doctors ,what a joke ,this country is on its arse

[jeff oakley]

My wife works at a very high level in the NHs and I hear about the problems they have regularly. I respect Norm but he seems to be confused, Doctors have never had control of the NHS budgets until the recent changes have been brought in and many of these "managers" are actually medical staff. My wife deals with them daily and there are those who truely think they can run multimillion budgets and are now finding out it is not that easy. There are other Doctors who say they are trained to heal people and know they do not have the business savy to run departments and just want to be a Doctor.

The big problem is if you allowed every consultant to buy every thing they wanted there would be no amount of money that would be enough for the NHS. Oncologists would want every drug produced for thier patients, every surgeon would want more tackle as it came out but there has to be a limit. The piece of equipment that the nurse said was not wanted, was probably demanded by someone who by the time it arrived had left. That is where the controls come in from the centre which must be sensible and not made on a whim.

Where it is very difficult is where one area allows one procedure or drug and another does not.

Many of the changes now are being driven from two directions, patient choice which with the agreement of the gp means you can ask for treatment at a specific location and the other is to reduce the costs.

The back office functions are being changed so you have the commissioning units, who are based around Doctors and the reporting and finance side. On the later these new units have 2 years before outside companies can compete for the NHS work. This has meant that exsisting NHS staff have been transferred with full terms but all the new staff do not get pension provision and the benefits which over the years will save millions. The threat of competition has already started to make a differance to attitudes towards keeping cost down on everything for the commissoning groups without affecting the care levels demanded.

The biggest problem with the NHS is Whitehall where faceless people suggest things to transient ministers and keep changing things. What the parties should do is agree to a 15 years no change policy to allow things to work. The NHS is a juggernaut which cannot change direction in a 5 year parliment.

The other problem is unions who have done a good job for their members at the expense of the care provided. Many nurses are on very good wages and in many cases deservedly so but we now have too many of these and not enough care assistants who do the tasks some nurse will not like daily ablutions with the patients. This added cost makes staffing levels lower.

The majority of people still hold the NHS in high regard, but to others the fact it is free makes it have little value. These are the people who don't turn up for Doctors appointments, who cancel specialist appointments at the drop of a hat. My Daughter is in the final year of Med school and has just completed two sections where she was working with Community Pediatrics and also Physciatrics. In both of these clinics the appointments are 30 mins and yet there were days when half the appointments were not kept. How can people not care enough to take their kids? If they had paid for the appointment I am sure they would have turned up.

I could go on but the subject is so huge and peoples knowledge is always going to be limited by what they are told. It is only when you get tragic cases like Stafford where Doctors and nurses forgot why they were there and let people die does the papers really get interested. We nevr have had all the facts and nevr will on the NHS but for all its faults it is still something other countries envy

[s2rrr]

Good post Jeff, just hope that Steve can get his issue diagnosed and treated sooner rather than later. I personally know of a couple who have recently gone through the Intensive care route at the same hospital as Steve where it was life or death and on leaving the ICU were palmed off with recuperation without any physio being offered and being stuck in a ward full of terminal patients. She had just spent 5 weeks in a coma to wake up in a dead end ward with no offer of ongoing medical care. Not something they were prepared to accept as the signs were your on your last legs my dear. They baled out and my mate is ensuring she gets exercise and fed as she should, not just left to rot. He is eternally grateful for her life being saved but she was basically left and could easily have given up and  relapsed. This was discussed with a couple of senior sisters they had befriended during her stay and they were horrified.

 

One thing I am not saying is that all hospitals are the same but another friends partner had a major infection of the lungs and nearly died but for what was almost last minute surgery to manually remove the infection. Right now I have a neighbours child who had  peritonitis, operated on and then sent home too early. Home for two days now back in for infection treatment involving all sorts of surgery and mechanical removal of infection products. It was almost like the private treatment system used to be were they operated very quickly on you then sent you home to have any ongoing infections treated by the state. Rather than completing the full procedure and recuperation. Bums in beds I guess. 

 

So rather than moaning about the NHS a machine which probably saved my life, my son wouldn't be 42 this year without them and numerous others and they do so every day, we should be thinking about making it better. That includes accepting that nurses do have to put up with too much sh*t and shouldn't have to, beaurocracy is still too high, patients should attend when given an appointment or change it before the event, people should also not waste doctors time by going to A&E for basic minor issues. The conflict of interest between NHS and private should be better managed. Have you watched 24 hours in A&E recently. I've also been in BUPA for years and its only been used for kids and wife -- so far.

 

Off now, said my piece, just want to hear from Steve that they have located his brain cell and it is ok.

