General Chit Chat

[Hoboh]

http://www.theguardian.com/society/2015 ... rust-chief

Troubled times ahead!

I have it on very good authority that things are just as bad a lot closer to home, if not worse. The system has run on goodwill for years, but the goodwill is running out, has gone or is off long term sick with stress.

Like my missis said, not in these words mind, "If the shit really hits the fan the magic money tree will appear, the buggers would be hanging from the lamp posts otherwise". I tend to agree but some poor buggers will suffer first!

[bobo the clown]

Whatever the details, and there will be good and bad examples aplenty, the NHS Senior Management will be very aware that ... in the end ... they'll get bailed out. If they get the chop they'll retire very nicely or simply take their failing sorry arses off to another Authority where the cycle will resume.

The tales of poor management and poor and profligate spending still abound. Their budgets are maintained, added to even, but you could double them and they'd still overspend.

[BWFC_Insane]

Whatever the details, and there will be good and bad examples aplenty, the NHS Senior Management will be very aware that ... in the end ... they'll get bailed out. If they get the chop they'll retire very nicely or simply take their failing sorry arses off to another Authority where the cycle will resume.

The tales of poor management and poor and profligate spending still abound. Their budgets are maintained, added to even, but you could double them and they'd still overspend.

This isn't true. The headlines and glib quotes talk about "protected budgets" for the NHS but the reality is different. Costs are rising far faster than budgets.

And cutting social care budgets has a huge impact on NHS hospitals. There isn't anyone to look after Mrs Miggins after her hospital stay? The option isn't there to turf her out onto the street so the hospital foots the bill.

The NHS has been underfunded since 2010 and there are only so many years you can carry on doing that before eventually it catches up with you. Now it is catching up. As said before it is probably a deliberate attempt to underfund it, create a crisis then privatise it, without losing too much public opinion. Of course that will be a massive disaster as we've already seen with privately run elements of the service.

[bobo the clown]

Social care gaps are the main blocking point ... agreed.

But it remains true that the NHS in general is well funded. Just it's a sin to point it out, apparently. We'll be hearing that the nurses are all angels next i guess.

There is huge waste and enormous mismanagement plus Terri confusion over priorities. It's a great institution but don't mistake that from being able to criticise aspects of it as well.

[Worthy4England]

Social care gaps are the main blocking point ... agreed.

But it remains true that the NHS in general is well funded. Just it's a sin to point it out, apparently. We'll be hearing that the nurses are all angels next i guess.

There is huge waste and enormous mismanagement plus Terri confusion over priorities. It's a great institution but don't mistake that from being able to criticise aspects of it as well.

So what is this government going to do about stopping the wastage? Cutting the budget (or freezing the budget) and hoping that the management which is probably where most of the wastage is vote themselves out of their unnecessary jobs doesn't constitute a plan. They'll look to cut the other services first and then complain about it. The last lot just putting more money in wasn't a plan either (just for balance).

I have dealt with NHS and MoJ and a few other Departments over the years and they're hidebound by middle management that are there for the sole purpose of protecting their fiefdom. The minute you suggest they might want to do the same thing as each other and split the budget, they see "loss of control - does not compute"....budget is power.

[BWFC_Insane]

Social care gaps are the main blocking point ... agreed.

But it remains true that the NHS in general is well funded. Just it's a sin to point it out, apparently. We'll be hearing that the nurses are all angels next i guess.

There is huge waste and enormous mismanagement plus Terri confusion over priorities. It's a great institution but don't mistake that from being able to criticise aspects of it as well.

I hear the wastage line a lot, but there have been attempts to bring in private firms to "cut" wastage and show the "public sector dunces how to manage" and they have, almost exclusively all failed.

Often wastage is assumed when hospitals pay lots of money for overtime or contract staff. But usually that is because there simply isn't the budget to have permanent staff filling the rotas. And it simply isn't an option to go any further understaffed than they already are. The culture is not one of profligacy but of patching essential things up however possible. Ultimately an NHS hospital manager is damned if they do and damned if they don't. If there is an operational crisis they get hammered. If patient safety is risked they get hammered. If in avoiding crises and avoiding endangering patient safety and adhering to government targets they go over budget they get hammered. The problem is that large parts of healthcare are by nature inefficient. The cost of life support if you were to run through a business case for it, is in fact grossly unfavourable in business terms. But hospitals and trusts have no choice. They can't just say "sorry your son can't have life support because it isn't worth it". The NHS is always going to be "wasteful" if you view it in a certain way. If you underfund it, the "waste" will only get worse.

