Amazing how all these people saying that the NHS needs to change, has outlived its usefullness, is a dinosaur, blah blah blah can’t manage to come up with an alternative. Surely its a simple matter?

Make it more efficient seems to be the theme…. How?
And what does efficient actually mean in healthcare terms?
The reason there are waiting lists in the NHS is because it is efficient.
You want inefficiency, look at the private sector; the reason you can have your op when you want is because their system is run for your benefit, in an inefficient manner. That’s why it costs so much compared to the NHS.

It’s not perfect, but until all you clever, well off, well fed, people come up with a different system, its the best we have.

Indeed – point to another system that does as much with as little money.

Sadly crikey, the clever, well off, well fed people have another system….they pay to go privately except in an emergency.

I will have to get my very small brain around the idea that “the reason there are waiting lists in the NHS is because it is efficient.” Looks like I can make a fortune re-writing basic economic text books then. Thanks for the tip!

by efficient I assume he means cost effective and efficient given the funding, The private sector takes money out of the system in profit and in principle it will always be more costly than a not for profit organisation as it has an additional costs [ shareholders dividends] that the public sector does not.

In order to have no waiting lists we would need to be able to do every operation on demand for the entire population at a moment notice…any idea of the cost of this or the amount of provision required?
We would need everyone ready to operate every day without any patients and paying all their wages and for the hospital etc…..it is hugely unlikely this model is more efficient than the NHS but it may be more effective and cost a lot more.
There is waiting in the private sector it is just shorter and part of that means it costs more as they have spare capacity which is wasteful.

you get what you pay for and we dont pay very much for the NHS relative to other countries…if we paid more we would get more be it via private or public delivery.

Teamhurtmore – the waiting lists are a function of having no spare capacity. reducing waiting lists requires spare capacity, zero waiting lists requires significant spare capacity.

One of the key reasons for the oft quoted as funding increased efficiency did not is this – that and improved treatments.
Improvements in care are seen as decreased efficiency as they can take longer or cost more.

Sadly crikey, the clever, well off, well fed people have another system….they pay to go privately except in an emergency.

Not if they are clever – as private healthcare has worse outcomes.

It does not cover an awful lot more than emergencies as well

TJ – of course they are. Its basic economics, we both understand that. Unlimited demand meets limited supply…….

Oh damn, is that the new text boom idea ruined already. Schade! 😉

As for legally having to tender due to EU reg thats not factually true.
That is a load of crap spouted by a lot of government bodies and councils who dont understand the law on tendering.

They understand very well. EU regs are used as an excuse and something to blame when they want to implement something that’s in their favour.

Not if they are clever – as private healthcare has worse outcomes.

I think this is what’s being missed, yes you can go private, but unless you are very wealthy, your private health insurance will only pay so far if you have a long term illness. So you end up paying more for what is effectively rationing.

The whole idea that the NHS is a massive drain on our economy, that we can’t afford it, that it needs to cut back is dimwittery of the highest order.

Healthcare isn’t how we save money, it’s not how we make money, it’s a really really good thing TO SPEND MONEY ON.

If you’d like to spend a significant proportion of your wages on paying an insurance company to pay a private organisation to provide you with healthcare you are dimmer than a dim thing.

or an american…remember respect the freedom to choose to have no access to healthcare…it always surprises me that it is only those who cannot afford to pay who choose not to pay rathe rthan the wealthy…who would have thunk it

As has been mentioned, the costs of healthcare have escalated dramatically, and the rate of inflation for healthcare products far outstrips that of the CPI or RPI. The tax-payer (that’s you) can no longer afford it.

The taxpayer can no longer afford it ? So what are we all gonna do – get sick and die ?

Private healthcare is more expensive than “socialized” healthcare provisions. If the taxpayer can’t afford public healthcare provisions then they sure as hell won’t be able to afford private healthcare.

Scrap the NHS and replace it with a private health provisions and healthcare costs in the UK as % of GDP will rocket. Plus considerably less people will get treated.

