what do you think of the nhs?

[Dryce]

I second that! The medical staff often work for an imperious and overbearing (and overpaid!) management.

This is unfair and is a form of stereotyping. It's a stereotype that is quite conveniently encouraged by medical staff.

Am I knocking nurses and doctors? No. But I won't inappropriately eulogise them either. They are professionals - most of whom are mediocre - and they make a living out of the NHS. So are managers in the NHS perfect. No they're just professionals - most of whom are mediocre - and they also make a living out of the NHS.

The problem with managing the NHS is that as a manager you are second class from the start - the stereotype is conveniently worked to make you to blame for the system while the medical staff get the plaudits. So how on earth can an organisation setup this way actually be managed effectively?

To break this cycle politicians, the media, and the public need to open their eyes a bit and maybe be a bit more objective. That nice friendly nurse who was so 'professional' might also be quite obstructive to improving working practices that would have had you in and treated sooner. Your oh-so brilliant surgeon to whom you are so thankful might (when he's not off doing less demanding private work that underutilises his talents - assuming that he is oh-so brilliant) be quite happy to deflect the blame for the waiting time you suffered to his management.

 

[peterg1965]

This is unfair and is a form of stereotyping. It's a stereotype that is quite conveniently encouraged by medical staff.

Am I knocking nurses and doctors? No. But I won't inappropriately eulogise them either. They are professionals - most of whom are mediocre - and they make a living out of the NHS. So are managers in the NHS perfect. No they're just professionals - most of whom are mediocre - and they also make a living out of the NHS.

The problem with managing the NHS is that as a manager you are second class from the start - the stereotype is conveniently worked to make you to blame for the system while the medical staff get the plaudits. So how on earth can an organisation setup this way actually be managed effectively?

To break this cycle politicians, the media, and the public need to open their eyes a bit and maybe be a bit more objective. That nice friendly nurse who was so 'professional' might also be quite obstructive to improving working practices that would have had you in and treated sooner. Your oh-so brilliant surgeon to whom you are so thankful might (when he's not off doing less demanding private work that underutilises his talents - assuming that he is oh-so brilliant) be quite happy to deflect the blame for the waiting time you suffered to his management.

Well said.

 

[grober]

Can Gerry Robinson Fix The NHS

This brief examination of one NHS hospital covered the issues quite well. Now part of an Open University course. Can Gerry Robinson Fix The NHS Its a bit of an eye opener. BBC/OU Open2.net - Can Gerry Robinson Fix The NHS?

 

[RoseTattoo]

Do not get cancer in UK

Time and again you hear the quote “Yes it does have problems but the doctors and nurses are wonderful and my operation went well.”
The UK has a love of its NHS which, in my view is totally misplaced.
I have been fortunate to have had dealings with the system in France, Luxembourg and Germany. When needing an operation I am asked 'Would next week be okay? Meanwhile my grandmother in UK waited two years for much needed hip operation and was continually put off.
The doctors are grossly overpaid in UK and under deliver, compared to doctors in say, Germany where they toil away for years on money that many office workers would turn down.
Right now we have a serious cancer patient in the family. If it wasn't tragic, the low standards set by the NHS in this case would be a joke. In reality they are third world standard and made worse by both medical and administrative incompetence.
If you remember Tony Blair being ambushed by an audience member on Dimbleby's programme, where Blair claimed that new standards had been set for booking times at local surgeries. The lady in the audience showed him how the administrators and doctors in these surgeries were cheating in order to meet the target - I believe it is the same with cancer patients. They claim a 31 or 62 day period from diagnosis to treatment. That in itself is scandalously slow and a death warrant to some people. In France or Germany you will be in hospital the next day and being treated. But the 31/62 days is from the time of diagnosis. Onto that you have to add the time to get appointments at your local doctor, hope that he recognises the symptoms or that is even more delay and possibly two weeks to get an appointment with a specialist. I am just beginning to get in my stride and so I won't bore you with more of this but I am angered so much by the smug, gratuitous, complacency of the medical profession.
And for those of you who have wonderful stories about being saved, I am very happy but understand that this is not always rocket science and also understand that rocket science is so simple, children can understand it, it is about diagnosis and there are lots of aids to that and application of the appropriate drugs, which is again prescribed. It is all about running an efficient organisation that can recognise and respond to the different needs of cancer patients. for some, quick diagnosis and treatment is essential but with the slow, nice and easy 'the doctor will see you now' service of the NHS, thousands will die in the UK whereas in other countries they would survive.

