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Millions to be affected by NHS plan to ration 34 everyday tests and treatments
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Old 03-12-2019, 19:44   #46
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by jfman View Post
Especially if you are one of those struggling to make ends meet that Old Boy cares so much about.
What's that got to do with the UK NHS?
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Old 03-12-2019, 19:50   #47
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by jfman View Post
Especially if you are one of those struggling to make ends meet that Old Boy cares so much about.
Tax havens, health insurance schemes....where are you picking this up from? That's not what I am advocating. You've been hallucinating again, it seems.

There are plenty of inefficiences in the NHS, and anyone who has visited a hospital on a few occasions can see that. Huge paper files being carted about, hospitals in one area unable to communicate or access your papers from your surgery if it's in a different area, trolleys with nothing on them being pushed in one direction, then another, with no obvious purpose - the list is endless.

We can do better than this.
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Old 03-12-2019, 20:14   #48
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

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Originally Posted by Sephiroth View Post
What's that got to do with the UK NHS?
Private sector healthcare is a worldwide enterprise.

---------- Post added at 19:14 ---------- Previous post was at 19:10 ----------

Quote:
Originally Posted by OLD BOY View Post
Tax havens, health insurance schemes....where are you picking this up from? That's not what I am advocating. You've been hallucinating again, it seems.

There are plenty of inefficiences in the NHS, and anyone who has visited a hospital on a few occasions can see that. Huge paper files being carted about, hospitals in one area unable to communicate or access your papers from your surgery if it's in a different area, trolleys with nothing on them being pushed in one direction, then another, with no obvious purpose - the list is endless.

We can do better than this.
Because something has no visible obvious purpose doesn’t mean it has none, as a lay casual observer with no medical expertise, no knowledge of the job roles, no knowledge of the internal workings of a hospital would surely agree?

We can do better I’m sure, which brings us back to the 2 trillion of debt accumulated from 40 years of neo-liberal capitalist failure. We lose £40bn a year in interest payments alone. Roughly one third of NHS expenditure in England.

Politicians have to be honest. Pay a few extra pence in tax, pay $321 a month in private heath insurance. Those are the options.

Last edited by jfman; 03-12-2019 at 20:26.
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Old 03-12-2019, 22:25   #49
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by OLD BOY View Post
Tax havens, health insurance schemes....where are you picking this up from? That's not what I am advocating. You've been hallucinating again, it seems.

There are plenty of inefficiences in the NHS, and anyone who has visited a hospital on a few occasions can see that. Huge paper files being carted about, hospitals in one area unable to communicate or access your papers from your surgery if it's in a different area, trolleys with nothing on them being pushed in one direction, then another, with no obvious purpose - the list is endless.

We can do better than this.
We tried, and failed - too much internal politics (between areas and trusts), disagreement on standards (as local systems had grown/been developed organically to meet local needs), incessant change outwith agreed contractual change, lack of suitably skilled staff (legal, compliance, IT business analysis and development), lack of additional staff to undertake the workload of those seconded to the Change Programme, political interference at local and national level leading to more unplanned change.

For comparison, I have worked on migrating the data from current systems and implementing an SAP ERP system in a University, which covered Finance, HR, and Education (about half the systems in use in the University at that time, but the rest had to integrate with the S4/HANA) - that took 3 years and about £30 million.

The NHS, with multiple times the complexity and organisational change required (you don’t just implement IT systems, you have to analyse the business processes required to support and drive the business forward, amend the systems to reflect the business processes, then redesign and train colleagues to be able to use the systems whilst doing their day jobs), would take decades and 10s of billions of pounds - we don’t plan or invest that long term in this country.