The Tory spin machine about NHS budget protection is frankly, just that, spin. They broke up large parts of the service, moved public health to local authority budgets then slashed their budgets but said "hey we're protecting the NHS" even though it was clever accountancy whilst actually cutting the budgets for large elements of it.

[Hoboh]

Whatever the details, and there will be good and bad examples aplenty, the NHS Senior Management will be very aware that ... in the end ... they'll get bailed out. If they get the chop they'll retire very nicely or simply take their failing sorry arses off to another Authority where the cycle will resume.

The tales of poor management and poor and profligate spending still abound. Their budgets are maintained, added to even, but you could double them and they'd still overspend.

This isn't true. The headlines and glib quotes talk about "protected budgets" for the NHS but the reality is different. Costs are rising far faster than budgets.

And cutting social care budgets has a huge impact on NHS hospitals. There isn't anyone to look after Mrs Miggins after her hospital stay? The option isn't there to turf her out onto the street so the hospital foots the bill.

The NHS has been underfunded since 2010 and there are only so many years you can carry on doing that before eventually it catches up with you. Now it is catching up. As said before it is probably a deliberate attempt to underfund it, create a crisis then privatise it, without losing too much public opinion. Of course that will be a massive disaster as we've already seen with privately run elements of the service.

Whoa there Mr Corbinesta, labour representative, the NHS was not funded correctly before that. The grinning goon and pompous one eyed Scotch git didn't do much for the NHS, it was more to do with wars and some bint called Prudence!

[bobo the clown]

Thank God the spin is only from the Tories Insanio. If the left were playing constant spinning games on this as well we'd be in a terrible state. Phew !!


... & take a look at the biblical scale mess the Socialist Republic of Wales is making of its fully devolved NHS. That's due to decisions, politics and poor, poor processes. They chuck enough money at it. It ain't down to that.


Even the Cymraeg have finally stopped denying it's in a mess with 3 out of 6 Authorities in special measures. 50% .... not that "special" really, is it ?

[Worthy4England]

^^ It's like listening to PMQ's So who do we think will sort it out?

[Bijou Bob]

That's the problem, it can't be sorted out and never will. We now live in a society where people expect their 4rses to be wiped for them. Had an argument with the other half? Go to the docs. Headache? Get to a and e. Add in an ageing population, the effects of smoking, pish poor diet and no exercise and the only option is an insurance based system.

[Abdoulaye's Twin]

Often wastage is assumed when hospitals pay lots of money for overtime or contract staff. But usually that is because there simply isn't the budget to have permanent staff filling the rotas. And it simply isn't an option to go any further understaffed than they already are.

Ok. This is the problem with management and fiefdoms. To stay under one budget you need an ever increasing other budget to cover the fact that the first budget is not enough, whilst the second budget is drawing on resources/stuff that costs significantly more. It all comes from the same pot ultimately, but the management in divvying it up into their fiefdoms are costing the taxpayer more than it needs to...and that my friend is shit management and not the Tories*.

* I should point out that I do think most Tory MPs are massive wankers.

[BWFC_Insane]

Thank God the spin is only from the Tories Insanio. If the left were playing constant spinning games on this as well we'd be in a terrible state. Phew !!


... & take a look at the biblical scale mess the Socialist Republic of Wales is making of its fully devolved NHS. That's due to decisions, politics and poor, poor processes. They chuck enough money at it. It ain't down to that.


Even the Cymraeg have finally stopped denying it's in a mess with 3 out of 6 Authorities in special measures. 50% .... not that "special" really, is it ?

There are a load of reasons for the problems in wales. However, many aspects of health provision in Wales are better than in England. Waiting lists however, are not.

The principle reason for this, is again a lack of funding. The Tories blame Welsh Labour and Welsh Labour blame the Tory cuts. Whatever the reason like the rest of the UK the costs are rising far quicker than the budget allows for.

Ambulances are another statistic commonly cited by the right, which again is a nonsense. Comparing ambulance response times in mainly rural and disconnected Wales to urban areas in England...yeah sounds a good comparison.

But however you slice it, the NHS cannot sustain it's services without appropriate funding. We are seeing that now, more clearly than ever.

As for your last point as far as I knew 1 of the 7 Welsh health boards were in special measures. Not sure where the 3 in 6 comes from?

[Worthy4England]

That's the problem, it can't be sorted out and never will. We now live in a society where people expect their 4rses to be wiped for them. Had an argument with the other half? Go to the docs. Headache? Get to a and e. Add in an ageing population, the effects of smoking, pish poor diet and no exercise and the only option is an insurance based system.

