The NHS

[Mungler]

I'm a fan of there being a national health service and I think nurses on the front line need paying more (not the managers etc) but I'm one of those that thinks it needs some reform be that charging a tenner to see a GP, charging for missed appointments or otherwise giving it a trim up.

 

The problem is (and you can see this from how the media report anything to do with the NHS) that the government has nowhere to go - the NHS is our sacred cow.

 

In a discussion over the weekend this league table of top 10 employers cropped up and it shocked me.

 

If you look at the map of the world we are this small island.... so why does our national health service employ more people than the indian army?

 

Indeed, there are only 5 bigger employers *on the planet* and 2 of those are super power armies.

 

[oldypigeonpopper]

hello, does that include agency staff ? it has always had too many managers, it can never be like Nye Bevan had started in 1946, our population has increased by 5 million in the last 10 years and that is not including births, today it stated on the news nurses are leaving in large numbers and it is not all about money ,

[ph5172]

It used to be the 3rd biggest at one stage i am sure - anyhow.....

 

You are right, the NHS is the political suicide button, push it and you are finished, thats the reason its been groaning on as is.

I am a big fan of the NHS and have had nothing but brilliant service, but it shows you when the NHS is the 'envy' of the the world for its treatments based on the fact no other country can work out how it functions.

 

We also had the same discussion and a few points were raised, probably along the same lines as yours....

1. GP Charging - We also came up with the magical £10 figure but then promptly worked out that those who 'pay into the system' would be paying again as there will obviously be an exemption clause, this boiled over into the missed appointment idea but again came to the conclusion there would be an exemption clause again.

 

2. What it needs is for someone to stand up and just say... Funding has increased above all other services year on year but the problem is basically treatments cost more and people are living longer. When the NHS was conceived you were treated for A-K and if you had O-U the chances were you died, in 1980 you were now treated for A-R and if you had S-X you died. Now with the advance in treatments you are now treated and probably survive A-Y and this increase survivability has a cost.

The cost of treating you for X in 1950 was ££ in 1980 it was £££ and now its ££££ that in hand means your survivability was ** and then *** and is now ****

I think if people saw that they may understand the pressures a little more

 

The model in its self will one of the best conceived models ever... when it was conceived and when it treated what was the usual aliments when it was.

 

The answer...... i dont think anyone wants to open Pandoras box

A 'basic' state funded service that covers you for XYZ and ABC needs to be paid for using a private policy?

An increase in NI to cover? - If i recall an increase in NI of 10% labeled as an NHS addition would be a hell of a lot cheaper than going and sourcing a private policy AKA the USA

 

If people want to keep the NHS state system as it it i think they need to swallow the pill that NI will have to increase to cover it, that or opt out of the NHS portion (i think i recall it was only 10% as NI isnt actually meant for the NHS) and try and source a private policy that will give the same level of cover at a better price........ could you source an all singing and dancing private policy for 10 or even 20% of your NI contributions?

Edited July 3, 2017 by ph5172

[Mungler]

It's not about agency staff.

 

It's the comparative - for example the U.K. is approximately 100,000 square miles and is 60% the size of the State of California, and yet our national health service employs more people than the indian military, or Royal Dutch shell, exon, Volkswagen, Toyota any bank or financial institution.

 

It can't be right that a little country like ours needs a health service with nearly 2 million people in it.

 

It might be different if as a nation we were all living to 130 years of age but we're not

 

Edit:

 

I also don't think it's just the cost of treatments - that wage bill is a massive recurring cost.

.

