NHS. Why?

[jeff oakley]

There is a lot of emotion on here which is not the best way to discuss things and many facts wrong. Consultants do work for the NHS, they have contracted hours but do work outside in private practice.

The hospital in question lost it's way, clearly they were afraid of their jobs if they did not keep within budgets and acted accordingly, but in the end it was the clinical staff who let the patients down. Other hospitals did keep within budgets and no one extra died, others like the Bath Royal just over spent massivly. The pressure to keep within budget became a prime cause in this failing, but again we do not yet know exactly why. Some hospitals have really bad abscence records and just spend on agency workers to fill in at huge cost others deal with that issue very firmly. In the area we live they cut this by having a bank system where exsisting staff were paid extra to work in NHS hospitals without making agencies multi million pound fotunes.

 

But now the system is changing, the GP's are the ones with the money to spend, but they are not business men so they are having services provided by new organisations. They have formed consortiums, for want of a better discription, and are buying services from these groups so they can still be Doctors but get better service and more say in the care of their patiets. The big savings are that these new organisations, which are still NHs at present will become seperate companies in the future, so no expensive pensions, no huge union interferance etc etc.

 

Norman said that the NHS spent 1/3rd on none medical staff, that is not corect, my wifes trust spent £4 million on none frontline staff out of £260 million total budget for the year. These costs will reduce in the new set up.

 

And finally, the reason that Labour have not kicked this up into a huge p******** contest, is that the reforms were started by them as whoever is incharge the costs were unsustaniable.

[Norman Verona]

Jeff, a goverment document a few years ago stated that 1/3rd of the total WAGE budget was spent on non medical staff. Not the total NHS budget.

 

I'm not saying the French system is the best just because I live here. The UN say it's the best. The French are very practical. This shows in many ways, not least their cars. Whoever else would have made the Citroen 2CV?

 

But the main reason the system serves the population well is that there are no non medical mangers and accountants. The system is run by doctors and whatever the doctor says the patient wants the patient gets, irrelevant of cost. They have a central government buying organisation and each hospital, which are, in effect, private draws from the central system.

 

Jeff, have I got this wrong, the consultants are contracted to the NHS, they are not employees like a nurse is?

[Norman Verona]

Stephen,

 

Red wine has less sugar than most white wines.

 

 

There are no regulations in the United States regarding labeling the sugar content of wines, so for exact information about the nutritional content of your wine, you should check with the winery. In general, most red wines have little or no sugar; most sweet wines are white. Key terms on the wine label can tip you off as to whether a wine will be sweet or not. Terms like "dry" indicate a wine with less sugar, while "semi-dry" or "off-dry" wines should be sweeter than table wines.

 

 

I understand why people would think wine contains a high amount of sugar. After all, it takes a lot of grapes to make a glass of wine … and grapes do contain natural sugar. But here is what happens: the grapes are picked, crushed and then allowed to ferment (the wine makers add their own special yeast). The process of fermentation actually converts the sugar in grapes to alcohol. So for the most part, most wines have little or no sugar in them. An exception would be a sweet or dessert wine.

 

 

The sugars in wine grapes are what make winemaking possible. During the process of fermentation, sugars are broken down and converted by yeast into alcohol (ethanol) and carbon dioxide. Grapes accumulate sugars as they grow on the grapevine through the translocation of sucrose molecules that are produced by photosynthesis from the leaves. During ripening the sucrose molecules are hydrolyzed (inverted) by the enzyme invertase into glucose and fructose. By the time of harvest, between 15-25% of the grape will be composed of simple sugars. Both glucose and fructose are six-carbon sugars but three, four, five and seven-carbon sugars are also present in the grape. Not all sugars are fermentable with sugars like the five-carbon arabinose, rhamnose and xylose still being present in the wine after fermentation. Further very high sugar content will effectively kill the yeast once a certain (high) alcohol content is reached. For these reasons, no wine is ever fermented completely "dry" (meaning without any residual sugar). Sugar's role in dictating the final alcohol content of the wine (and such its resulting body and mouthfeel) will encourage winemakers to sometimes add sugar (usually sucrose) during winemaking in a process known as chaptalization solely in order to boost the alcohol content - chaptalization does not increase the sweetness of a wine.^[1]

 

 

So maybe the doctors do know more than you credit them with.