There are in England:

207 clinical commissioning groups
135 acute non-specialist trusts (including 84 foundation trusts)
17 acute specialist trusts (including 16 foundation trusts)
54 mental health trusts (including 42 foundation trusts)
35 community providers (11 NHS trusts, 6 foundation trusts, 17 social enterprises and 1 limited company)
10 ambulance trusts (including 5 foundation trusts)
7,454 GP practices
853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations

How do you gain agreement with all these groups on a standard way of doing things?

tl:dr - it’s not that simple or easy
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Old 03-12-2019, 22:39   #50
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

The fun thing is they'll probably have to something at some point, even if it's transitioning in a new system for new generations of patients whilst the rest of us use older systems.
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Old 03-12-2019, 22:47   #51
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Kidney stones would no longer be removed in an operating theatre and instead would be treated with sound wave therapy to reduce the pain.
Whatís wrong with that?

Quote:
It would also see patients told to use physiotherapy or painkillers to dull the pain of an arthritic knee rather than undergo an exploratory surgery
I would have always thought that surgery be the last resort anyway?

Quote:
similarly, in future adenoids would not be removed because evidence now shows that it ďis not necessary, doesnít work well and can cause problems like bleeding and infectionĒ
Evidence is evidence.

Iím just going off the article but it seems from those examples to be completely rational.
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Old 04-12-2019, 08:36   #52
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by jfman View Post
The average health insurance premium in the USA is $321 a month for individual coverage.
30% of that goes towards administration costs. That is how inefficient the American system is.
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Old 04-12-2019, 08:39   #53
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by Angua View Post
30% of that goes towards administration costs. That is how inefficient the American system is.
Oh it's very profitable for some, to whom we're an open goal if we're daft enough to elect Mr Blobby.
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Old 04-12-2019, 10:41   #54
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by jfman View Post
Private sector healthcare is a worldwide enterprise.

---------- Post added at 19:14 ---------- Previous post was at 19:10 ----------



Because something has no visible obvious purpose doesn’t mean it has none, as a lay casual observer with no medical expertise, no knowledge of the job roles, no knowledge of the internal workings of a hospital would surely agree?

We can do better I’m sure, which brings us back to the 2 trillion of debt accumulated from 40 years of neo-liberal capitalist failure. We lose £40bn a year in interest payments alone. Roughly one third of NHS expenditure in England.

Politicians have to be honest. Pay a few extra pence in tax, pay $321 a month in private heath insurance. Those are the options.
You are re-writing history if you are trying to deny now the mess that Labour left behind when they lost power, and you are ascibing views to me and others that we do not have.

As far as the NHS is concerned, I would remind you that the Conservatives stripped a huge layer of management out of the NHS after they came to power in 2010 and nobody seems to have noticed! We have a way to go yet. Problems are not resolved just by throwing money at them and the measure of a well-run service is not how heavily they are sponsored by the State.

---------- Post added at 09:41 ---------- Previous post was at 09:34 ----------

Quote:
Originally Posted by Angua View Post
30% of that goes towards administration costs. That is how inefficient the American system is.
Who said we need to be like the US?
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Old 04-12-2019, 11:07   #55
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Most systems are setup to protect the system whether that is private or public. Those running in ensure that they are looked after first.

So whatever and however it's funded the admin layers are protected and the front end both patient and practitioner are looked after only as it helps the admin layer.

I used to work in NHS IT at a specialist hospital. Was always annoyed that we updated our platforms to meet new requirement and others with big, paid for systems couldn't. Then we hear about how it's so hard to build a NHS network and me thinks that some of the issues need a firm hand rather than technical waffle. The NHS should specify the interface and suppliers/unit comply with that interface e.g. a query looks like this and you provide the answer like this - how you do that is then irrelevant.

The problems in other areas are similar, too much interference in the minutia. The NHS supplies standards/targets, units work to those however they want to. Being ridiculous, a national target to deal with farm incidents isn't needed for an inner city hospital but (if not careful) would still be a target needing budget set aside.
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Old 04-12-2019, 12:46   #56
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by tweetiepooh View Post
Most systems are setup to protect the system whether that is private or public. Those running in ensure that they are looked after first.

So whatever and however it's funded the admin layers are protected and the front end both patient and practitioner are looked after only as it helps the admin layer.