Edited July 3, 2017 by Mungler

[JohnfromUK]

Good and interesting post - and I don't know the answer. I am a supporter of the NHS and it has served me well in a (generally very healthy so far) life. However - there is MASSIVE inefficiency - two simple (and trivial, but probably illustrative of the culture) examples;

I have a regular prescription - which includes 28 days worth of pills (simple common blood pressure pills and statins) and I drop it in at the surgery, and collect the goods 3 days later. A few months ago - I went to collect - and it wasn't ready. The dispensing team explained that they couldn't get the 5mg pills I needed. My response was to ask when they could get some - as I wasn't 'out of stock', and I'd call back when they had them. The dispenser said that if they weren't in soon - they would give me twice as many 2.5mg pills (of which they had plenty in stock) - and I just take two a day. I said that was a good idea - and why didn't we do that now if they had them, save a journey, save time etc. No they couldn't do that - I had to see a doctor to get a prescription change, the computer record would have to be changed once the doctor had approved the change, and it would all take at least a week - and two more visits by me to include a doctors appointment! Simple example of how the bureaucracy took precedence over a simple common sense solution - and was going to cost time, the doctors, mine, the computer clerk's and the dispensers - rather than a quick common sense work around.

The second example is also similar - in that my pills come in a 28 day 'blister pack' - which is surprisingly hard to open, packed with an information leaflet in a fancy multi coloured well made box which also has Braille writing. I understand from a medical friend that the pills themselves are pennies - and the packaging/branding pushed the price up massively. However, apparently they are not allowed (by NHS rules) to prescribe a simple 'bottle' of pills, but have to supply the expensively packaged version. I can buy the pills for (considerably less than prescription cost) from a chemist, but have to have a prescription - which would have to come from a doctor under private treatment (which is expensive). So - I have the NHS version - which cost them well over cost price - and is annoying to me.

[Vince Green]

The trouble with the NHS is the massive amount of waste, not only in materials but everything they do. My 85 year Mother old had some health problems, not life threatening, last year and she was admitted to hospital where they did loads of test, blood tests, scans, xrays, ECG etc.

 

As a result she was transferred to a sister hospital in the same trust six miles away. When she got there they did all the tests again, why? what a totally unnecessary waste of resources and it meant she occupied a bed for two days longer than necessary.

 

When the time came for her to be discharged they came round about 10am one day and said she could go. It was the following morning before they had done the paperwork and they had got the antibiotics from the hospital pharmacy for her to take home that she finally got out.

 

That is just gross inefficiency, repeat that delay for every patient and you have a massive cost and holds up people from being admitted

 

They were going to arrange for transport to bring her home, again why? We didn't need it, we didn't ask for it. I was there anyway so it was not rocket science that I would be taking her but she could have got a cab for £10 outside the door. What would transport have cost?

 

They are just over baking the cake all the time and the more they do it the more it is expected

 

Another story that happened to a customer of mine. A 40ish year old mountain biker he had a crash and broke his leg. His discharge from hospital was delayed for several days because occupational health had to visit his house and do an assessment. That's just ridiculous work creation and delay

Edited July 3, 2017 by Vince Green

[scolopax]

The NHS is the millstone which over time will drag successive otherwise competent governments down. The public will not tolerate anything which is perceived to be damaging to the institution, no matter how prudent or necessery for its own survival. I suggest a 5% pay cut across the board......with 10% for those earning above £80K

[Paddy Galore!]

seems crazy doesn't it? it's my understanding that the NHS is tied into contracts with suppliers, from paper towels to whole buildings, these companies are privately run and need to make a profit, unfortunately as has been reported in the past the price of some of the stuff they have to buy is over inflated. The nhs has a limited budget and everything has to come out of that pot, wages, rent, pensions, compensation etc.

on a tangent here but I went through the mill a few years back, and as it turned out it was all down to a misdiagnosis. what could have been rectified with a course of iv antibiotics and maybe a month off work turned into 5 years of immune suppression, including chemo, steroids etc, and a major heart op that didn't go quite to plan and left me with a brain injury. God knows how much that little lot cost.

[Yellow Bear]

The trouble with the NHS is the massive amount of waste, not only in materials but everything they do. My 85 year Mother old had some health problems, not life threatening, last year and she was admitted to hospital where they did loads of test, blood tests, scans, xrays, ECG etc.

 

As a result she was transferred to a sister hospital in the same trust six miles away. When she got there they did all the tests again, why? what a totally unnecessary waste of resources and it meant she occupied a bed for two days longer than necessary.

 

When the time came for her to be discharged they came round about 10am one day and said she could go. It was the following morning before they had done the paperwork and they had got the antibiotics from the hospital pharmacy for her to take home that she finally got out.