 

Bob

[SteveD]

fpmsl bob     :cry:  no brain cells here wuv           but i am going in next week  

agreed though there are a few good doctors and nurses , there were a couple that really made me laugh while in hospital and the same ones really had enthusiasem for the job you could clearly see that and they made everyone smile and feel alive ,the others seemed like zombies going through the motions , people need to feel wanted and like they are being helped not left in a bed without knowing whats going on like i was for days worrying myself stupid ,there were others like this to ,thats what needs sorting which leads me back to this country is fcuked mode , if we got rid of all the imigrants and scum that come from other countries ,send them all home where they come from no fcuking about on a plane and goodbye see ya , that will leave clearer roads (less stress) more jobs (happier people) more room in hospitals more housing free'd up , no need to build thousands of new houses on green belt like around us , when they  have loads of waste land yet they insist on building on lovely fields and land instead of using the places where huge factorys have been demolished and land sat looking a total eye sight and mess

get rid of all the pikeys that are littering our country side robbing folk blind ,send em home

that then will leave happier medical staff who can then understand what patients are saying and leave them happier in there jobs which then makes happier patients , job sorted

[Wile E. Coyote]

Norman, I'm more than happy to address the points you've raised, but before I do would just highlight that I recognise Jeff's description of the system far more than I do yours.  To make it easier to follow, I've included my comments in bold.

 

<start>

My conclusion having been in both systems is that the NHS is spending huge sums of money on non-medical management of medical departments. Would you bring in household electricians to manage a car workshop? NO - but there is no good reason why the manager of a firm of electricians couldn't manage a car workshop. 

 

Would you get a workshop manager to manage a carpenters shop? No good reason why they shouldn't - they don't need to cut precise dovetails themselves. I could go on but I'm sure you get my point. But you're missing the facts that  many of the non-clinical NHS managers have detailed and specific management skills and experience that most clinicians don't have... and that many of the mid-tier managers are former clinicians... and that there is clinical representation at Board level in all NHS commissioning and provider organisations.

 

Is this non-clinical management bad?  No, far from it in general - for examples of the transferability of management skills, look at the mobility of executives between sectors in the commercial world.  But there are of course examples of very poor practice.  But I could also give these for clinical managers... it would not help the discussion though, so I won't.

 

Are you telling me this is the case. Are you saying that the senior doctor of a department can choose what he needs to provide the service needed. Yes - won't always get everything requested though as there are sometimes bigger picture considerations (namely that budgets aren't limitless and things need to be prioritised, something that does not change by switching to exclusively clinical managers, and is no different to in any other enterprise).  Are you telling me that the nurses also have a say on how their job can be changed to provide a better service? Yes - there were almost 200,000 pledges made on NHS Change Day.

<end>

 

For various reasons I'm not going to discuss too much more on a public forum, but it is worth reflecting on how/whether clinicians automatically make good managers, or can suddenly become qualified accountants etc, or how having a four year old getting a dummy taped to its head - something that happened at Mid Staffs in the run up to the publication of the Francis report (i.e. when the Trust was already under the spotlight) - was a result of non-clinical instead of clinical management.

 

There are some very difficult decisions ahead for the NHS (and the public it serves) and, whilst its obvious you don't like what you perceive to be happening inside it (and your views are, I suspect, not dissimilar to other members of the wider public), the stark reality is that the NHS of 25 years hence will not be the same as the NHS we see today.

[Norman Verona]

I am not saying the medical people are all to blame. 

I'm not saying that managers have to be accountants.

If you had any industrial experience you would know that the best managers are those that have done the job they are managing people for. If you put and electrician in charge of a car workshop you will have serious problems in weeks. People will try it on amd when they get away with bulls*** they just keep going. I've seen it. A friend had a large woodworking business and a friend of his was thrown out of a job. Being a nice chap he gave the out-of-work chap a job running his shop. He went bankrupt in 12 months.

 

You are confusing management with administration and accountancy. I'm saying a doctor should manage his department. Of course not all can do this. However France seems to find enough that can. Mind you they do have more doctors and nurses to choose from.

 

Anyway, not relevant.

 

Please remember the thrust of my argument. The money saved by handing over management to the doctors will enable far more doctors and nurses to be employed and far more equipment to be purchased.

 

I know a few NHS doctors and my daughters sister-in-law is a senior nurse. They all say the same thing, the management do not always understand what's needed and bully and intimidate the doctors and nurses if any complaint is raised. One of the doctors I know does attend management meeting. However he tells me he's not really listened to and they make there decisions even if he objects. Not always but sometimes. The only opinions he has are medical practices.