I used to work in NHS IT at a specialist hospital. Was always annoyed that we updated our platforms to meet new requirement and others with big, paid for systems couldn't. Then we hear about how it's so hard to build a NHS network and me thinks that some of the issues need a firm hand rather than technical waffle. The NHS should specify the interface and suppliers/unit comply with that interface e.g. a query looks like this and you provide the answer like this - how you do that is then irrelevant.

The problems in other areas are similar, too much interference in the minutia. The NHS supplies standards/targets, units work to those however they want to. Being ridiculous, a national target to deal with farm incidents isn't needed for an inner city hospital but (if not careful) would still be a target needing budget set aside.
I worked in NHS IT many many moons ago when The Spine , Choose and Book and ETP were trying to be implemented.

I used to see the clinical systems trainers coming back from training primary care (GP's) on C&B they would be distraught as many GP's surgeries would just completely ignore what they were being told to do or actively refuse to do it. and that was only IF they could get past the practice manager (who generally were incredibly obnoxious individuals who took every opportunity to block progress)

There was and to a degree still is a considerable disconnect between primary and secondary care services within the NHS.
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Old 04-12-2019, 16:15   #57
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by OLD BOY View Post
You are re-writing history if you are trying to deny now the mess that Labour left behind when they lost power, and you are ascibing views to me and others that we do not have.

As far as the NHS is concerned, I would remind you that the Conservatives stripped a huge layer of management out of the NHS after they came to power in 2010 and nobody seems to have noticed! We have a way to go yet. Problems are not resolved just by throwing money at them and the measure of a well-run service is not how heavily they are sponsored by the State.

---------- Post added at 09:41 ---------- Previous post was at 09:34 ----------



Who said we need to be like the US?
That statement is factually incorrect - the numbers started going down in 2007.

Quote:
This attack on management and their poor handling of the NHS is a familiar refrain, with even the former Minister for Health Jeremy Hunt joining in by declaring: “We should today ask whether the NHS made a historic mistake in the 1980s by deliberately creating a manager class who were not clinicians.”

And successive governments have backed up their doubts about the value of managers. From 2007 to 2012 the average ratio of managers to staff in the NHS fell by nine per cent.

This is despite changes to NHS organisations, such as the shift to Foundation Trusts, which increases autonomy, responsibility and arguably demands more managers, not fewer. However, from the political left and right, both agree that there are too many managers in the NHS.

But our research debunks that myth, finding instead a strong statistical link between an increase in the number of managers and the performance of hospital trusts on a number of measures.

In fact, according to the data, the NHS would be wise to put aside a portion of the annual £20 billion to hire more managers, especially as the Government will apply five tests on plans to use the money, which are:

Improving productivity and efficiency
Eliminating provider deficits
Reducing unwarranted variation in the system so people get consistently high standards of care wherever they live
Getting much better at managing demand effectively
Making better use of capital investment
Meeting these tests will require good management, and that will probably require more managers, something the NHS is severely short of compared to other sectors.

In a highly complex organisation like the NHS - the fifth biggest organisation in the world - managers are needed to co-ordinate tasks to meet these Government tests.

Currently there are around 31,000 managers employed in the English NHS. About a third of those are ‘hybrids’ – doctors or nurses with a frontline position and a management role – while the rest are dedicated managers. But in an organisation of 1.36 million employees that amounts to less than three per cent of the workforce.

This contrasts with the UK economy as a whole, where managers make up 9.5 per cent of the workforce. It might be there are other roles that involve some sort of management, but such a disparity makes it hard to argue the NHS has too many managers.

Indeed, our research shows that more managers will help the NHS meet the Government’s tests, particularly around efficiency. With my colleagues Ali Altanlar and Gianluca Veronesi, we used data from 150 acute hospitals in England from 2007 to 2012 to find out what impact managers have on performance.

This study found that even a small increase in the proportion of managers (from two to three per cent of the workforce in an average hospital trust) could be significant.