 

That is just gross inefficiency, repeat that delay for every patient and you have a massive cost and holds up people from being admitted

 

They were going to arrange for transport to bring her home, again why? We didn't need it, we didn't ask for it. I was there anyway so it was not rocket science that I would be taking her but she could have got a cab for £10 outside the door. What would transport have cost?

 

They are just over baking the cake all the time and the more they do it the more it is expected

 

Another story that happened to a customer of mine. A 40ish year old mountain biker he had a crash and broke his leg. His discharge from hospital was delayed for several days because occupational health had to visit his house and do an assessment. That's just ridiculous work creation and delay

A lot of this is due to the "compensation culture" that has developed - the amount paid out in "out of court settlements" to some people if one of these steps is missed and something, even very minor, goes wrong is outstanding so insurance dictates that every step is taken and logged whether needed or not.

[Scully]

I'm out of my depth admittedly regarding the intricacies of NHS finances, but have personal experience of the incomprehensible amount of resources wasted.

I recently had need of steroid injections, which I was required to order ( from a prescription ) from the town pharmacy. Not a problem; five minute job for me.

When the steroids arrived I had to take the morning off work ( self employed so unpaid, but again not a problem ) and take myself and the steroids to Carlisle ( a sixty two mile round trip ) where a private physician would inject them into my heel.

All done and dusted, and I didn't ask why the treatment couldn't have been carried out in my home town, but was informed by a receptionist that if I couldn't drive to Carlisle I could go in a hospital vehicle at no cost to me.

[mel b3]

A lot of this is due to the "compensation culture" that has developed - the amount paid out in "out of court settlements" to some people if one of these steps is missed and something, even very minor, goes wrong is outstanding so insurance dictates that every step is taken and logged whether needed or not.

this is very true , its also one of the many reasons that , police , fire service , local authority , and any other public service costs so much , its just millions of pounds worth of *** covering , it appears to be one of the many symptoms of the general disintegration of society .

 

my personal point of view is.

 

id happily pay an extra £20.00 per week ni if it helped the nhs and society in general.

id happily pay £10.00 for a doctors appointment.

people that miss doctors appointments for no good reason , should be put in the stocks and pelted with rotten tomatoes .

[Twistedsanity]

Don't worry, as soon as beardo Branson has finished buying it all up we will all be paying anyway, it's nice that melb is happy to pay an extra £20 a week in ni but many folk can't afford to heat their homes let alone find £80 a month to pay towards a service that we already pay for

[mel b3]

Don't worry, as soon as beardo Branson has finished buying it all up we will all be paying anyway, it's nice that melb is happy to pay an extra £20 a week in ni but many folk can't afford to heat their homes let alone find £80 a month to pay towards a service that we already pay for

id happily pay more if it was for the greater good, and got used as it should , but i certainly wouldnt expect folk to pay as much if they couldnt afford it.

 

in reality (not all) most of us that , shoot, fish, drive cars , could quite easily afford it , but would resent paying it as much of it might(probably would) get wasted.

[ShootingEgg]

Don't worry, as soon as beardo Branson has finished buying it all up we will all be paying anyway, it's nice that melb is happy to pay an extra £20 a week in ni but many folk can't afford to heat their homes let alone find £80 a month to pay towards a service that we already pay for

So you are a want something for nothing kinda guy..

[Gordon R]

Too much wastage in the NHS, too many managers. They have a manager for just about every department.

 

The days of the Matron running the place, with a small accounts department, another for wages etc, have long gone, but it has swung too far. It's all about budgets and fiddled statistics.

[Mungler]

It's the raw numbers - they tell you a lot. Indeed, it's not about inefficient working, expensive drugs or badly run hospitals it's the 'the NHS employs 1.7 million people' and we are but a small island 60% the size of the single state of California.

 

Seriously, what on earth?

 

And yes, once you get to grips with that shocker and the factor in expensive drugs, inefficiency and everything else, you start to realise we're proper ****ed to keep it all going in its current state and fully funded by tax payers.

.

Edited July 3, 2017 by Mungler

[Gordon R]

It beats me where they are all employed. Hospitals closing down for fun, never enough staff on duty, empty wards etc.

