The NHS reform discussion thread

[chris9991]

I don't know if anyone saw this in The Guardian today. It paints a bleak picture but surely things aren't as bad as that

http://www.guardian.co.uk/commentisf...-waiting-lists

[Alan Fry]

Originally Posted by chris9991

I don't know if anyone saw this in The Guardian today. It paints a bleak picture but surely things aren't as bad as that

http://www.guardian.co.uk/commentisf...-waiting-lists

The NHS needs more money and more resources and less reform and PFI!!!

[tweetiepooh]

The NHS does need reforming but an issue that would face any government of any persuasion is that those who get to implement any change are those who are most in need of reforming and the ones who actually never get reformed.

As a crude example, say it's identified that job cuts are needed. The first task is to employ lots more admin and HR bods to implement those cuts. Nett result is there is little saving but degradation of service.

I used to work in the NHS back some years and I bet it hasn't changed much. Far too much bureaucracy and middle management (who can't manage), huge waste and inefficiency.

We promote the best (nurses, doctors, technicians) to management roles that they may not be suited to and keep the less good in those jobs.

We don't get rid of the dead wood who stay employed by just doing the work they are paid for, no initiative, no desire to do extra but they are "covered" by "The Unions", often they are the union reps.

So we need to get the best people into the jobs they are best at and empower them to make those jobs better. This may mean "promoting" less good (doctors, nurses, technicians) to management roles they may excel at and keeping good ones in the roles they love. (Need to address rewards here.)

Focus treatment where it is best needed, we can't afford everything. To my mind focus on prevention more than cure, maybe business needs to pay a little to this end in short term as they benefit if staff don't go off "sick". This is the hard one, if you are one who is in need of treatment then you need it.

[Matthew]

Originally Posted by tweetiepooh

...

I used to work in the NHS back some years and I bet it hasn't changed much. Far too much bureaucracy and middle management (who can't manage), huge waste and inefficiency.

We promote the best (nurses, doctors, technicians) to management roles that they may not be suited to and keep the less good in those jobs.

All very true, exactly the same is going on at the trust I work for at the moment!

[Alan Fry]

Originally Posted by tweetiepooh

The NHS does need reforming but an issue that would face any government of any persuasion is that those who get to implement any change are those who are most in need of reforming and the ones who actually never get reformed.

As a crude example, say it's identified that job cuts are needed. The first task is to employ lots more admin and HR bods to implement those cuts. Nett result is there is little saving but degradation of service.

I used to work in the NHS back some years and I bet it hasn't changed much. Far too much bureaucracy and middle management (who can't manage), huge waste and inefficiency.

We promote the best (nurses, doctors, technicians) to management roles that they may not be suited to and keep the less good in those jobs.

We don't get rid of the dead wood who stay employed by just doing the work they are paid for, no initiative, no desire to do extra but they are "covered" by "The Unions", often they are the union reps.

So we need to get the best people into the jobs they are best at and empower them to make those jobs better. This may mean "promoting" less good (doctors, nurses, technicians) to management roles they may excel at and keeping good ones in the roles they love. (Need to address rewards here.)

Focus treatment where it is best needed, we can't afford everything. To my mind focus on prevention more than cure, maybe business needs to pay a little to this end in short term as they benefit if staff don't go off "sick". This is the hard one, if you are one who is in need of treatment then you need it.

The NHS needs more money and resources, not reform! Until the NHS gets the resources and money, only then can the NHS reform and in a way that does not involve competition and the private and voluntary sector!

Alan, the NHS year on year has had more money and resources - in fact, the NHS budget in 2003 was £67 billion, and in 2013 will be £125 billion, which is nearly doubling in 10 years.

When would be the right time to reform?

As long as services are free at the point of need, why does it matter who supplies them?

Originally Posted by Matthew

All very true, exactly the same is going on at the trust I work for at the moment!

The trust i work for is going through massive change at the moment with the PCT that we used to work for due to be wound up in 2013,loads of redundancies have taken place and people are still going.

Originally Posted by heero_yuy

I was going to post the facts but I couldn't be assed as it simply won't sink in.



Exactly my take. As it is many functions in the NHS are partly or wholly privately sourced. I couldn't care a fig who provides the service or whether they actually make a profit out of it.

Too many people think the NHS should be run for the benefit of those who work for it rather than the patients it is there to provide for.

Working the the NHS as i do i think you are being a little harsh there.

As we are seeing with the JSA workfare scheme being investigated several times by the police in relation to A4e once you have profit hungry companies involved and large amounts of money changing hands,private companies have been involved in the NHS in the shape of PFI and look what has happened.

http://www.healthdirect.co.uk/pfi-ri...s_ripoffs.html

http://www.telegraph.co.uk/health/he...hospitals.html

A word of warning to all those wishing to see a much greater involvement of private companies in the NHS be careful of what you wish for the companies are not be run by charites.

[Alan Fry]

Originally Posted by Hugh

Alan, the NHS year on year has had more money and resources - in fact, the NHS budget in 2003 was £67 billion, and in 2013 will be £125 billion, which is nearly doubling in 10 years.

When would be the right time to reform?

As long as services are free at the point of need, why does it matter who supplies them?

So why do I have to pay for Cancer Drug, Dentists and Prescriptions (In England)?

Also, the increase was only enough to compensate for the many years for under investment, we need to spend far, far more!

[Chrysalis]

Originally Posted by Hugh

Alan, the NHS year on year has had more money and resources - in fact, the NHS budget in 2003 was £67 billion, and in 2013 will be £125 billion, which is nearly doubling in 10 years.

When would be the right time to reform?

As long as services are free at the point of need, why does it matter who supplies them?