I disagree that the only option is an insurance based system. In either event, the citizens of the UK would fork out for it. Whether that's through private insurance or national insurance. In either event, the cost of the Services required would remain the same, no?

[BWFC_Insane]

Often wastage is assumed when hospitals pay lots of money for overtime or contract staff. But usually that is because there simply isn't the budget to have permanent staff filling the rotas. And it simply isn't an option to go any further understaffed than they already are.

Ok. This is the problem with management and fiefdoms. To stay under one budget you need an ever increasing other budget to cover the fact that the first budget is not enough, whilst the second budget is drawing on resources/stuff that costs significantly more. It all comes from the same pot ultimately, but the management in divvying it up into their fiefdoms are costing the taxpayer more than it needs to...and that my friend is shit management and not the Tories*.

* I should point out that I do think most Tory MPs are massive wankers.

It isn't that though. You don't have the luxury of saying "well we'll stop this service or stop doing that" you have to at all times keep critical services operational and comply with statutory regulations etc.

Often it would be better value to have the permanent staff all in place. But then it becomes impossible to do that so contract staff and temporary cover are used which may because of the shorter term nature of a problem be cheaper. Then there is a headline saying you spent "£x" on contract staff and people start talking about waste. Or you end up in overspend having tried to fix the issue and have headlines about that.

See the hours junior doctors work as an example. It'd be nice to be able to consider the running of an NHS hospital in the same way as a business but it isn't the same. Little is in your control. You have to have plans in place, but if there is sudden demand for beds, or a flu outbreak or a nurse shortage or whatever, you HAVE to carry on. You cannot close shop, or fill gaps the way others might do.

I'm not saying the entire thing is a Tory problem. It is broader than that. The problem is that the cost of healthcare is rising faster than the allocated budget. We're rapidly coming to a cross-road. Pay more for the NHS to maintain service or reduce the range of services provided, or indeed the quality and standards of that service.

As it is we're limping along doing nothing, hoping it will just "carry on regardless".

[Hoboh]

Without sounding churlish about a reasonable discussion on NHS funding, just where are all these resources a struggling organisation can, in some peoples views, provide to all and a sundry we should be accepting to our shores?
The NHS is a marvellous institution, one we should be proud of how it is run is another matter.
Many suppliers to the NHS, MOD etc. seem to view it as a golden goose, drug companies we are told need the high prices charged to cover development costs, all well and good if they made reasonable profits as well but not the huge sums they actually make.
When we are happy in a society to pay top consultants per year what a bloke kicking a bag of air around earns in a week through lobbing money into an Australian pirates coffers, who is at fault?

[Abdoulaye's Twin]

Often wastage is assumed when hospitals pay lots of money for overtime or contract staff. But usually that is because there simply isn't the budget to have permanent staff filling the rotas. And it simply isn't an option to go any further understaffed than they already are.

Ok. This is the problem with management and fiefdoms. To stay under one budget you need an ever increasing other budget to cover the fact that the first budget is not enough, whilst the second budget is drawing on resources/stuff that costs significantly more. It all comes from the same pot ultimately, but the management in divvying it up into their fiefdoms are costing the taxpayer more than it needs to...and that my friend is shit management and not the Tories*.

* I should point out that I do think most Tory MPs are massive wankers.

It isn't that though. You don't have the luxury of saying "well we'll stop this service or stop doing that" you have to at all times keep critical services operational and comply with statutory regulations etc.

Often it would be better value to have the permanent staff all in place. But then it becomes impossible to do that so contract staff and temporary cover are used which may because of the shorter term nature of a problem be cheaper. Then there is a headline saying you spent "£x" on contract staff and people start talking about waste. Or you end up in overspend having tried to fix the issue and have headlines about that.

See the hours junior doctors work as an example. It'd be nice to be able to consider the running of an NHS hospital in the same way as a business but it isn't the same. Little is in your control. You have to have plans in place, but if there is sudden demand for beds, or a flu outbreak or a nurse shortage or whatever, you HAVE to carry on. You cannot close shop, or fill gaps the way others might do.

I'm not saying the entire thing is a Tory problem. It is broader than that. The problem is that the cost of healthcare is rising faster than the allocated budget. We're rapidly coming to a cross-road. Pay more for the NHS to maintain service or reduce the range of services provided, or indeed the quality and standards of that service.

As it is we're limping along doing nothing, hoping it will just "carry on regardless".