[7daysinaweek]

The nhs sees over a million people a day, every contact, procedure and treatment is subject to recording of that information. Each patient now produces more information than ever before. I will give you the following example in community nhs services. A patient who lives alone has become housebound with reduced mobility, they ring gp surgery and says they think they have a pressure ulcer ( used to be called bed sore) on their bottom. The receptionist records this and gets passed to the dr, gp contacts pt and and sends referral to community nurse to visit, dr records this.

 

Community nurse receives referal, referal recorded and scanned on to electronic caseload for community nurse team by admin clerk. Referral discussed within nursing team prior to visit for appropriate care planning. Nurse undertakes home visit and undertakes holistic nursing assessment which involves all of the following:

 

wound assessment

mobility assessment

social enviroment assessment

assessment of all activities of living and physiological systems

sleeping

breathing

eating micturition (weeing)

elimination (bowels)

personal self care

mental health

blood pressure, temp pulse recorded

falls risk assessment

dementia screen

among other things

pain assessment

 

All recorded in patient held note which takes hours. Also all recorded onto electronic system for data sharing agreement with gp.

 

Wound assessment found to be a high grade pressure ulcer and pt unwell, dr contacted and advises pt to be admitted to hospital, pt has mental capacity and declines admission to hospital and wishes to be treated at home, dr then records this, reviews pt and prescribed antibiotics as pt has a infected wound, again recorded. Community nurse dresses wound and care plan put into action re dealing with the wound. Pt is found to have decreasing mobility and underweight,community nurse does referral to dietician for nutrition assessment, referral for phlebotomy services for urgent blood profile. referral social services for assessment for package of care from carers at home and to assess for any further aids, care agency have to undertake assessment which all needs documenting and recording. Community nurse orders special bed, cushion for pt from community equipment services which all needs delivering and recording. Pt referred to safeguarding adults as classed as vulnerable. Medicines review from gp.

 

All of above requires recording. Under national wound policy because pressure ulcer is high grade, reportable and esculated to risk management team and board in the trust and rca, root cause analysis of how patient developed pressure ulcer and what measures have been implemented to manage and safeguard further complications and deterioration of patient condition.

 

As you can easily see just what appears to start as one wound can require a huge amount of input from many individual organisations and people, this example is for only one wound, i have many patients who have multiple co-morbidities (health concerns) As above this pt would have required, care plans for nutritional, wound care, social care, safeguarding vulnerability and a host of other things. Some patients have loads of of problems and produce staggering amounts of information which all is required to be recorded. The reasons for this include, appropriate care planning to optimise the best outcomes for the patient, medical and nursing litigation( if you did not record it it did not take place) planning and delivery of nhs and social services at a strategic level.

 

One patient can cost approx £5000 pound for a couple of months total care to heal a wound at home, anther may run to the cost of well over a million pound within 10-15 years depending on what the input nursing and social is at home.

 

So the reason we have so many staff is one of the main reasons is the legal system which drives collection of patient data by delivering services to negate litigation, but more importantly to deliver best care for the individual, learn lessons and structure future services.

 

atb

7diaw

[Vince Green]

The nhs sees over a million people a day, every contact, procedure and treatment is subject to recording of that information. Each patient now produces more information than ever before. I will give you the following example in community nhs services. A patient who lives alone has become housebound with reduced mobility, they ring gp surgery and says they think they have a pressure ulcer ( used to be called bed sore) on their bottom. The receptionist records this and gets passed to the dr, gp contacts pt and and sends referral to community nurse to visit, dr records this.

 

Community nurse receives referal, referal recorded and scanned on to electronic caseload for community nurse team by admin clerk. Referral discussed within nursing team prior to visit for appropriate care planning. Nurse undertakes home visit and undertakes holistic nursing assessment which involves all of the following:

 

wound assessment

mobility assessment

social enviroment assessment

assessment of all activities of living and physiological systems

sleeping

breathing

eating micturition (weeing)

elimination (bowels)

personal self care

mental health

blood pressure, temp pulse recorded

falls risk assessment

dementia screen

among other things

pain assessment

 

All recorded in patient held note which takes hours. Also all recorded onto electronic system for data sharing agreement with gp.