 

I know the NHS can be wonderful, my children were also treated in the NHS. However we can get complacent that all is well and we should leave it as it is because of our personal experience. Worse still, as you say, we can have politicians constantly change things.

 

All I can say is you should come here for a week or two and talk to the people who work and run the French system.

 

One of the differences between the UK and France on a government level is that deep down France is a communist country. Not communist in the Soviet Union model but communist in the sense they really look after their communities and the elected politicians know that their job is to look after the French population. If they don't they will be thrown out. Here the politicians leave doctors to run the health service & teachers to run the education system.

 

This leads to the position, that with budget constraints each department in a hospital can have what it needs as that department will not overstep the mark.

 

I'll finish on a little story that I know off as it happened to a neighbour and friend here in France. 

 

He was diagnosed with very early cancer due to a having a very rare syndrome. The morning this diagnosis was made he was booked into the cancer clinic in Nantes, about 50 miles away. After lunch he was in an ambulance and taken to the clinic. He was given MIRA scans all afternoon until they found the tumour which was the size of a pea and "hidden" between lung and heart. The following day he had a chamber inserted in his chest and chemo therapy was started.

 

He reacted very badly to his treatment and was prescribed several drugs to help counteract his reaction to the chemicals. 

 

He was not paying tax in France but he did have a French medical card, a Carte Vitelle. The doctor treating him prescribed a particular drug and asked his wife to ensure he took it as it was very expensive. She blurted out "But were English" meaning she didn't want to be a "freeloader". The doctor smiled at her and said "So, I should let him die?" I made a note of this drug and asked an oncologist at Carlisle hospital what it was. The answer came back that he was not allowed to prescribe that drug as it was too expensive.

 

Would this happen in the UK. My information is that it wouldn't. 

 

Spend a week here, I'll introduce you to Camille who is a GP and runs a small hospital, we can go to Nantes Hospital (called Hotel Dieu). See for yourself how they do things here.

 

I know I said "lastly" but one more. In the past two weeks I have spoken to two people who have had very bad experiences with the NHS. One's child was seriously ill and not diagnosed despite several visits to the doctor. The other was in hospital and told he had to go to the toilet unattended as they were too busy to take him. He had a hemorrhage whilst in the toilet, passed out and fell, breaking his ankle. It took three days for the consultant to visit him and he tells me he didn't even speak to him, just read the notes asked the nurse a few questions and left. 

[s2rrr]

Blimey, I'll stay out of that exchange, just here to say to Steve good luck on your visit next week and with the right approach and questions you should be able to either get them to state very clearly what your issue is and/or to have a series of tests completed to determine what is happeneding and a follow up course of treatment possibly. A CT scan can tell you if you have had a brain attack TIA in the past ( my mothers Consultant said so anyway ) but as in my case the damage healed up it won't pick the scars up as they have gone that was by MRI and CT may be slightly different here. Bit like tungsten inclusions on a radiograph bright white spots.

 

Steve  don't get frustrated as the system has limitations and its a matter of perseverance and if they do find it,  the cell that is, let me know if you don't mind either on this public forum where we can discuss your piles in great detail        or by pm.

 

Stick with it mate it will all become clear

 

Back to Norm vs WEC and the NHS debate, over to you guys

 

Bob

[martyblues]

And the new manager of the NHS, is

 

 

 

 

 

 

 

 

 

 

Sir Alex Ferguson

[Norman Verona]

Don't joke, he'll motivate his department and raise the morale of the staff.

 

But it'll never work, he's not a medic  

[s2rrr]

Can handle a hair drier I believe.

 

Bob

[Wile E. Coyote]

Norman, I do have plenty of industrial experience.  For a supervisory role, I agree, hands on experience is essential - but do not believe this to be the case for management roles.  It is very very rare for a non-clinician to have supervisory responsibility for clinicians in the NHS.

 

In terms of clinical managers.  Part of the reason France can find sufficient is due to the greater level of privatisation.  It rarely makes financial sense for a senior doctor over here to take a management role.  Suspect there would be more willing to step forward if the NHS was private... alternative is to pay them on par with clinical work, but that then increases costs for a yet-to-be-demonstrated improvement in overall performance.  However, keep eyes and ears open and you'll see over the next couple of years how much more efficient the NHS has become following commissioning activities being handed to doctors.

 

On drugs being "too expensive" - in the UK, drugs and procedures are evaluated by NICE with a balance of cost and effectiveness being taken into account.  So when "too expensive" is trotted out, it's usually missing the supplementary "for the impact it would have vs. alternatives".  Personally I think top-ups should be permitted, but that's a can of worms that is steered well clear of...

