Funding the NHS

[DonPeffers]

68 A&E consultants write to PM regarding over-stretched NHS    http://www.telegraph.co.uk/news/2018/01/11/hospital-crowding-soars-amid-rising-cases-norovirus-aussie-flu/    and   http://metro.co.uk/2018/01/11/patients-dying-intolerable-nhs-crisis-ae-doctors-tell-theresa-may-7221514/ 

‘Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space. Some of our own personal experiences range from over 120 patients a day managed in corridors, some dying prematurely. An average of 10-12 hours from decision to admit a patient until they are transferred to a bed.’

I've posted before on the forum that additional funding is required for NHS cradle to grave care but what is the best way forward?

1. A funding formula written into law?

2. Setting up a cross-party committee to oversee the funding of NHS and removed from party political considerations?

3. Increasing National Insurance and possibly Income Tax to provide additional funding?

4. Other suggestions.

It seems the current model is not working so what are the views of the collective? Have your say now while you still have the strength as it might be too late when you are on a trolley or waiting in an ambulance.

[Captain Colonial]

That £350m a week (£18.2bn annually) promised by the Brexit camp would be a good start.  Oh wait, that promise made by Boris Johnson and Nigel Farage wasn’t true?  I’m shocked.

[Arm]

Sounds like there is an immediate fix required and that's a large injection of cash - we are led to believe. Not sure how that will provide immediate relief. But if its needed then it will probably happen.

Long term would we pay more per person for the services ? Maybe if there was a clear plan that it would fix the problem.

However I suggest further money in would just disappear into a large unaccountable black hole.

BTW the hospital near me is brilliant and I have total admiration for the Nurses and Doctors.

[DonPeffers]

Not left EU yet so not yet saving the £10Bn yearly contribution. Bigger shock https://www.theguardian.com/politics/2018/jan/11/nigel-farage-backs-fresh-brexit-referendum-to-kill-off-issue

[andy665]

If my wifes experiences of working in and around the NHS is anything to go by there is certainly not a shortage of money in the NHS - what there is a glut of is stupid, ill-informed kingdom builders who are wasting money like its going out of fashion

[Lyonspride]

 

I believe that the only reason the NHS is in trouble, is because it's being run into the ground (or bring made to appear that way) by people who stand to profit from privatisation............. They have private health care, so why should they be bothered?

[Terry Everall]

IMHO the NHS needs more cash injections as well as funded care plans and homes for the elderly to free up hospital beds

We need to train more doctors and nurses

Finally we need to pay more NI contributions and a bit more tax as in the long term we all benefit. Its a great service but you cant run it on a shoestring 

[CraigHew]

1 hour ago, andy665 said:

If my wifes experiences of working in and around the NHS is anything to go by there is certainly not a shortage of money in the NHS - what there is a glut of is stupid, ill-informed kingdom builders who are wasting money like its going out of fashion

Having had a lifelong career in the NHS I must agree with the above quote. 

I'd go further and say up until the early 80's things in general were OK,  then the NHS started inventing managerial posts and support service divisions. To date a huge (and I mean HUGE) plethora of support service posts exist, either counting beans, designing software to help count the beans, making sure all beans are treated fairly, regardless of colour or creed.

Combined with that are thousands and thousands of managerial posts spread across many layers.

Meetings, budgets, targets, meetings.

Somewhere in all this there are a minority of NHS staff who actually treat patients.

 

Put simply: Cash isn't the answer. 

[stephenh]

£126 billion is quite a big shoestring, Terry. It is something in the region of £2,000 per person (man woman and child) in the Country.

It probably does need more money, but it needs to be more efficient as well.

However there is a serious issue with care in the community, which is causing the crippling bed blocking problem in the hospitals. I don't know how they can solve that, but I suspect it is again down to needing more money to go into the system, to meet the needs of an ever increasing pensioner population.

edited to add: Craig's post is interesting. However the bare figures of manager numbers can be misleading. It is my understanding that, for example, matrons are classed as managers, and I don't think many would argue that we should do away with matrons!

[DonPeffers]

7 minutes ago, CraigHew said:

Having had a lifelong career in the NHS I must agree with the above quote. 

I'd go further and say up until the early 80's things in general were OK,  then the NHS started inventing managerial posts and support service divisions. To date a huge (and I mean HUGE) plethora of support service posts exist, either counting beans, designing software to help count the beans, making sure all beans are treated fairly, regardless of colour or creed.

Combined with that are thousands and thousands of managerial posts spread across many layers.

Meetings, budgets, targets, meetings.

Somewhere in all this there are a minority of NHS staff who actually treat patients.

 

Put simply: Cash isn't the answer. 

So if andy665 and CraigHew are correct regarding enough funding going into the NHS (and I respect their views) how do we stop the waste and ram the message home to all politicians that we want to see more efficiency, better results and not just an accountants overview that more money has gone in?

[andy665]

40 minutes ago, DonPeffers said:

So if andy665 and CraigHew are correct regarding enough funding going into the NHS (and I respect their views) how do we stop the waste and ram the message home to all politicians that we want to see more efficiency, better results and not just an accountants overview that more money has gone in?

My belief is that it needs a complete rethink and restructure

More doctors, nurses, social care staff (front line) having a say in how the money is spent

Private operators only where it is proven to provide more efficient service 

Take the NHS out of politics - its used as a political football and guess what - any plans are made for a 5 year term only -how the hell can the NHS be run properly on such a short term strategy. Lets have a cross party group, combined with clinicians putting a plan together that will work

Completely combine NHS and social care - completely under one roof

Change the way doctors surgeries are run - my wife has seen it - huge amount of A&E stuff could be handled by surgeries that seem to be run as a money making machine for the partners at the moment 

Put the focus back on provision of care rather than the measurement of it

Stop some operations / treatments being on the NHS - controversial I know but things like IVF, sex change, non required caesarian births should be chargeable - lets get the focus back on what is really required then we can look at a "nice to haves"

It would be a long and painful process, probably with lots of jobs lost (but many more created where it matters) - have any of the political parties got the nerve to do it - of course not as results would take more than the term of a parliament to be seen

 

.