When you are routinely using expensive agency staff then you haven't planned resources/budgets correctly. Of course you have to use them at times, but the NHS is routinely using them. I have experience of having to resource services that are subject to wild fluctuations of need and can confidently say that the NHS is pissing money away needlessly. They aren't helped by governments, but it is entirely within the power of management to do much much better.

[Hoboh]

Supply and demand, tell the more expensive agencies to do one and watch the price come down, these buggers have no market otherwise.

[Bijou Bob]

That's the problem, it can't be sorted out and never will. We now live in a society where people expect their 4rses to be wiped for them. Had an argument with the other half? Go to the docs. Headache? Get to a and e. Add in an ageing population, the effects of smoking, pish poor diet and no exercise and the only option is an insurance based system.

I disagree that the only option is an insurance based system. In either event, the citizens of the UK would fork out for it. Whether that's through private insurance or national insurance. In either event, the cost of the Services required would remain the same, no?

Disagree by all means, but make people pay for the privelege of a Gp appointment and usage will drop. Impose a blanket ban on a and e dispensing scripts for paracetamol and the drugs bill drops. Make folk take some responsibility for their own health and enforce measures that support it and usage and cost drop. It's doable, it'll just be an unpleasant culture shock at first. I'm not big on stats, but around 80% of people leave a and e having had no treatment. 79 families allegedly account for 10% of my local hospitals budget. Cut out the wasters, the irresponsible and the lazy and we can afford an nhs.

[Worthy4England]

That's the problem, it can't be sorted out and never will. We now live in a society where people expect their 4rses to be wiped for them. Had an argument with the other half? Go to the docs. Headache? Get to a and e. Add in an ageing population, the effects of smoking, pish poor diet and no exercise and the only option is an insurance based system.

I disagree that the only option is an insurance based system. In either event, the citizens of the UK would fork out for it. Whether that's through private insurance or national insurance. In either event, the cost of the Services required would remain the same, no?

Disagree by all means, but make people pay for the privelege of a Gp appointment and usage will drop. Impose a blanket ban on a and e dispensing scripts for paracetamol and the drugs bill drops. Make folk take some responsibility for their own health and enforce measures that support it and usage and cost drop. It's doable, it'll just be an unpleasant culture shock at first. I'm not big on stats, but around 80% of people leave a and e having had no treatment. 79 families allegedly account for 10% of my local hospitals budget. Cut out the wasters, the irresponsible and the lazy and we can afford an nhs.

I don't disagree with much of what you've said there ^. I disagree that the only option is an insurance based system. I think some of the stats you quote demonstrate that there's probably a few folks that need weeding out. 79 families accounting for 10% of a hospital's budget doesn't stack up for me (not that in I don't believe it, but clearly there's some significant pi$$ taking going on if it's true - unless it's in Leigh where everyone is from the same family).

NHS direct nearly always refers folks to A&E as do GP's if there's something not immediately apparent to them like an axe buried in yer head - in which case they'll refer you anyhow.

[Abdoulaye's Twin]

That's the problem, it can't be sorted out and never will. We now live in a society where people expect their 4rses to be wiped for them. Had an argument with the other half? Go to the docs. Headache? Get to a and e. Add in an ageing population, the effects of smoking, pish poor diet and no exercise and the only option is an insurance based system.

I disagree that the only option is an insurance based system. In either event, the citizens of the UK would fork out for it. Whether that's through private insurance or national insurance. In either event, the cost of the Services required would remain the same, no?

Disagree by all means, but make people pay for the privelege of a Gp appointment and usage will drop. Impose a blanket ban on a and e dispensing scripts for paracetamol and the drugs bill drops. Make folk take some responsibility for their own health and enforce measures that support it and usage and cost drop. It's doable, it'll just be an unpleasant culture shock at first. I'm not big on stats, but around 80% of people leave a and e having had no treatment. 79 families allegedly account for 10% of my local hospitals budget. Cut out the wasters, the irresponsible and the lazy and we can afford an nhs.

I'm living somewhere with an insurance based system and I really wouldn't recommend it. The cost is exorbitant, partly because every test imaginable is often ordered and doctors with a different sorts of targets might be required to flog a few operations more. You go see a GP and more often or not you are referred to a specialist...all at extra cost to your insurance company and yourself through higher premiums and the flat fee you pay on top for each visit. You then have the folk whose insurance has more exceptions than coverage, or who get a chronic disease that insurers no longer wish to cover. Those people usually end up bankrupt. ou copuld of course try to legislate against a lot of these problems, but do you trust a government and their regulator to actually manage it?

The NHS for it's faults is brilliant, it just needs to managed better and have less political interference.