The other bright ideas are for GPs to do all the commissioning of services – basically fragmenting things but would allow private companies to bid for patients from GPs.

Of course, this will 'save' a load of money as middle management is stripped out of the NHS…
However, GP's seem to moan they have little time and a lot of stress already so, what happens
a. there'll be incentives (more cash) driving acceptance of the plan.
b. sooner or later the GP's will have to take on their own middle management to run their budgeting = yep, more money being spent.
The above is the thoughts of MrsMM, long serving NHS employee, in Finance…

You can't have your cake and eat it

Exactly what she said several years ago when I was pondering why the HNS cannot simply treat everyone with any drug they need – it would simply be a bottomless pit into which money would be thrown. Thrown, that is if we put up income tax and pointed the funds that way…

Her position – one key issue on costs is consultants – seemingly a law unto themselves – expensive, inefficient and more money grabbing than any banker when it comes down to it – reporting their surgeries are 'full', miraculously finding diary space when waiting list incentives (additional payments) so the trust can meet it's target, come available…

Feel i might regret posting this as I'm not able to back this up should the flames rise but hey, MrsMM is 'at the coal' face as it were, thought it might offer another perspective…

Her position – one key issue on costs is consultants – seemingly a law unto themselves – expensive, inefficient and more money grabbing than any banker when it comes down to it – reporting their surgeries are 'full', miraculously finding diary space when waiting list incentives (additional payments) so the trust can meet it's target, come available…

Both my wife and i work in the NHS and she works in HR. She has also points out that they get a lot more than the board or even chief ecxutive. They doctors arent much better demanding money for this and that such as moving expensise and things like child care if they come for an interview. This is the area where hundreds of thousands are wasted.

AT the start of the NHS the two groups most opposed to it were a) the Tory party and b) the doctors. No surprise to see a) giving control to b) in the guise of efficiency. This is an idealogical policy (just as closing the coal mines was).
I look forward to the Government telling Tesco to sack it's middle management (accountants, buyers, logistics etc) to concentrate efficiency on the customer by devolving responsibility to the shops!

IanW – Member

"This forum seems very left wing. State employees feeling a bit anxious?"

No, NHS user feeling a bit anxious. They gave me back my leg. And if I was american my diabetes medication would have pretty much bankrupted me (despite the fact that their healthcare system is actually more expensive not less). If we let it be picked apart it'll be a tragedy IMO.

As an NHS manager, my biggest worry at the moment is not the £20m cuts my trust has got to find over the next four years, or even GP commissioning (although I think that's a disaster waiting to happen in loads of ways), it's the massive cuts in social care that are quietly happening in local authorities across the country. Without it the NHS will grind to a halt as beds are blocked and people referred because no one else can cope. We, like many other trusts are thinking about how we might be able to free up cash to fund social care because without it we're stuffed.

TJ wrote

Management costs are low as are management saleries in the NHS – a part of the issue

The nhs is very efficient.

Compared to what, other than your favourite of % against GDP? I do agree with you re management salaries but peanuts and monkeys spring to mind! That is not my experience/impression (re efficiency) and I would give examples were it not for the fact that myself and colleagues have been warned that discussing matters on any forum or talk platform may lead to disciplinary action.

I_did_dab – Member
I look forward to the Government telling Tesco to sack it's middle management (accountants, buyers, logistics etc) to concentrate efficiency on the customer by devolving responsibility to the shops!

Why would the government dictate the internal hierarchical dynamics of a private company?

Woody – in comparison to other EU health services. Partly due to the simpler funding stream ( altho that advantage may be disappearing)

Management costs are a lower % of total spend than most. ( from figures I saaw a couple of years back)

It also costs less than most.

todays stupidity. The NHS in England has put 1.7 billion aside to pay for this reorganisation. Thats as much as the tories claim will be saved over 7 years. Of course the savings won't be that much anyway. Thats about 3 new district general hospitals.

http://www.bbc.co.uk/news/health-10647910

Utterly ridiculous Waste of money for ideological reasons – to create a market for private companises in the NHS

Thank fully the condems have no authority here

The NHS in England has put 1.7 billion aside to pay for this reorganisation.

It's figures like that which make my blood boil. £1.7 billion is an enormous sum of money and it's bandied about like it was an investment of pennies which would pay big dividends in terms of efficiency and savings in the future. We all know it won't and all it will achieve is add another huge administration burden and associated costs, with no benefit to the patient.

Another perspective…

I have lost count of the number of times I have gone to work to find (amongst others)

1. Operating list cancelled – no beds to put patients in – thus get paid to do sod all, patients have to be done elsewhere/out of hours for payment

2. List running late – short staffed, can't send for the patient blah, blah

3. List running late – the ward got confused and the patient isn't ready

Most NHS surgeons like working hard. (most). Often the reason for poor usage of capacity is not the operating surgeon.