 

Lastly, on your lastly, "too busy" can sometimes happen even in the best run centres (impossible to know what else was going on at the time),  but it's still difficult to see what a doctor deciding not to speak to a patient has to do with some of the management being non-clinical...

[User0083]

Between my wife and myself we have 18 in nursing (NHS, private and military). The best run hospitals have been the military run hospitals with private being the worst. With the military, every military person has management drill into them from the start and for part of promotion we have to do Command, Leadership and Management courses. So every person requires a level of understanding.

Doctors do not

Nurses do not

Some doctors may be "natural born leaders", many are not. Most nurses can't manage their own children, let alone budgets and things... However some may be "natural born leaders" and very good. I feel to improve this country all professions should require formal Green, Amber, Red style results from Command, Leadership and Management courses as people progress through the promotion structure. Then a Red result would give employer/promotion decision to reflect the employee's job role. So a natural born leader can be brought into a leadership role and naturally caring people can be in their caring roles.

My biggest bug bare in nursing is uniforms and appearance! If you're a nurse, be a nurse and dress/act as on. "Hair off the collar" means in a bun, tied up and out the way, not just in a pony tail! Pink hair and metal all over your face... Really? I say bring back discipline towards a professional appearance and if you're going to discipline a nurse for a necklace and cross, as it's not uniform, discipline across the board, no matter to the religion! I've had nurses in bangles! A British nurse can't wear her engagement ring due to infection control, but if another ethnicity wants to wear bangles, the can... Grrr...

[Norman Verona]

Doctor not talking to the patient has nothing to do with the management. My friend now cannot attend his son's wedding in Italy as he can't drive and is not allowed to fly with a cast on his leg. Also, as he's self employed will be losing a substantial sum of money due to being unable to go to work. ed to add that they told him they were understaffed due to budget cuts. 

 

You don't understand the French system. It is not private in the sense that the US is private or like the private sector in the UK. Each hospital is completely autonomous and pays it's way by making charges for the service it provides. An invoice is raised for every patient. HM's invoice for her emergency helicopter lift, 20 days in intensive care and 6 weeks on the ward came to 50,000€. I present a Carte Vitelle at the reception and the government is billed for their social services contribution. I get an invoice for the balance. All emergency services are rated 100%. The bill to me on that occasion was 760€, about the same as the cost of her being at home for the period.

 

The hospitals are owned by the government but are non profit making. The ambulances are private and get paid by the hospital and the patient contributes. I reckon, without getting the slide rule out, that the cost to the patient in France is about the same as the NI and prescription charges in the UK. nearly everyone has private insurance to cover the cost of their bit. It would be about break even for us due to our age.

 

There doesn't seem to be a problem with missed appointment or too many patients seeking medical attention for the simple things like a cold. They have to pay. A doctor's consultation is 22€. Normally, if I ring the doctor for an appointment at 09:00, I'm asked if I want it this afternoon or tomorrow.

 

The doctors (sometimes professors) who run the departments are not fully employed so doing. They practice their speciality at the same time. Please don't think on the NHS model with forms to fill and all the other paperwork that NHS staff have to complete. The hospital has an admin team who will look after the servicing and general supplies. They also have an accounting department who raise the invoices, collect the money and manage the budget. By the way the nurses do the cleaning of the wards. Lynne was on a corridor with about 20 rooms, each with two beds and a toilet. There were at least 20 nurses on duty at any time. If a patient rang a bell a nurse would appear in a few seconds. There was a doctor on duty at all times and the head doctor would do his rounds, accompanied by his students, every day.

 

I suppose the downside is that French doctors are the worst paid in Europe. However they don't seem poor to me.  

 

The point is that over here the medical care system is run to treat patients, whatever it costs. The doctors are not told what to do by anyone, they choose how to treat their patient. There is no "Post Code lottery" here.   They have a lot more money to do that because they do not spend huge sums on management.

 

 

I will take your word for the fact that the changes taking place will solve all the problems.

 

I trust the object of the change is not to save money but to provide the best health service in the world. I'll be happy when we get there.

[User0083]

I'm a bit lost...

I'm not trying to describe the French system or compare. I don't know it at all. I'm not even 100% on NHS or Private. I know differences between how hospitals feel from staff and patient side of things. Been a patient and nurse in both systems... And German. I know that the military wards ran smoother and working in them is far better. As a patient I had more confidence in military staff. I think to do with uniform and professionalism. It could be better paid military nurses and better patient-nurse ratio... But feel old fashioned discipline wouldn't go a miss.