[Alan France]

Fully agree with CraigHew, just more money won’t make much difference.

24/7 hospital based GP surgeries, let’s call them Polyclinics, to keep the pressure off A&E.

Convalescent homes to remove bed blocking.

Remove many of the non clinical layers of management.

Try and encourage some members of the BMA to stop acting like militant trade unionists.

When my wife had a medical emergency whilst skiing in Lake Tahoe, the hospital care was perfect, with many of the non clinical staff volunteers. But the US system is very expensive and it cost the insurance company $30k.

 

 

[jeff oakley]

My wife is a finance director in the NHS my Daughter a Dr in Coventry and Warwick. There are many problems and the medical staff are not one of them in my opinion. 

In the last two years I have had both parents die having had wonderful NHS treatment. On Christmas eve my Father in law was taken ill and we got to see the best of the NHS and the worst.

37 waiting on trollies, over 50 waiting in waiting room and 16 ambulances waiting to unload, no beds in hospital to get people in for many reasons.

Some despicable people, will not take relatives home as it will spoil Christmas, was one reason but by far and away the biggest reason is there is no where to send people who are well enough to go home but not strong enough to cope alone. We want the Fil home but sadly that is not possible yet for him due to condition.

So what to do, in no particular order.

1 Sack Hunt, he has lost any support of medics, pure and simple. There would be no issue if we had a 7 day NHS with the new contract for JD, and yep it has got worse.

2 De politicise the NHS. Set up a cross party committee with real power to set spending over a 5 year period.

3 Stop endless reorganisations, part of point two to be honest. Have regional funds to spend without the need to get money elsewhere.

4 Let those regions spend what they need on what they chose. It is true the NHS gets more money each year, but much of it is ring fenced and if not spent on the current pet, it goes back to the centre whilst they cut spending on patients. 

5 Have one computer and one accounting system. It seems incredible that there is no standardisation of everything. One CCG get a report another a different one both sying the same thing. 

6. Hand over procurement to the private sector and supply chain. If we had one  company, say Tesco, who can manage to slash the costs by getting rid of duplicated departments and making sure supplies were always available then why not. The public sector is not good at cost effective procurement, even allowing them to make a profit from that we would save billions, not only in product but in pensions etc.

7 Stop paying agencies for staff. Pay the NHS more to do locum and extra hours and there would be again millions saved. Even where they have tried to have hospital controlled  staff banks, they still fall short and pay extra to a company.

8 Make private health care tax deductible, it is wrong that you pay more to save the NHS money and more people might buy into it if they could see a saving.

9 Re open convalescence homes next door to hospitals so people have somewhere to go which should be properly funded.

10 Stop sending so much money out as foreign aid until we sort this mess out.

11 Have identity cards so we can see entitlement to the service. My daughter has had people turn up in A&E with scans they have brought with them whilst visiting family over here and then need urgent medical treatment.

12 All carriers, boats planes etc to ensure any passenger has medical insurance, if any get through they pay. Life saving should not be down to cost, but delivering children is a known issue in areas near airports, especially complicated ones.

13, Stop funding everything people want. Viagra, IVF, cosmetic, unless necessary, for example breast reconstruction, drugs so gay men can have unprotected sex, gender reassignment treatment and I am sure many others we could add in. I have nothing against any of those groups but we need a grown up discussion as there is not a bottomless pit and given a choice between some kid getting cancer drugs or someone having a *******, it is a no brainer.

14 stop PFI, poor value for money for years to come.

15 fund places for more Dr's and Nurse training fully funded, even if there is a payback mechanism if they leave before say 5 years has passed.

I could go on but until the two warring factions stop, Labour throw even more money at it, Tories say money not the answer, but have no answer. What is for sure is the NHS must change and we must demand it. Most people do not really care too much until they need it and see how bad it is. As we age we will all need it more and more.

Sorry for the long post but it cannot go on and neither party is willing to understand the problem without resorting to points scoring.

[Alan France]

Very good points Jeff, especially PFI.

[neptune]

My dad spent 3 months of last year on and off in hospital. When I called 999 for an ambulance in november,  I explained he was having difficulty breathing and they could see his history, it still took 1 hr 20 mins for the ambulance to arrive. It came from leicester to loughborough and we had to advise which hospital to go to which was nottingham city . Although he was transferred quickly from ambulance care to Hospital care we still had to wait over 4 hrs to see a doctor in a& e before he was admitted. 

Whilst in hospital scans and tests were requested and these could take days to happen. If the nhs has sufficient funds it really isnt targeted wisely.

Sadly he passed away in December but the nursing staff treated him with such care and dignity even though it meant taking so much longer to care for him.

Throughout his long illness i have spent alot of time with him at hospital appointments over the past 3 to 4 years particularly. When  you finally get to see the specialists they have all been utterly amazing, patient, never given up trying to make his lot better.  I  couldnt fault the doctors, or nursing staff. They were amazing even providing 1 to 1 observation by his bedside towards the end. Trying to get an appointment is a whole other story..

We are so lucky to have such dedicated , caring front line staff. I just wish the back office admin staff and so called management saw the efforts and effect that the nursing staff achieve so consistently. Perhaps then the NHS could and find the desire to change from within and recognise who is best placed to drive the change