Funding the NHS

[Alan France]

Check out Virginia Mason in Seattle. Private, non profit hospital. That’s the thinking we need, using Toyota inspired lean with a target of zero mistakes. In the UK it appears large sums are spent by bureaucrats defending mistakes instead of learning from them. 

I’ve heard a couple of their lectures at conferences and there is a reason they are in the top 1% of US hospitals. Why keep doing the same things over and over again when it doesn’t work.

https://www.virginiamasoninstitute.org/

[Blatman]

Sponsor a hospital and the cry will be "privatisation by the back door". To me this demonstrates a lack of forward thinking by whoever shouts that, especially if the cost to the service/taxpayer is neutral and the resulting patient care is positive.

[jim_l]

You could argue with the 'Save our NHS' and 'Our NHS is in crisis' brigades that in fact it is THE BEST it has ever been, how can you argue that?  well, in just a decade there are about 2 million more people alive over the age of 65, and hundreds of thousands more alive over the age of 90.   You can have a heart attack now and by the time your anxious family come to see you are ready to go home, stents fitted. More and more people surviving cancers etc.  

The problem you have when you get so good that more people survive heart attacks and cancers, is that they eventually come back with similar or other things that just get more complicated with age, the bulk of the NHS budget is spent on the elderly, and the success of the NHS just increases demand.  So, it isn't a question of cuts to NHS funding, it is a question of whether we are willing to fund the massive increase in demand that its success creates. 

People often intentionally confuse the provision of care by private companies with a move towards private healthcare funding, it scares the people that don't know the difference.   I do think that it often gets done more cheaply in private hands through the creation of less well paid jobs, which benefits no-one except the well off, there should be robust minimum job standards when the government contacts out taxpayer funded work!  

and finally...I think it is broadly accepted that the NHS is not very efficient , too many managers,  many of those promoted by virtue of time served rather than ability to manage, too many staff that are poorly motivated because they are poorly managed, high sickness rates, wasted opportunities to do more with the massive purchasing power they have, etc.  I think there are huge opportunities to do more with the current budget. 

...my two penn'orth...

 

 

 

[Blatman]

On 2/7/2018 at 19:48, jim_l said:

I do think that it often gets done more cheaply in private hands through the creation of less well paid jobs, which benefits no-one except the well off,

That's a question of degree. I suspect to those in minimum wage jobs we count as well off, what with our expensive toys and well paid (by comparison) jobs, money in property and foreign holidays...

[jim_l]

Nice to hear from you Mr Searchmeister, I am not sure what your point is there but can clarify what I meant.   I was comparing a) the job being done in the NHS by someone on a good package of pay, benefits and a pension scheme, with b) the job being done in the private sector by someone on the minimum wage , someone making a profit on that and taking it offshore. 

Initially b) looks like it gets done more cheaply for the taxpayer, but the worker in  b) pays less tax, probably gets no sick pay, little pension entitlement, claims more benefits, is generally more state dependant.  So in the end the taxpayer can be worse off.  I am just suggesting that there should be minimum standards set in the contracts when work is outsourced so that this doesn't happen. So for example someone doing outsourced work for the NHS should be on a package similar to NHS employees, then if the company can make a profit out of doing it more efficiently, then good. 

 

 

 

[Blatman]

Every chance I missed the point there!

 

[jeff oakley]

The biggest savings are in staff costs.  Rate of pay, pensions and sick pay is the biggest. NHS employed cleaners will be paid a low wage but will get an NHS pension plus sick pay of 6 month full pay and 6 months half pay for a genuine illness, or not so genuine if they are playing a stress card.

Private company will pay minimum wage, a stake holder pension and two weeks sick pay if you are lucky for the same job. The NHS will pay redundancies and then they will have to reapply to the new company on new terms.

Where it is in a back office function, like accounting, staff are Tupied over but they soon learn that sickness is dealt with much quicker by Occupational Health meetings and staff tend not to like the pressure that a private company puts on staff to perform as the best do.

There is no internal benchmarking across the NHS on back office functions, because too many do not want themselves to be judged.

You could argue that any company taking on a contract should pay exactly the same terms and conditions, but that would mean no savings at all would be possible. It is sad for the individuals concerned but if the job is done as well or better for less money in functions which are not medically related, then is that wrong?

NHS supplies for example, is the most inefficient organisation there is, a distribution company like Tesco would make it work so much better as they can move huge amounts of stock daily as they are geared for it.

Whatever the NHS debate will rumble on and on and there will never be enough money as age of population, size of population and medical advancements change

[tolf]

Top wasting money by employing external business consultants who get paid a fortune to tell the NHS How to save money. Also stop issuing medication Andy drugs when not necessary.

when I was in hospital for 4 days, the nurse came round every 4 hours with paracetamol and Ibuprofen- I told her I was not in any pain and did not want them. After 4 days I handed back over 50 tablets, which went straight in the bin. If I need them I will ask for them. Imagine them doing this for every patient, although the costs per tablet are tiny, it all adds up.

Also seems to me that senior management in the NHS who have no medical skills and browse spreadsheets every day, get paid far too much.

rant over.