 

Wound assessment found to be a high grade pressure ulcer and pt unwell, dr contacted and advises pt to be admitted to hospital, pt has mental capacity and declines admission to hospital and wishes to be treated at home, dr then records this, reviews pt and prescribed antibiotics as pt has a infected wound, again recorded. Community nurse dresses wound and care plan put into action re dealing with the wound. Pt is found to have decreasing mobility and underweight,community nurse does referral to dietician for nutrition assessment, referral for phlebotomy services for urgent blood profile. referral social services for assessment for package of care from carers at home and to assess for any further aids, care agency have to undertake assessment which all needs documenting and recording. Community nurse orders special bed, cushion for pt from community equipment services which all needs delivering and recording. Pt referred to safeguarding adults as classed as vulnerable. Medicines review from gp.

 

All of above requires recording. Under national wound policy because pressure ulcer is high grade, reportable and esculated to risk management team and board in the trust and rca, root cause analysis of how patient developed pressure ulcer and what measures have been implemented to manage and safeguard further complications and deterioration of patient condition.

 

As you can easily see just what appears to start as one wound can require a huge amount of input from many individual organisations and people, this example is for only one wound, i have many patients who have multiple co-morbidities (health concerns) As above this pt would have required, care plans for nutritional, wound care, social care, safeguarding vulnerability and a host of other things. Some patients have loads of of problems and produce staggering amounts of information which all is required to be recorded. The reasons for this include, appropriate care planning to optimise the best outcomes for the patient, medical and nursing litigation( if you did not record it it did not take place) planning and delivery of nhs and social services at a strategic level.

 

One patient can cost approx £5000 pound for a couple of months total care to heal a wound at home, anther may run to the cost of well over a million pound within 10-15 years depending on what the input nursing and social is at home.

 

So the reason we have so many staff is one of the main reasons is the legal system which drives collection of patient data by delivering services to negate litigation, but more importantly to deliver best care for the individual, learn lessons and structure future services.

 

atb

7diaw

That's a brilliant explanation

[ShootingEgg]

Friend of mine is at work today started at 9am in a clinic, had patients booked in etc. First one to show arrived for a 2pm app. She had a full days clinic and so far 2 people have turned up. This annoys me, we say money is wasted by the nhs, yet we the patient can be as bad, not showing up costs too

[Medic1281]

Friend of mine is at work today started at 9am in a clinic, had patients booked in etc. First one to show arrived for a 2pm app. She had a full days clinic and so far 2 people have turned up. This annoys me, we say money is wasted by the nhs, yet we the patient can be as bad, not showing up costs too

Well I can see instant savings to be made here.....

First, sack your friend = instant saving £25k (just a figure, no idea what your friend does)

Each no show appointment costs £100? So by sacking your friend, we no longer have 10 no shows per day saving £1000 per day!

 

Easy money!! (All said with tongue in cheek!!)

[AVB]

The nhs sees over a million people a day, every contact, procedure and treatment is subject to recording of that information. Each patient now produces more information than ever before. I will give you the following example in community nhs services. A patient who lives alone has become housebound with reduced mobility, they ring gp surgery and says they think they have a pressure ulcer ( used to be called bed sore) on their bottom. The receptionist records this and gets passed to the dr, gp contacts pt and and sends referral to community nurse to visit, dr records this.

 

Community nurse receives referal, referal recorded and scanned on to electronic caseload for community nurse team by admin clerk. Referral discussed within nursing team prior to visit for appropriate care planning. Nurse undertakes home visit and undertakes holistic nursing assessment which involves all of the following:

 

wound assessment

mobility assessment

social enviroment assessment

assessment of all activities of living and physiological systems

sleeping

breathing

eating micturition (weeing)

elimination (bowels)

personal self care

mental health

blood pressure, temp pulse recorded

falls risk assessment

dementia screen

among other things

pain assessment

 

All recorded in patient held note which takes hours. Also all recorded onto electronic system for data sharing agreement with gp.