As for no cut in funding by this government, the huge cuts in local authority support services, plus the cutting back or complete scrapping of funding to charities (which incidentally provide excellent value for money) will result in the NHS having considerable more work and responsibility, but with no extra funding. So in effect “cuts” in available cash.

Still, no great concern for this government……lots of juicy profit will be generated from a multi-billion pound sector of the economy which up ’til now has avoided the greasy hands of the privateers – the last of the “family silver” to be sold off. And of course we’ll be a lot more like a America …….. which has got to go down well with the Tory supporters of Atlantic Bridge – the disgraced Dr Liam Fox’s little pet “charity”.

typo alert there ernie you said charity when you meant werity

IGMC

Its not very often I do this but this one line from TJ is correct

TandemJeremy – Member

Its not about improving efficiency its about preparing the NHS for wholesale privatisation[/u]. Check the links between tories and private healthcare companies

… and the best way to ‘reduce costs’ in the NHS is to make people healthier. This is the bit that politicians in particular, and people in general seem to struggle with, largely because it involves paying out money now to prevent problems in the future.

There is absolutely no point in putting alcoholics on Intensive Care units at £2000 a day when they get liver failure or pneumonia. Investment in programmes like Sure Start, educating children, lifting children out of poverty, throwing money at making poor peoples lives better now will pay off in the future, both in terms of medical care and in terms of social problems.

How much does it cost to stop someone getting an opiate addiction?
A lot less than putting them in prison for a few years then giving them methadone and benefits for the rest of their lives.

How much does it cost to stop someone getting an alcohol problem?
A lot less than a lifetime spent in and out of hospital until an early death intervenes.

People say ‘You’ll never solve these problems by throwing money at them’, you know what? We don’t know that because no one ever has, because every government that comes along thinks it’s better to adopt a short term ‘look how hard we can be on the feckless wasters’ attitude which simply exacerbates the problem.

Your society, you decide…

Your society

Not yet it ain’t. In fact it’s less so than it was the year the NHS was founded.

While you walk among us ernie, there is hope. 😉

I work in both the NHS and private sector doing essentially the same jobs.

Its not even funny how poor the managerial side of the NHS is….ditto for infrastructure etc….clinical standards are more or less the same, the NHS does some things better like sending me on placements in order to gain expertise from people who work in settings unfamiliar to me….but the private firm audit my paperwork every 3 months to make sure my standards are maintained….the NHS has never audited my paperwork.

The private firm i work for runs services across Hampshire, Wiltshire, Gloucestershire, Essex, Lincolnshire and runs it all from a single control room in Essex….the NHS Trust i work for has operations in Surrey, Sussex and Kent and has control rooms in all three counties.

The NHS provides excellent emergency clinical care and pretty good routine care (although if you can afford private insurance you soon realise how slow the NHS is by comparison)….but the NHS has masses to learn from the private sector about how to use money efficiently.

but the NHS has masses to learn from the private sector about how to use money efficiently.

In lots of ways I agree, but then again….

The private sector isn’t a political football like the NHS. The private sector isn’t treated like a piggy bank, to be raided when the worlds bankers mess up. The private sector doesn’t deal with the poor, with the drug addicted, with the alcoholics, with the premature babies, with the old, with the mentally ill, with the sad, with the lonely, with the detritus of a system that views worth in terms of a pay packet and a fancy car.

In terms of efficiency, let me ask again; what is efficiency when talking about healthcare?

How much is an anaesthetic delivered in a private hospital?

£200?
£300?
£400?

…and when that anaesthetic, or that surgery, or that procedure, or those implants go wrong, which organisation picks up the pieces?

Is it your efficient private sector?

(Here’s a clue; No, it’s jeffing not.)

Private sector is not more efficient. Operations done privately cost more than done on the NHS.

Ok …. I have no great political axe to grind .. I am just going to say this from my viewpoint.

I am a bit of a strange creature in the NHS. I have two hats that I wear .. a clinical one (no I am not a Doctor or a Nurse, I am what is known as an Allied Health Professional… think of people like Dentists, physiotherapists, psychologists, etc) so in my field I do actually know what I an talking about clinically, and I have a managerial role… I am the manager of the NHS unit I work in and have a multi million pound budget to look after.