 

[Smatt]

A few thoughts regarding the NHS:

This is a service which started out giving basic medical care shortly after the war. Since it was initiated, the UK population has rocketed.
Many new medical conditions have been discovered and numerous others are more widely recognised. Alzheimer’s, for example, is in the media a lot at present. The incidence of this is going up, mainly because people are living longer; in the past people would die long before they got to the age where Alzheimer’s sets in. This is similar for many conditions.
In addition the typical consumer(nee patient) wants all they can get for free, including basic prescriptions(which cost pennies over the counter, but many pounds as a prescription), cosmetic treatments, transport to & from hospital, translators(for immigrants), ambulances on demand for any triviality, etc. 'I've paid my taxes; its my right'!.
Britain has an ageing population- people not only live longer, but they live longer with many serious medical conditions, all requiring regular reviews, treatment, prescriptions etc.
The NHS is struggling under this huge financial & manpower burden. When something goes wrong, the consumer will then sue the NHS for all they can with the help of free legal aid & friendly no win, no fee solicitors.
As the working, tax paying population reduces in volume, how can funding continue at current levels to feed the increasing volume of elderly with all of their health demands?
In addition, just about everyone advises to see a doctor for any reason -to 'get checked', to get time off work, for holiday insurance, for new housing, for time off school, to ‘cover’ the employer, in fact make up any reason you can & I'm sure it has happened.

The health service is now taking over from the family. Basic medical advice, like how to treat a cold or how to wind a baby used to be passed on by a knowledgeable aunt/gran/uncle, etc. Now, with the fragmented family, it is the medical service. When someone is 'down' the best people to help would/should be their loved ones, but the default helper now is 'aunty NHS'.
‘Loving’ relatives generally( I know there are many exceptions) no longer want to look after their handicapped or dying relative. They would rather someone that does not know them did it!

People don’t look after themselves- the average UK national does little exercise, is overweight, drinks too much & may or may not smoke. They do not take responsibility for their own health, but they want the government to do so! When the inevitable heart disease or lung cancer in smokers occur, who do they turn to for the very costly treatment required? When hugely obese women find out they have infertility(a common problem in obesity), who pays for the IVF at a few thousand pounds per cycle?

The basic structure of society has changed radically over the 60 or so years that the NHS has existed. The NHS is doing its best to keep up & to change systems to accommodate demands.
The ‘NHS’ is not a simple provider; it is the largest employer in Europe & is a mishmash of different services- numerous different clinical specialities, countless different levels/types of employees & all of the supporting infrastructure, performing anything from the stereotypical ‘cutting edge’ heart/brain surgery & curing cancers, all the way down to the unglamourous duties which rarely make headlines like cutting toenails, cleaning out earwax & toileting for those who cannot do it for themselves.

People talk about the ‘nanny state’ in a negative way, but that is what the changes in society have actually demanded. If people/society don’t like it, then they need to think what society as a whole can do about it, rather than always looking to the government or the NHS to sort it all out.

The NHS does provide a service and it should do its best to maintain high standards & to keep up with demands of ‘end users’. But, it is struggling, and maybe we need to consider some alternative systems for the future?

 

[Smatt]

I have been fortunate to have had dealings with the system in France, Luxembourg and Germany. When needing an operation I am asked 'Would next week be okay?

But did you have to pay?

 

[RoseTattoo]

In addition the typical consumer(nee patient) wants all they can get for free, including basic prescriptions(which cost pennies over the counter, but many pounds as a prescription), cosmetic treatments, transport to & from hospital, translators(for immigrants), ambulances on demand for any triviality, etc. 'I've paid my taxes; its my right'!.

I would have quoted more as you make a lot of good points. In the end though these arguments are used as a cop out by the medical professionals who create a lot of this extra work themsleves.
What can be done?
1. Payment. In Germany and other countries when you go to the doc, you pay and you pay for everything. You then submit a claim and get most of it back but you do pay. This is bureaucrtaic but it does cut out a lot of time wasters and therefore helps reduce cost enormously. The politicians seem afraid of such an approach but if it reduces costs and improves stanards what is the problem.
2. Education. Yes we all need to be more health savvy. that starts when we are about -9 months and proper care and attention would help.
3. Prognosis rather than diagnosis. the whole medical world is based on fixing problems after they have happened. Try it the way Mercedes do with their computers - spot problems before they occur.
4. Technology. Many doctors could be replaced by simple diagnostic tools. Enormous cost savings. I now await the favourite quote of doctors in these situations 'And then you will have more deaths'.