It matters because something has to give when profits are involved.

To a private company its profits > everything else. They have to think of the bottom line first. Especially if its a shareholder owned company.

Private healthcare is ok when the rich are the customers because they will pay the premium needed to get good healthcare and for the company to make their profit. But when it has to supply to millions of poor people the margins will drop and they will cost cut.

The 125 billion budget isnt the problem, we were simply correcting the fact the nhs was so under funded under the previous tory government. It is still less funded than other developed countries as a % of GDP.

The waste that occurs in the NHS I would expect alot of it is private contractors milking the NHS knowing its funded by the government. Its common practice for private companies to think they hit the jackpot whenever government money is involved.

[Alan Fry]

Originally Posted by Chrysalis

It matters because something has to give when profits are involved.

To a private company its profits > everything else. They have to think of the bottom line first. Especially if its a shareholder owned company.

Private healthcare is ok when the rich are the customers because they will pay the premium needed to get good healthcare and for the company to make their profit. But when it has to supply to millions of poor people the margins will drop and they will cost cut.

The 125 billion budget isnt the problem, we were simply correcting the fact the nhs was so under funded under the previous tory government. It is still less funded than other developed countries as a % of GDP.

The waste that occurs in the NHS I would expect alot of it is private contractors milking the NHS knowing its funded by the government. Its common practice for private companies to think they hit the jackpot whenever government money is involved.

Please can you be Heath Secretary!

---------- Post added at 10:41 ---------- Previous post was at 10:36 ----------

Originally Posted by heero_yuy

You're quite right to highlight the dodgy PFI initiatives of the last decade. These seem to have been entered into by the naive and the private companies have run rings round the civil servants. Shiney new facilities have come on line and made the politicians look good but the bills are still to be picked up by subsequent administrations.

I conden the morons who signed the contracts, not the companies who took advantage of free money, it is what their shareholders expect them to do.

That does not detract from the fact that competition between providers will drive down costs to the NHS. You can argue that it also drives down wages but that is the inevitable result.

You could of course keep everything in the NHS and double the wages but if the budget remains the same, and in these straitened times it has to, then halve the number of medics, porters, nurses, doctors...

Why should health workers face a wage cut?

As for Competition, take the USA for example and I would rather have one good heathcar provider, rather than many bad ones!

Until I see the rich selling they cars, yachts, planes and other luxury good, I am not convinced that we are in "straitened times"

Also I 100% disagree with PFI and we should pay all the debts relating to it and ban its use!

Originally Posted by heero_yuy

You're quite right to highlight the dodgy PFI initiatives of the last decade. These seem to have been entered into by the naive and the private companies have run rings round the civil servants. Shiney new facilities have come on line and made the politicians look good but the bills are still to be picked up by subsequent administrations.

I conden the morons who signed the contracts, not the companies who took advantage of free money, it is what their shareholders expect them to do.

That does not detract from the fact that competition between providers will drive down costs to the NHS. You can argue that it also drives down wages but that is the inevitable result.

You could of course keep everything in the NHS and double the wages but if the budget remains the same, and in these straitened times it has to, then halve the number of medics, porters, nurses, doctors...

Will competition drive down costs though PFI contracts were awared only after ahem competition rather then drive down prices they seem to have increased, as you said the private companies see public money as a free bonanza.

They may well decrease the size of the wage bill but one things for sure they will not cut down on their profit bill,and instead of money being directed at staff shareholders will see a windfall.

I would not suggest keeping things as they are however behind the scenes big changes are currently happening, with in effect PCTs being stripped and a layer of management is going and GPs being put in charge of comissioning,for good or bad although many seem quite reluctant.

[Chrysalis]

Originally Posted by heero_yuy

You're quite right to highlight the dodgy PFI initiatives of the last decade. These seem to have been entered into by the naive and the private companies have run rings round the civil servants. Shiney new facilities have come on line and made the politicians look good but the bills are still to be picked up by subsequent administrations.

I conden the morons who signed the contracts, not the companies who took advantage of free money, it is what their shareholders expect them to do.

That does not detract from the fact that competition between providers will drive down costs to the NHS. You can argue that it also drives down wages but that is the inevitable result.

You could of course keep everything in the NHS and double the wages but if the budget remains the same, and in these straitened times it has to, then halve the number of medics, porters, nurses, doctors...

One thing that should go is locking patients to their postcode.

eg. all the GPs in my inner city area are of low standard but in areas outside of the city council they are of much higher quality but because of where I live I cant use them. If patients were given freedom to go where they like for healthcare then there is competition within the nhs but still kept as a public provided service.

Is this what you mean?

Originally Posted by Chrysalis

One thing that should go is locking patients to their postcode.

eg. all the GPs in my inner city area are of low standard but in areas outside of the city council they are of much higher quality but because of where I live I cant use them. If patients were given freedom to go where they like for healthcare then there is competition within the nhs but still kept as a public provided service.

Is this what you mean?

The only problem i could see with that being there are surgeries were i live and neighbouring areas where the surgery is fit to bursting and they simply could not take in other patients from neighbouring postcode areas.

[Alan Fry]

Originally Posted by richard1960

Will competition drive down costs though PFI contracts were awared only after ahem competition rather then drive down prices they seem to have increased, as you said the private companies see public money as a free bonanza.

They may well decrease the size of the wage bill but one things for sure they will not cut down on their profit bill,and instead of money being directed at staff shareholders will see a windfall.

I would not suggest keeping things as they are however behind the scenes big changes are currently happening, with in effect PCTs being stripped and a layer of management is going and GPs being put in charge of comissioning,for good or bad although many seem quite reluctant.

Fancy buying shares in NHS plc?