My unit is (I like to think) well run and has come in under budget every year for the last 11 years, at the same time we have never failed to hit any of our activity targets except reasons outside our control (Fire and Snow). … That is until this year.

Does this mean that we get congratulated, respected, or even F***ing great big bonuses at the end of the year?

… that was a bit of a rhetorical question to which the reply is NO.

What we actually got was shat on to help out another unit who were grossly underperforming, and at the same time my budget was cut, because some other twonk had overspent.

Whilst I accent that many people in the NHS are hardworking dedicated professionals… we have to accept that the NHS us universally poorly managed.

Nurses don’t spend their time wafting around with halos on… some of them are great, really really great … some of them are small minder petty, jobs worth, idol, wastes of good air.

Doctors …. again some of them are fantastic, truly fantastic. But many of them are not.. many of them are to be despised.

I know loads of GP .. who do a good job but at the same time are money grabbing and self centred. Surgeons who deliberatly manipulate the waiting lists to make them longer… That way they get paid more for doing the job … the one they should have been doing for the NHS.

BTW if the waiting lists are longer it is a hell of a lot easier to get people to go privately … would you pay if you could be seen next week on the NHS.

If the patients don’t go privately the NHS had time limits meaning that the Doctors got paid a whole load more for doing initiative clinics on the weekends etc.

I work in the NHS and it is a bag of worms… will “Call me Dave” sort it out? Will he heck as like.

But I do believe that the GP commissioning could do some good.

My apologies to the good folk out there in the NHS trying to do a good job despite the system… you know if you are one of us.

End of rant

Sancho – Member

It’s a mess at the moment and a huge waste of money, maybe the nurses should concentrate more on nursing and less on managing.

Aye, cutting management and back-office will definately achieve that.

TJ….thats because a private insurance firm is footing the bill, the hospital i had my tonsils out in was like a hotel compared to the NHS hospital i was in for chest pains….of course it costs more…the point is though that its not tax payers money paying for it so it can be as expensive as it likes.

Crikey….as soon as a private firm works out how to make a profit from A&E type cases, dementia, drug addicts, mental health etc then they’ll tender for those areas too.
There are already private Minor Injuries clinics sprouting up across London because people dont want to sit in A&E for hours to have a few stitches….some would rather pay £100 and get it done straight away.

TJ….perhaps i should have said overheads are less in the private sector then?
It’s farcical that my NHS trust pays through the nose to run and maintain three control rooms across three counties but the private firm i work for can run operations in many more counties from just the one control room….this kind of expenditure (extravagance?) from the NHS is a complete waste in this day and age.

It’s the same story with training suites/venues in my NHS trust, we are one trust but operate and maintain a training centre in each of the three counties that we encompass….the private firm has one training suite in Essex and instead pays people’s expenses to go to Essex for updates etc as it’s much cheaper….this is the kind of thing NHS managers should be looking at.

The trouble is that as soon as NHS reforms are mentioned then the usual alarmists make out that the sick and needy will be denied care….look away from the clinical side of things (as in my examples) to see just how much money can be saved without touching the clinical budget.

we have to accept that the NHS us universally poorly managed.

This.

But why is it so?

It’s because the healthcare system is seen as soft, as unimportant, and so we promote people to management positions when they reach a point of sufficient seniority, when they get to the right place at the right time, not because they are good at managing.

Again, throw some money at the problem, employ the best managers that you can and it will pay dividends, instead of letting the press slag off ‘health service managers’ as if they are worthless.

I can’t do my job without a good manager, yet am hamstrung by muppets doing an essential job poorly.

Crikey….i think the major problem with your idea is that the best managers would put forward ideas that the Unions in the NHS would fight tooth and nail to avoid as it would mean the end to a lot of cushy practices in the NHS currently!

deviant – Member

It’s farcical that my NHS trust pays through the nose to run and maintain three control rooms across three counties but the private firm i work for can run operations in many more counties from just the one control room….this kind of expenditure (extravagance?) from the NHS is a complete waste in this day and age.