Although having only a modest impact on patient satisfaction, larger numbers of managers resulted in a five per cent improvement in hospital efficiency and a 15 per cent reduction in infection rates.
https://www.wbs.ac.uk/news/how-many-...uk-s-nhs-need/

The clue's in the title - managers manage workloads and budgets, allowing the clinicians to focus on patients.

---------- Post added at 15:15 ---------- Previous post was at 15:02 ----------

CF'ers may find this informative (it's from 8 years ago, and the reporting and funding have got even more complex since then).

https://www.kingsfund.org.uk/publica...rs-and-the-nhs
Quote:
For primary care trusts (PCTs), the recent Health Select Committee Report into Commissioning identified a continuing rise in administration costs dating from the purchaser-provider split in 1991 and was critical of the government's inability to supply 'clear and consistent data about transaction costs' relating to billing and commissioning.

The regulatory framework for health care in England has also become more complicated. A report in 2009 by the Provider Advisory Group, made up of NHS and independent sector providers, concluded that there was unnecessary duplication in the information NHS providers in England are required to submit to the 35 key regulators, auditors, inspectorates and accreditation agencies. Supplying this information has led to an increase in the number of non-clinical staff employed by the NHS.
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Old 04-12-2019, 18:48   #58
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by OLD BOY View Post
You are re-writing history if you are trying to deny now the mess that Labour left behind when they lost power, and you are ascibing views to me and others that we do not have.

As far as the NHS is concerned, I would remind you that the Conservatives stripped a huge layer of management out of the NHS after they came to power in 2010 and nobody seems to have noticed! We have a way to go yet. Problems are not resolved just by throwing money at them and the measure of a well-run service is not how heavily they are sponsored by the State.

---------- Post added at 09:41 ---------- Previous post was at 09:34 ----------



Who said we need to be like the US?
Anyone who cares to look back at the amount of debt, in real terms, will see it has risen for 40 years. It’s an absolute fallacy to blame the Labour Party for 40 years of flawed neo-liberal capitalism. Ten years on from New Labour there is still a defecit, and more debt than ever.

---------- Post added at 17:47 ---------- Previous post was at 17:46 ----------

Quote:
Originally Posted by Hugh View Post
That statement is factually incorrect - the numbers started going down in 2007.
Old Boy doesnít care for facts. Merely obfuscation of reality to blame Labour for everything.

---------- Post added at 17:48 ---------- Previous post was at 17:47 ----------

Quote:
Originally Posted by Angua View Post
30% of that goes towards administration costs. That is how inefficient the American system is.
Profits creamed off, less spent on patient care. Glorious for shareholders Iím sure.
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Old 04-12-2019, 19:25   #59
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

Quote:
Originally Posted by jfman View Post
Anyone who cares to look back at the amount of debt, in real terms, will see it has risen for 40 years. It’s an absolute fallacy to blame the Labour Party for 40 years of flawed neo-liberal capitalism. Ten years on from New Labour there is still a defecit, and more debt than ever.

---------- Post added at 17:47 ---------- Previous post was at 17:46 ----------



Old Boy doesn’t care for facts. Merely obfuscation of reality to blame Labour for everything.

---------- Post added at 17:48 ---------- Previous post was at 17:47 ----------



Profits creamed off, less spent on patient care. Glorious for shareholders I’m sure.
The profit for the Insurance companies, Hospitals and Doctors comes out of the 70%
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Old 05-12-2019, 18:08   #60
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Re: Millions to be affected by NHS plan to ration 34 everyday tests and treatments

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Originally Posted by jfman View Post
Anyone who cares to look back at the amount of debt, in real terms, will see it has risen for 40 years. Itís an absolute fallacy to blame the Labour Party for 40 years of flawed neo-liberal capitalism. Ten years on from New Labour there is still a defecit, and more debt than ever.
You know very well that Gordon Brown wasted all our reserves. That was the reason we had a bigger problem than we would have had with the financial crisis. The debt has risen substantially since then due to the deficit, which had to be addressed at the same time.
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