 

[Shude]

When something goes wrong, the consumer will then sue the NHS for all they can with the help of free legal aid & friendly no win, no fee solicitors.

I listened to a radio4 podcast recently that went into great detail about this. I assumed that "no win no fee" meant that Solicitors were very picky about their cases and that they would only take on ones that would win. It turns out that in order to cover the ones that don't win their legal fees are sometimes £800 per hour. Their "time" can include waiting for delayed trains FFS! The whole show had me pounding my fist into my palm, I should know better than to listen to these shows!

 

[Smatt]

medical professionals who create a lot of this extra work themsleves

????

So if they are ‘good points’, then how can they be a ‘cop out’?

We are talking about different things; you about individual cases, I am talking about the greater societal role.

It is very difficult to compare different nations & cultures & their health systems. The continent has a stronger family ethos, and also generally have private systems of healthcare.
Paying for services would cause a revolution in the whole NHS. Whether better or worse, hard to say, but it would cut down on time wasting certainly.


From your list of 4 points, I would say that 2 & 3 are really the same thing- educate people in order to prevent disease. I discussed the issues relating to 1, 2 & 3 already.

I agree doctors can be replaced by diagnostic tools & in many cases this is sensible. This is what is happening on the swine flu helpline and most ‘out of hours’ services employ technicians or nurse/ paramedics instead of drs.
Also many providers employ nurses as they cost less than doctors, plus there is a shortage of drs, although research indicates they don’t actually save much money as nurses take longer, request more tests & often end up referring to a doctor at the end anyway.

As to point 3, I assume you mean (primary)‘Prevention’ rather than 'prognosis'? There are lots of educational & screening campaigns. The latter generally help- despite media controversies, but the former usually falls on deaf ears. It really is only legislation that has made a significant difference over the years, eg smoking (on a tangent ;fuel efficiency on cars -how is it that overnight the fuel economies of cars have suddenly leaped upwards by introduction of stop start & other technologies, when these are actually old tech & been around for years? It must be because of legislation & potential penalties against manufacturers if they did not introduce them!)

 

[stevieb15]

Tries to deliver too much when it should concentrate on essential and emergency health provision, if people want something else they should pay for it themselves.
Having more administrators than beds seems bizarre.
Omission of dentistry equally bizarre.
Glad we've got one,although imperfect!

 

[Shude]

There are lots of educational & screening campaigns. The latter generally help- despite media controversies, but the former usually falls on death ears.

One of the greatest Freudians EVER.

 

[Dryce]

Tries to deliver too much when it should concentrate on essential and emergency health provision, if people want something else they should pay for it themselves.

The trouble here is where do you draw the line. I'd draw it based on *health*. Some people actually draw it a bit more into what I would call 'lifestyle',

Having more administrators than beds seems bizarre.

Why?

Beds aren't necessarily a good measure of anything. Obviously if you need one and they don't have one available that's possibly a problem but one of the astonishing changes in health care over the last 30 years has been the reduced need for the traditional bed.

The important measurements are really capacity and associated contingency.

Omission of dentistry equally bizarre.

Well it's not completely omitted, assuming that you can find a NHS dentist.

Glad we've got one,although imperfect!

Ditto.

 

[RoseTattoo]

Smatt when i say that you make good points, I mean that you make good points but you pose them as fait accompli - that is the way it is. I am trying to propose solutions.
A revolution in both the NHS and in the public's expectations of the NHS would be a good thing and I see the experience in Germany and France as being completely relevant. Yes, there are cultural differneces but they have little bearing on defining the need and then servicing that need.
Yes I am talking about my own specific cases but only in terms of how they demonstrated to me the overall low standards that had been set and that these are applied universally. That doctors generally accepted these should, I believe be a concern, unless they were the ones giving such advice in which case others should be concerned. In investigating further I was able to read the minutes of various health authority meetings. I could not believe how patrician and shambolic these were. There was no management, just a litany of problems and a verbal shrugging of shoulders;- nobody taking repsonisbility, no action points and no deadlines. The main concern was meeting the targets. While this is laudable it means that we get management by statistics and not by the business objectives. The statistics are some daft means dreamt up by bureaucrats to prove that somebody who isn't doing their job can show that they are doing it. What also impressed me was reading about equipment deficits on basic items. How can an organistaion spend 1bn or thereabouts on an IT system that doesn't work yet still not have enough equipment for basic diagnosis? Something is deeply rotten in the Kingdom of Denmark and explanations and excuses for this are just not good enough.

