor resources and unrealistic expectations. They subsequently employed 3 people to cover the same roll and had some others covering tasks formerly part of the roll. They also tried to implement some new software to work out shift patterns for the wards. They had no concept of what was even required let alone the ability to develope it in a reasonable timeframe. I think it's still being developed and the shifts are done with paper and pencil before being copied to the roster. The rules of working one day shift immediatly following a night or doing day night day, or having no day off in a 7 day spread etc plus having 'leave' requests considered for normal family activities etc. I know for a fact that my partners pay packet is probably correct little more than half the time! The stories I hear (and she keeps a lot to herself) would finish many a business in short order, but it's not a business so cannot be looked on in just that manner.
In terms of the benefits I have received, for many years i was your typical bloke and saw my doctor every few years, but age and a pre existing condition that has developed has me using the facilities of the local hospital a couple of time a year or more. Service always exellent if not timely, the administration leaves much to be desired but just about functions. All those years of 'paying my stamp' are looking like a good investment for my and my families future.
I also think peoples expectations of what they should get for free from an NHS are sometimes unrealistic and possibly beyond the 'intent' of what was created after WWII. Free teeth and glasses with access to a doctor and prescription drugs is different from the technology and medical advances now available to a cutting edge service (which the NHS definatly is).

Jalapeno

Only thing I'm certain of is that we should not pour more money into a broken system (which it is IMHO) - radical change is needed - I have no idea what or how - but the current state of affairs is non-functional.

Big centralised uber-hospitals doesn't feel right - needs to be more community based health care, but that's just a gut feel based on no science at all.

scrumhalf

I had a small procedure late last year and whilst the hospital staff were great there were practices and procedures that just seemed to be illogical and wasteful of time and resources.

I sent an email to the hospital's CEO outlining these but never even recieved the courtesy of a reply.

Fretwired

Jalapeno said:

Only thing I'm certain of is that we should not pour more money into a broken system (which it is IMHO) - radical change is needed - I have no idea what or how - but the current state of affairs is non-functional.

Big centralised uber-hospitals doesn't feel right - needs to be more community based health care, but that's just a gut feel based on no science at all.

^^

Agree.

I have aged parents and had to take my dad to see a specialist at an NHS hospital last week. It was a small community hospital in Hertford. He had an appointment at 12:00 noon and was seen on the dot, dealt with and left at 12:30.  Excellent treatment. My mother goes to another community hospital and gets similar, excellent treatment. Even our main hospital is good, if a little slow when busy.

We also have mobile doctors and high tech ambulances - when my brother in law had a heart attack he was kept in the ambulance and stabilised before he was taken to hospital - the ambulance had all the kit and the paramedics knew what to do.

However, a friend of mine died due to the fact there was no specialist weekend cover - it happens.

Throwing money at the NHS won't work. A big problem is we take it for granted. My parents local GP goes mad when people don't show up (it can be 30 per cent of the time). And people need to take more care of their own health. Too fat, smoke and drink too much then the NHS is not for you.

I'd scrap Uni fees for people studying medicine so long as they work in the NHS for a minimum of 10 years. The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Overall I think the NHS does very well. However the left use it as a political football as its one area they can attack the Tories - privatisation whilst ignoring the damage done through Labour's PFI initiatives.

exocet

We need to restrict the demands that we place upon it or face paying an awful lot more.

Either some form of charging to "access services" - even a notional £50 covered by some form of insurance policy would help.

Enforce similar access charges for overseas visitors. When I received treatment in France last year for a head injury, most of the cost was met via E111 however I still had to pay a token 80 euros or something. I paid with a credit card, all very straight forward.

We also need to help ourselves, obesity and smoking related illnesses can be reduced if "we" want to help ourselves.

ESBlonde

I know it's a difficult point, but the amount of administration used defending malpractice and making huge awards out of NHS funds is a waste. Proper management in the first place would mostly remove the need to defend the cost and make the funding award in the first place.
I realise this is a generalisation, but the sums involved are massive and mainly go back into the NHS for future care of those directly effected. I have somewhat over simplified this.
Would i feel different if one of mine suffered at the hands of a medical professional? I don't know, but you still can't undo what happened and the NHS will still provide the extra care required.

Drew_TNBD

octatonic said:

Kill all the old people.

Nah. Kill the non-natives.