Do those 3 control rooms do exactly the same job as the one? Do they do it for the same number of patients, hospitals, staff, service?

deviant – Member

It’s the same story with training suites/venues in my NHS trust, we are one trust but operate and maintain a training centre in each of the three counties that we encompass….the private firm has one training suite in Essex and instead pays people’s expenses to go to Essex for updates etc as it’s much cheaper….

Again, is it the same number of staff? Same range of training?

The trouble is that as soon as NHS reforms are mentioned then the usual alarmists make out that the sick and needy will be denied care

Is the RCN a “usual alarmist” then ? As I understand it, it was only today they announced that they were withdrawing their support for the NHS reforms because “of real fears that the needs of the market could come ahead of the needs of patients”

Amazing how all these people saying that the NHS needs to change, has outlived its usefullness, is a dinosaur, blah blah blah can’t manage to come up with an alternative. Surely its a simple matter?

Sorry mate, but no it’s not simple. I don’t have a master plan, but personally I think we have to realise that the NHS isn’t free… it costs money. Secondly, it isn’t a bottomless pit. Once we realise these two points, then we may start appreciating the NHS for what it is: a health service to ensure the health of the nation. Missed appointments, not turning up for an op, medication not being taken appropriately, requesting unnecessary ops, using the ambulance service as a taxi service, staff abuse, I could go on but you get the idea.

And let’s take the politicos out of the equation. Then we can stop this constant fiddling, re-organisation and vote-buying initiatives (hello free prescription in Wales). Why not have a proper and professional national and regional management team with professionals sitting on the board? Hospital and primary care services complimenting each other??

And here’s a thought, why not engage the PMIs to offer insurance to those that want? And if you are a higher rate tax-payer and do not take up a PMI, maybe they should pay an extra supplementary tax.

And no mention of scrapping the NHS 🙂

BTW, cost on an anaesthetic in the private sector? Depends on what op you are having, but as low as £80. Surprised?

its not tax payers money paying for it so it can be as expensive as it likes

..and as inefficient, because the cost can be passed on.

some would rather pay £100 and get it done straight away.

Handy, but what if you don’t have £100?

and instead pays people’s expenses to go to Essex for updates

…and the private company has been asked to make how much saving? How many cuts in their budget? While still maintaining the same level of service and meeting the same targets?

…and for every person you take away for a days training, who does their job while they are away? Who runs that A&E? Who manages that theatre? Who cleans that floor? Who drives that ambulance?

Efficiency of the kind you describe is easy when you have no other commitments, when you have a duty of care to actual people, it takes on a whole new perspective.

Yes, of course you are correct that the NHS could become more ‘efficient’, a term which no one has yet chosen to define…, but it is far more complex than you think.

Take swine flu, for example. What did your private sector do to prepare for a potential epidemic?

Nothing.

What did the NHS do?

Made a commitment to double, that’s DOUBLE, critical care beds, and bought/hired/scrounged/stole(not really) enough equipment to do exactly that.

Efficient? No, hopelessly inefficient. But we had to.

these private hospitals – where do they get their staff from? who paid for thetraining?

TJ….perhaps i should have said overheads are less in the private sector then?

Nope – much greater

And let’s take the politicos out of the equation. Then we can stop this constant fiddling, re-organisation and vote-buying initiatives (hello free prescription in Wales). Why not have a proper and professional national and regional management team with professionals sitting on the board? Hospital and primary care services complimenting each other??

Yup – I think most of us would agree

Efficient? No, hopelessly inefficient. But we had to.

I like that ……. best cutting remark/turning the tables I’ve heard in a long time. Worth an easy 10/10 🙂

Wow, TJ states his opinion as fact once again.

How can even you possibly think that having 3 training suites and 3 control rooms equals less overheads than the single control room and training suite of the private firm? 😆 You’re becoming a parody of yourself.

Hahahaha!

Anything that could possibly be done to the NHS would only have a minimal effect on how effective it is at dealing with this countries health concerns.