 

[Smatt]

I was theorising why 'that is the way it is' at present, and proposing that it needs to be radically changed re basic concepts & accountability to make a significant difference, as many small incremental changes have led us to where we are now, to a place where many would admit is not ideal.

I am trying to propose solutions

Where?

Looking at other countries' models of care is not exactly a groundbreaking, new suggestion. The professions within the NHS are constantly looking at other models of care to gain inspiration and this has influenced change but has at times been to the NHS' unfortunate detriment. Other countries also look toward our models of care.
An example would be developing the market economy by tendering out services to the private sector, such as 'NHS supplies'. Whilst this service was far from efficent in terms of organisation, it was much cheaper than all the private firms (who are efficient, but charge much more) who have jumped into their place.
Tendering out cleaning services means that the cleaner is accountable to their manager, rather than the ward sister, so devolving control & producing a 'collusion of anonymity' which you hint at.

How can an organistaion spend 1bn or thereabouts on an IT system that doesn't work yet still not have enough equipment for basic diagnosis?

Agreed. This is a political move & is a shambles

I don't know the solution, but I don't believe it is just about beating our chests & demanding that the NHS/government do something about it, when society as a whole are only looking out for themselves

 

[pipmk]

Having been the recipient of an operation in France it's a mixed bag, no waiting lists, very good facilities but the cost is horrendous. Most French have an occupational entitlement or belong to a mutual,but you should see their tax rates to pay for it.
So literaly you pays your money and takes your choice.

As an aside the Nurses failed the entrance test for the SS as they were too cruel,but the chef came round at 11 to discuss the lunch menu and the appropriate wine. Only in France.

As I was going under the Nurse was looking at screwdrivers to remove the pins in my leg so I asked her to check the tracking and valet me afterwards.

 

[RoseTattoo]

Looking at other countries' models of care is not exactly a groundbreaking, new suggestion.

An example would be developing the market economy by tendering out services to the private sector, such as 'NHS supplies'. Whilst this service was far from efficent in terms of organisation, it was much cheaper than all the private firms (who are efficient, but charge much more) who have jumped into their place.

I will stop trying to trade points and try to be constructive. Yes, agency type privatisation is is not necessarily the way to go.
IT is important especially in terms of managing and distributing key information whether it be administrative or medical.
I have seen many disastrous IT projects in my time and they all follow a general pattern; poor requirement (objective) setting, poor high level direction and poor project management. If that is combined with a complex design, complex technology and complex management structure you woudl be better off buying a furnace and using the money to provide heat in the winter.
Solution 1 IT.
Get a sensible, mature, business orientated, highly experienced project manager and an equivalent who knows how the health system works and what needs to be done.
They will end up with a massive list of requirements.
Cut these down to what is possible and achievable in a moderately short term. Do not attempt to do everything and produce a high level plan of how teh short term can be achieved and an overview of the long term. Build a team to do this.
Use experienced project managers and aim to keep the teams as small as possible.
Use an established methodology, which adds cost but provides predictability.
Providing you try nothing fancy in the way of ideas or technology it will work, more or less on time and more or less in budget.
Solution 2 - Leadership.
This is about a crisis of confidence at all levels. I suspect that a lot of people are doing their best but become de-motivated and frustrated by their inability to achieve anything. Politicians cannot solve this nor can money. Some clear leadership is needed - a real CEO and/or chairman for the NHS. Gerry Robinson was the right sort of idea and maybe still is.
Personally I would prefer somebody who knows the business, can inspire, communicate and can get things done. I think of Monty(who overall I think made some terrible gaffes) but he took over a demoralised defeated army in Egypt, stood before his men and made one of the most inspired speeches ever. That bought him some time. He then started delivering to his men and after several months they started moving forward. Yes, it was expensive and time consuming but I just want to illustrate the point. Anyway i understand that he is no longer available.
It only takes a few small achievements for everybody to see that change is possible and that they can contribute to it.
Solution 3. Pay as you go.
Pay £20 for example for a hospital or doctor's visit and get £15 back. Cumbersome but it would cut out the time wasters. However I am fully aware that some of the time wasters are in need of some sort of service. Some are just lonely people and this is one way to get a sympathetic ear or maybe psychiatric cases. A route for them needs to be found.
Solution 4. Training.
Build prevention into the system and start training doctors and nurses in this. Maybe put 30 mins on the school curriculum once a month. Just cutting down the pregnancy rate in teenagers would bring big savings.
Solution 5 Technology
I have sat at my computer a number of times in the last year and thought that it must be possible to use the system for some basic testing and screening. Put your hand into a special glove that can measure all the vital systems and maybe even take and analyse a blood sample. Spit into a container.