Jalapeno

Fretwired said:

I'd scrap Uni fees for people studying medicine so long as they work in the NHS for a minimum of 10 years. The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Friend of our's daughter just finished a degree in Radiography - NHS paid all he tuition.  She's just started at a hospital.

Agree about PFI - that's half the problem, servicing that huge debt.

ICBM

Jalapeno said:

Fretwired said:

The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Agree about PFI - that's half the problem, servicing that huge debt.

If the contracts were drawn up in typical government fashion it can't be paid off early without compensating the companies for the profits they won't then make, so it could be much more expensive even than the value of the debt. The corporate lawyers weren't foolish enough not to think about protecting their licence to print money.

Tuscan777

I went to pick up a prescription last week, paid my £8.40 (I think), sat down and waited. 14 other people came in during that time all stated they didn't have to pay.

So, from this incredibly thorough analysis, I conclude that I am pretty much supporting the NHS in my area.

4114Effects

ESBlonde said:

My partner is a senior nurse within the NHS, she was for a brief time a Matron a couple of years ago but stepped down because of poor resources and unrealistic expectations. They subsequently employed 3 people to cover the same roll 

That's one poorly run catering department for sure. 

Axe_meister

It's not just the NHS that is badly managed. I'd say the entire social system is.
We deal with our Local Education authority SEN department on almost a daily basis. The level of incompetence when it comes to admin is beyond pale.
loss of documents, left hand not knowing what the right is doing, out right lies when trying to defend their incompetence.

Go private (health and education) everything in regards to your case is fully documented/tracked. You phone up and they know who you are from your phone number and you are directed to the right person straight away.
I'd hate to be somebody with below average Education/intelligence and try to navigate the system.

boogieman

My wife was a nurse specialist in an anti-coagulation clinic and a coronary care unit prior to that. She's also been a ward sister in the past. She eventually grew to hate all the crap and pressure put on her and couldn't wait to get out... she took early retirement three years ago. She's had a letter today, sent via the College of Nursing, basically asking her if she's had second thoughts and wants to return to her job. They must be getting pretty desperate. 

spark240

I had cause to go to Walsall manor hospital a few years ago at around 12.00 midnight, I went in the wrong entrance and had to walk all the way through to get to the right ward. It was like a ghost town, no staff, no patients, and I thought all this ££££££ of equipment and resources not being used?....  there no future in that.

Fretwired

ICBM said:

Jalapeno said:

Fretwired said:

The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Agree about PFI - that's half the problem, servicing that huge debt.

If the contracts were drawn up in typical government fashion it can't be paid off early without compensating the companies for the profits they won't then make, so it could be much more expensive even than the value of the debt. The corporate lawyers weren't foolish enough not to think about protecting their licence to print money.

The idea is the government borrows some money while its cheap and takes the debt onto its books - as the NHS is publically owned the government are technically liable anyway. The government then makes the payments and the NHS takes the debt off its books - as you say it would be too expensive to get out.

Waste of money:

PFI: £2.9 billion

Agency staff: £3 billion

Naff drug deals: £2 billion

That's a lot of money.

Fretwired

ICBM said:

Jalapeno said:

Fretwired said:

The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Agree about PFI - that's half the problem, servicing that huge debt.

If the contracts were drawn up in typical government fashion it can't be paid off early without compensating the companies for the profits they won't then make, so it could be much more expensive even than the value of the debt. The corporate lawyers weren't foolish enough not to think about protecting their licence to print money.

The idea is the government borrows some money while its cheap and takes the debt onto its books - as the NHS is publically owned the government are technically liable anyway. The government then makes the payments and the NHS takes the debt off its books - as you say it would be too expensive to get out.

Waste of money:

PFI: £2.9 billion

Agency staff: £3 billion

Naff drug deals: £2 billion

That's a lot of money.

Fretwired

Jalapeno said:

Fretwired said:

I'd scrap Uni fees for people studying medicine so long as they work in the NHS for a minimum of 10 years. The government should also borrow money while its cheap and write off the PFI debt. It would save the NHS about £3 billion a year.

Friend of our's daughter just finished a degree in Radiography - NHS paid all he tuition.  She's just started at a hospital.

Interesting.

A friend of mine has two children who are now junior doctors - they both studied medicine at Cambridge University and are heavily in debt . My friend is helping them out though - she and her husband are £500 per hour corporate lawyers. Not short of a few bob ... :-)