The real problem is that too much stress or pressure is being put on the NHS by unhealthy, unfit people, poor diet, abusive life styles, combined with stress and polution add to that naturaly occuring ailments or conditions and you have more and more people requiring to use the system/resource that the NHS represents.

Perhaps the best course of action would be to encourage individuals to alter there behaviour and attitude towards themselves, also support for individuals that choose to change their thinking and subsequent behaviour.

Rather than debate this point or that point which would simply waste time, it might be much better if all of us that are concerned with these issues encourage people we know to eat a balanced diet and exercise regularly as well as other changes.

If you know of any websites that are involved in encouraging this change in perspective, or that give support with exercise / dieting advice why not post them into this thread.

No I haven’t really read the arguments of this thread, I’m not in the mood to argue, also I’m mental remember.

Without the capacity to effect change, debate is simply pointless posturing.

Yes fandango, yes to almost all of that.

The problem is that by disparaging the NHS, and by forcing it to make ‘savings’, we make it appear to be a second class service, which in turn makes it easier to claim that it isn’t working, and make it easier to run it down further.

It’s the best system we have, and should be a source of pride and consequently investment, rather than a political football to be supported or undermined according to whichever group of politicians are trying to dick us over this time.

Devient – because I have seen the figures for private healthcare in general and know for a fact that overheads are higher for the same level of activity. I also worked in a unit before and after it went PFI and saw the increase in overheads

Overheads may be less in that small non clinical area you work in however in general private healthcare is more expensive because of its higher overheads amongst tother factors

As crikey points out you are not comparing like with like as well

The problem is that by disparaging the NHS, and by forcing it to make ‘savings’, we make it appear to be a second class service, which in turn makes it easier to claim that it isn’t working, and make it easier to run it down further.

To fair that’s been the strategy across the board for a very long time. What always comes to my mind is the railways – the underinvestment in the railways in Britain for decades was practically criminal. Until the final year before privatisation of course, when investment was suddenly doubled. How the railways ever managed to function is a complete mystery to me. Now government subsidy to the privitised railways is 5 times what it was pre-privatisation.

How can even you possibly think that having 3 training suites and 3 control rooms equals less overheads than the single control room and training suite of the private firm? You’re becoming a parody of yourself.

well northwind asked you for numbers- how many staff in theprivate bit how many staff in the NHS?
Any evidence that travelling for all the NHS staff to one locale would reduce costs?
It would depend on many factors …none o fwhihc you have covered or answered when challenged….dont let that stop you attacking TJ though
It would depend on the figures but it is pretty obvious you are not comparing like with like

The army costs more to run than my car..inefficient bastards.

deviant – Member

How can even you possibly think that having 3 training suites and 3 control rooms equals less overheads than the single control room and training suite of the private firm?

There’s a lot of ways it could mean less overheads- shipping staff around to training centres stops making sense quickly when you’re dealing with more staff. Combining control rooms that do different jobs, or cover geographical areas in a way that makes local knowledge useful, can be less effective. And so on.

Junkyard, the numbers are comparable….its why private firms are taking so many NHS contracts at the moment (and were doing so long before this Government)….because they are able to approach the PCTs and undercut the NHS tenders.
The PCTs arent conjuring money from think air to throw at the private sector, they will go with whoever is cheapest for them….the private firms i’m involved with all have far fewer premises, far less managers etc than their NHS competitors….there is no good reason why the NHS cant look at how this is done in the private sector and incorporate it into state practice….but there are far too many vested interests in the NHS for this too happen (unions, politics etc).

The number of patients not being treated within the NHS waiting-time limit has soared by 43% since the coalition took office, official figures show.

Just come in from the cinema, not my choice but guess the film! Probably not the best preparation for further comment on the NHS. So JYs picture of JMK last night and Maggie, Maggie, Maggie tonight. Not sure where to turn!!!

Streep for an award and Broadbent for best supporting actor.

Last thought – 11 Year old economics focuses on efficiency alone, when we grow up we talk about efficiency and effectiveness. Too many 11 year olds are bought into manage and change the NHS though.

Now dreams of Keynesianism or Thatcherism????