Okay I have visitors and must go.

 

[Smatt]

I will stop trying to trade points and try to be constructive. Yes, agency type privatisation is is not necessarily the way to go.
IT is important especially in terms of managing and distributing key information whether it be administrative or medical.
I have seen many disastrous IT projects in my time and they all follow a general pattern; poor requirement (objective) setting, poor high level direction and poor project management. If that is combined with a complex design, complex technology and complex management structure you woudl be better off buying a furnace and using the money to provide heat in the winter.
Solution 1 IT.
Get a sensible, mature, business orientated, highly experienced project manager and an equivalent who knows how the health system works and what needs to be done.
They will end up with a massive list of requirements.
Cut these down to what is possible and achievable in a moderately short term. Do not attempt to do everything and produce a high level plan of how teh short term can be achieved and an overview of the long term. Build a team to do this.
Use experienced project managers and aim to keep the teams as small as possible.
Use an established methodology, which adds cost but provides predictability.
Providing you try nothing fancy in the way of ideas or technology it will work, more or less on time and more or less in budget.
Solution 2 - Leadership.
This is about a crisis of confidence at all levels. I suspect that a lot of people are doing their best but become de-motivated and frustrated by their inability to achieve anything. Politicians cannot solve this nor can money. Some clear leadership is needed - a real CEO and/or chairman for the NHS. Gerry Robinson was the right sort of idea and maybe still is.
Personally I would prefer somebody who knows the business, can inspire, communicate and can get things done. I think of Monty(who overall I think made some terrible gaffes) but he took over a demoralised defeated army in Egypt, stood before his men and made one of the most inspired speeches ever. That bought him some time. He then started delivering to his men and after several months they started moving forward. Yes, it was expensive and time consuming but I just want to illustrate the point. Anyway i understand that he is no longer available.
It only takes a few small achievements for everybody to see that change is possible and that they can contribute to it.
Solution 3. Pay as you go.
Pay £20 for example for a hospital or doctor's visit and get £15 back. Cumbersome but it would cut out the time wasters. However I am fully aware that some of the time wasters are in need of some sort of service. Some are just lonely people and this is one way to get a sympathetic ear or maybe psychiatric cases. A route for them needs to be found.
Solution 4. Training.
Build prevention into the system and start training doctors and nurses in this. Maybe put 30 mins on the school curriculum once a month. Just cutting down the pregnancy rate in teenagers would bring big savings.
Solution 5 Technology
I have sat at my computer a number of times in the last year and thought that it must be possible to use the system for some basic testing and screening. Put your hand into a special glove that can measure all the vital systems and maybe even take and analyse a blood sample. Spit into a container.

Okay I have visitors and must go.

Sorted then!

 

[peterg1965]

Good thread, if only the Politicians would read it.

As has been said earlier, the NHS has become a 'sacred cow'. Amoungst many other topical national issues it is something that cannot be fully discussed if that discussion involves a level of criticism - immigration is another huge issue that Politicians devote their energies to at their peril.

It requires political leadership to tackle the endemic issues with the NHS and to revolutionise, not tweak, healthcare provision in the UK. Our ageing population demands this. (The other 'hot potato' is State Pensions - maybe another thread!) We simply do not have political leaders who have the guts, determination, leadership, passion and drive to radically sort out and modernise (maybe even partially dismantle) the NHS. My only hope is that David Cameron, once in office, getting there on a ticket of maintanence of the Status Quo, has the b******s to drive through effective change.

I for one would be content with compulsory health insurance, with a safety net for those who cannot genuinely afford it, provided there is a tax reduction to partially compensate. Wasn't there once tax relief on Health Insurance back in the 80's? I dare DC to bring it back.

 

[wemorgan]

As has been said earlier, the NHS has become a 'scared cow'.

it's a bull, but you get the idea

 

[peterg1965]

it's a bull, but you get the idea

Whoops............ corrected for the hard of hearing!