The comment above about social care is very valid – increasing numbers of hopsital beds are full of patients who do not need to be in hospital awaiting social care. Social services are excellent at dragging their feet – although again may be matters beyond their control…

I don't understand why the NHS dosen't charge a flat rate fee for ALL operations, be it a hip replacement or something smaller and more routine like a cortisone injection. £30 say. I don't think that's out of reach for the poorest of the poor – if grandad needs a heart transplant i'm sure the family could have a whip-round even if they are all on benefits.

That way everybody puts money in the pot which helps to pay for the most expensive procedures.

That way everybody puts money in the pot which helps to pay for the most expensive procedures.

Don't we all do that now anyway, with obvious exceptions.

And a whipround wouldn't work as the 'poorest of the poor' or those on benefits do not have money for such things. Fags, booze and ….-off big tv's, yes, healthcare no! What would you do, deny them treatment until the next benefit cheque arrives or they have a bit of luck on the geegees ?

Apologies for the looooonnng post, but this excellent comment by 'alisdaircameron' in response to a Grauniad article is worth reposting – it is bang on the money.

Polly, don't even buy in to the idea that GPs will be commissioning: the odd one who doesn't much like clinical work may (thus in essence ceasing to be much of a GP), but the overwhelming bulk of commissioning will be contracted out/outsourced by the consortia (n.b. as most GP practices are private partnerships, how are the 'forced marriages' into consortia not a top-down approach, Mr Lansley?).
(cf the instruction from David Nicholson: working with consortia to support the creation of commercial and NHS commissioning support capability to enable the work of consortia. Note the order, private before NHS and also note that the big private consulting firms have thoroughly infested the upper echelons of the DH, and are ready to roll with their battalions of bright, but ignorant, sharp-suited fresh-from-Uni ‘troops’. Also see: Kingsley Manning, business development director at Tribal, which also already provides commissioning support services to some parts of the NHS, cautiously welcomed moves which the firm said "could lead to the denationalisation of healthcare services in England".) We won't get an erosion of bureaucracy : the difference is that it will be a private bureaucracy.
We'll see direct outsourcing to the multinationals (mainly American) whose whole modus operandi is utterly unsuited to universal healthcare. They see this as a golden opportunity and may employ some NHS staff made redundant from PCTs etc to ease their entry to the 'market', though they've already had their placemen/women on secondment in the DH for well over a decade.It was (New) Labour’s ‘direction of travel’ too. From the purchaser/provider split to FTs, the drive was all about marketisation, and allowing entry to the private sector. Fragmentation, competition ahead of cooperation or a joined-up NHS, and cherry-picking by those private sector entryists didn’t seem to bother New Labour. They undermined the NHS’s foundations, which is what is making its so bloody easy for the Tories to demolish. Welcome more (costly) hard-nosed private sector management consultants that don’t understand how the NHS ethos, and have less respect for medical professional ethics, but are supremely confident (arrogant?) in their MBA knowledge and ability. Most probably, then, those aforementioned multinationals will establish partnership subsidiaries with ex-NHS staff. Private healthcare is mostly very simple – focusing on elective surgery, usually with a patient that already has a diagnosis. It's a matter of looking up the procedure on the code list to see if it is minor/intermediate/major, and pay the consultant and anaesthetist accordingly, then pay the hospital for use of facilities and 'hotel services'. The NHS is massively more complicated and that’s before you even bring in mental health and community services – the private sector doesn’t get involved with these much because they are largely ill-defined, high risk and unprofitable.
Every one of these 500 consortia will need to have offices, IT systems, managers, administrators and secretaries. They might primarily negotiate with their nearest hospital, but also with regional and national specialist units. On the other side, the hospitals will have to negotiate with lots of different consortia, rather then primarily with their local PCT. The outcomes of these negotiations will be all manner of complex contracts – payment of some of these will depend on outcomes, but meaningful outcomes are notoriously hard to measure outside of surgical pathways.
And this is just elective admissions, who will fund emergency admissions, and what about community and mental health services, where the care given doesn’t happen in a nicely defined episode in a hospital?
So how is this going to reduce the administrative overhead, the count of the 'dreaded' NHS managers that are necessary to try and make government policy work? Opportunities for ambitious GP Practice managers, ex NHS managers, and suppliers of health orientated IT systems and business services. We thus arrive at a point when many familiar faces will be performing commissioning functions, their old job, with a new master, more remote than local PCTs in some respects, with the influence of the profit-driven commissioning partners felt more strongly too.
As to David Nicholson's letter this week, a lot of people think it had quite sinister undertones: SHA and PCT staffs have to reduce costs whilst
managing the changes to the new system whilst 40% of them face redundancy but whilst doing all of this, they are instructed to stay on the pitch and not be commentators: in other words deliver the changes without question, and if they do question they will be seen as poor leaders…and probably jobless?

Separation of healthcare providing and commisioning has been in the planning for a fair while now, with recognition that PCTs cannot provide and commission services.

Makes me wonder what the lack of "suits" within a PCT structure will mean to GP services, some practices struggle already to provide a good enough patient service, maybe these are the practices who will commission private services?