[iain m]

We already have sufficient laws to lock up major company executives and Bankers for fraud, Hospital Managers for manslaughter and every one in between guilty of perverting the course of justice which can and should carry a life sentence not a few months. We had health care cover for 30 years, when my wife used it the 29th year the premium increased 300% , we have since used the NHS and we are very  lucky to have 2 good hospitals in Chichester and Worthing. What I see in all Government organisations is poor performance and this will not alter until we have performance related pay, less people with more incentive to improve, poor management just employing more people is not the answer. 

[Norman Verona]

Iain, the news report said that the law would have to be changed for prosecutions to be made in future cases. I may have heard it incorrectly. That's waht I asked in the original post.

 

However, I feel you're right, another tier of management will not help. The answer is for more medical people not more management.

 

I've told this one before. After waiting 3 months for an echography (Ultra Sound) in Northern General Hospital, something that was done in 2 hours in France, I was telephoned and asked if I could come in on a Saturday. I was given the following Saturday. I went and found the nurses were working unpaid on Saturday mornings to try and get the waiting list down.

 

The nurse told me that when she started 25 years earlier the consultant ran the department and they had fortnightly staff meeting solely to see how they could improve the service. Any equipment they needed was requested and provided.

 

Now, she said, the department was run by a non medical management team. She pointed to a large machine with a cover on. They purchased that for us, it'll never get used. We asked for 3 more nurses.

 

Doctors can run their departments, they do not have to be accountants. The accounts departments can look after the money. Point is if all the money going into non medical management went into medical staff the morale would jump. If the departments were provided with what they requested on medical grounds the service would improve.

 

One things for sure. If doctors were running the service on medical grounds the disgrace that occurred at North Staffordshire hospital would not have happened.

[D7PNY]

There's certainly a wide spread problem of mismanagement in the NHS!

 

The wife is a paediatric nurse and the employment conditions she faces are a joke.  (Granted she is off on maternity leave currently).

 

The NHS make cost savings where here and there but none of those cost savings ever seem to get spent on the main issues - which in our experience is dangerous understaffing!

 

Drives me mad when the wife comes home after a shift without getting a break, having done the jobs of others with no thanks.  If I ever treated any employees at work in even remotely the same manner there would be lawsuits raised.  Makes my blood boil that the NHS appears above the law!

 

Cheers,

 

Dave

[Norman Verona]

There seems to be a suggestion that the NHS runs on a culture of fear. 

 

So, straight from the horses mouth via the horses husband (please apologise to your good lady, I'm only calling her a horse figuratively).

 

The NHS need more medical staff, not more managers.

 

 

 

On a slightly different subject but related. I worked with the South Yorkshire Police for 10 years. The waste was incredible. The force has 7 headquarters. The government ask for savings which is instantly converted to staff cuts. I reckon I could save more than is being asked without cutting one officer from the payroll.

 

I'm sure the NHS could easily do the same.

 

As you can see this subject makes me really mad. I wouldn't have even given it a thought before moving here and, unfortunately, having to use the French medical system. I, like many here, thought the NHS was good. 

 

guest works, I assume, in Queen Elizabeth Hospital. His experience will be good as it's a flagship hospital used by the military to treat the severely wounded soldiers sent back from Afghanistan. If I've got that wrong then I apologise.

[jeff oakley]

Hi Norm,

 

The consultants are contrated to the NHS but in a complictaed way they are still employed and hence get pension etc. You may be correct in what you say on the wage budget, but the problem with that is the definition of non medical, or more accurate none essential. In that staff figure you have some hospitals who have cleaners, cooks, boiler men, maintanace men etc. All essential to the efficent operation of the hospital, without them nothing happens. You then have managers who again without them no one gets paid, nothing gets ordered again nothing runs. We seem to have an obssesion with the title manager, but this is wrong. Many are managers who are medically trained but are now working from another direction. The ones who are the problem in my wifes opinion, who works at a very senior level in the finance of the NHS, are those employed to constantly reprot back to whitehall. They send dictates and everyone in those positions is afraid to send back the wrong message. Dictates like they need a cycling to work coordinator, not essential at all but counts against the hospital if they had none.