 

Wound assessment found to be a high grade pressure ulcer and pt unwell, dr contacted and advises pt to be admitted to hospital, pt has mental capacity and declines admission to hospital and wishes to be treated at home, dr then records this, reviews pt and prescribed antibiotics as pt has a infected wound, again recorded. Community nurse dresses wound and care plan put into action re dealing with the wound. Pt is found to have decreasing mobility and underweight,community nurse does referral to dietician for nutrition assessment, referral for phlebotomy services for urgent blood profile. referral social services for assessment for package of care from carers at home and to assess for any further aids, care agency have to undertake assessment which all needs documenting and recording. Community nurse orders special bed, cushion for pt from community equipment services which all needs delivering and recording. Pt referred to safeguarding adults as classed as vulnerable. Medicines review from gp.

 

All of above requires recording. Under national wound policy because pressure ulcer is high grade, reportable and esculated to risk management team and board in the trust and rca, root cause analysis of how patient developed pressure ulcer and what measures have been implemented to manage and safeguard further complications and deterioration of patient condition.

 

As you can easily see just what appears to start as one wound can require a huge amount of input from many individual organisations and people, this example is for only one wound, i have many patients who have multiple co-morbidities (health concerns) As above this pt would have required, care plans for nutritional, wound care, social care, safeguarding vulnerability and a host of other things. Some patients have loads of of problems and produce staggering amounts of information which all is required to be recorded. The reasons for this include, appropriate care planning to optimise the best outcomes for the patient, medical and nursing litigation( if you did not record it it did not take place) planning and delivery of nhs and social services at a strategic level.

 

One patient can cost approx £5000 pound for a couple of months total care to heal a wound at home, anther may run to the cost of well over a million pound within 10-15 years depending on what the input nursing and social is at home.

 

So the reason we have so many staff is one of the main reasons is the legal system which drives collection of patient data by delivering services to negate litigation, but more importantly to deliver best care for the individual, learn lessons and structure future services.

 

atb

7diaw

 

Very good scenario. The question is how would this have been handled 30-20-10 years ago? And have the inevitable changes in procedure resulted in a better outcome for the patient?

[Vince Green]

I was driving back to London this morning listening to the radio and there was a discussion about over the counter stuff that gets supplied to people on prescription. Paracetomol, atheletes foot cream, E45 cream, cotton wool, cotton buds etc

 

Paracetomol alone costs the NHS £88 Million a year

 

Inevetably somebody phoned in and said some people cant afford 19p to buy paracetomol but a person's income is not an issue within the remit of the NHS.

 

People get vaccinated to go on holiday, if they can afford the holiday they can afford the vaccination

Edited July 3, 2017 by Vince Green

[ShootingEgg]

Well I can see instant savings to be made here.....

First, sack your friend = instant saving £25k (just a figure, no idea what your friend does)

Each no show appointment costs £100? So by sacking your friend, we no longer have 10 no shows per day saving £1000 per day!

 

Easy money!! (All said with tongue in cheek!!)

She is a sexual health nurse.

 

And glad you put that last line in.. My sun burn from yesterday was getting a deeper shade of red hahaha

[7daysinaweek]

 

Very good scenario. The question is how would this have been handled 30-20-10 years ago? And have the inevitable changes in procedure resulted in a better outcome for the patient?

 

Hi avb

 

good question?

 

most certainly 30- 20 years ago patients would not have received this level of service, as knowledge and advances in management of conditions was nowhere near what it is now. 10-20 years ago our aetiology of wound conditions and care planning was extremely limited. Most management of pressure ulcers was chronic management and in my long experience at best a significant proportion of ulcers would never heal, the statistics for mortality (death) related to pressure ulcers was high. All the measures put in place have resulted in a significant lowering of mortality rates from septicaemia secondary to pressure wounds. I have seen many patients have wounds that had been managed for 10 years and with addition of the measures above have resulted in promoting wound healing and prevention of reccurence. Hard to believe but the nhs sometimes gets it right in some areas. Cost of pressure ulcers to nhs currently running around 1.5 - 2.2 billion per annum. Phew!

 

atb

7diaw

Edited July 3, 2017 by 7daysinaweek