Whithall dictates the hospitals must buy from NHS supplies, which are a typical goverment department where pens cost pounds when you add up thetransport etc that could have been bought locally for pence.

 

There is many things wrong in the NHS but in the case that has lead to this thread, it still comes back to the medical staff failing. In the report a doctor said they got immune to the screams of pain from the patients, a consultants who complained was suspended and then went back and stayed quite. It is a tradgedy for the victims.

 

I also think that someone should be held to account and as I can see there are several medical staff who are being struck off, as for prosecuting then as I said before that would be much harder to acheive. And where does the culpability stop? Ulitimatly the minister for health and the goverments who have created this situation with obbsessions on every little thing, but the chances of redress against them is nil.

[nefarious_]

The news report said that the law would have to be changed for prosecutions to be made in future cases. I may have heard it incorrectly. That's waht I asked in the original post.

I haven't seen that news report, but there's no reason why corporate manslaughter doesn't apply to hospital management. Whether the CPS choose to pursue it is another matter, but that doesn't change the law, and victims families can still pursue private prosecutions.

 

Perhaps the issue in this case is how far up the management chain the culpability can be proven.

 

If management put in a structure for care that they believed to be sufficient, but that struture or plan was not followed, then it would be difficult to establish corporate manslaughter. Likewise, I suspect that non-medical management cannot be deemed to have been negligent in medical matters unless they can be shown to have specifically acted against the advice of medical staff.

 

At the same time, medical staff would have to be deemed to have made an actively negligent decision in their delivery of care, not just failed in their duty of care.

[Norman Verona]

As far as I can see it was gross under staffing that was the root of the problem.

 

It would also appear that the cleaning staff were sacked to save money.

 

 

The report seems to lay the blame on the management not the medical staff.

[nefarious_]

As far as I can see it was gross under staffing that was the root of the problem.

 

It would also appear that the cleaning staff were sacked to save money.

 

 

The report seems to lay the blame on the management not the medical staff.

 It would be very hard to establish a direct causal link between a specific decision to reduce non-core staffing numbers and a specific death - perhaps that's why they're saying no corporate manslaughter.

 

One of the unfortunate features of being an NHS manager is having to take decisions that you *know* will result in a higher mortality rate. E.g. budget is cut 10% and wherever you take it from, you know your "performance" stats will suffer - somebody, possibly many people, who would have left the hospital alive will now die as a direct result. Hospitals and doctors have to make decisions all the time which effectively put a financial value on saving lives.

 

That's not to say the managers in this case weren't useless, inept, lazy or failed to do their jobs properly in some other way, but in legal terms its a bit of a leap to say that a particular department head's decision to cut the facilities budget by 10% (which led to a 40% reduction in cleaning staff, which led to a 50% increase in MRSA cases etc etc) makes him direcly culpable for someone dying.

[Nick Algar - Competition Secretary]

I think what it annoying us the most is that under Labour spending on the NHS increased very significantly, whilst according the reports from the media actual care seemed to go down. So when one Trust is found to have failed why is someone or maybe more than one person not being held to account for it. As has already been said as a company MD I would have been held personally liable for corporate manslaughter and could have ended up in jail. Why is that not happening to these people. Yet again Civil servants being let off. 

[Young Pretender]

As with mother industries the NHS has many management posts filled by people that are not good at management.  The problem is that unlike other industries poor performance in the NHS has far more severe consequences.  Now tell these 'managers' that you are going to base their performance on targets set by the government and enforced by regulators who will assess their performance on nothing else.  Their own, and their families, livelihood depends on meeting these targets.

 

So my answer to the original question is no, managers should not be held accountable for incidents, not if incidents occur in pursuit of said targets.  Government and regulators should.

 

In future, management performance can be based on patient care and accountability is possible.

 

My comments are not directed at north staffs because I don't know any details.  They are my long standing opinions on the failings within the NHS, despite believing that it is still a great institution.

[Norman Verona]

If a soldier obeys orders which breach the Geneva Convention on war he is prosecuted for war crimes.

 

Read up on the Nuremberg trials.

[Norman Verona]

Assuming it's on iplayer it may be worth watching the first 10 minutes of last nights One Show.