[Closed] NHS cuts - you're in charge - what services do you get rid of?

A complete misunderstanding of what it is in theory?

or a complete misunderstanding of what its become in practice?

🙄

The level on debate on here is pretty pitiful.

1) The discussion in the real world is about prioritisation not out right cuts. Taking money out of hospitals and directing to community interventions to prevent need for more costly hospital care. Particular advantage for those with co-morbidity

2) Lots say cut managers. I assume you don't expect hospitals to operate as some anarcho collective in which case someone is going to have to manage eg an average acute trust wjth 10,000 employees and a budget of £400m. Do you expect clinical staff to do it, HR, estates, supplier management, activity management, stocks, stores finance IT etc etc? We pay all that money to train clinical staff to do something they really want to '- then you want us to require them to spend increasing amounts of time doing management - bizarre. There is clearly a need to make sure management is at an optimum level but what evidence is there that NHS is over managed? OECD analysis shows our healthcare system is actually relatively efficient. BTW matrons are senior nurse managers, they never went away.

3) do no treat the fat, indolent, drunk, druggie etc etc. Who draws the line, what BMI, how many beers etc. What about other risky activities? But that isn't really the point, the NHS is a poltical idea basec on a post war concensus. Either you have universal healthcare or you don't. If we really don't like it then gove to a risk based insurance system, but I would suggest you avoid being poor or old. Not a country I want to live in, where the poor die of preventable causes and the rich live behind locked gates

4) 24hr surgey. Basically sweating the assets as per manufacturing industry. False premises abound. Capital is relatively small part of NHS costs, typically less than 10% of revenue if publicly funded. Surgey is a relatively small part of NHS spend. Hospitals do provide 24hr in-patient and emergency care from much of the estate. Where do all the extra doctors and nurses come from? Where do all the extra patients come from (double or triple capacity would clear baclkog very quickly then ru n out of people to treat). In manufacturing you would shut 1/2 to 2/3 of the capacity, centralise onto most moden site, run 24hrs. So we close all those surgey units and book you in for day case knee surgey at 4am in a surgey unit 50miles from where you live, being done by a sleep deprived junior. Great!

No-one would argue the NHS is perfect, but perfection is not possible, optimum is the target. There is a debate to be had on management, personal responsibility and reconfiguring services - but the answer is not in the Daily Mail

Haven't read all the threads but there's a bloke at work who's missus works in patient records, & he reckons she's on more money than my missus who's a senior staff nurse on a paediatric HDU.
If it's true, I'm thinking...WTF!

no more final salary pensions (this is the way most firms are going now)

There's not many staff on that scheme anymore it's been abolished.

One more observation - the current change to community based commissioning is partly so expensive (although less than 1% of annual budget for 3 years which isn't quite the calamitous figures that Andy Burnham likes to kick around) because staff contracts were so spectacularly badly negotiated in the first place - the last lot in power had and failed to take an opportunity to modernise some of them under Agenda for change with the result that even minor changes now give staff the entitlement to massive redundancy payouts for what are akin to tupe provisions for every other employer in the uk.

Drac - it hasn't been abolished at all - the benefit received is still index linked and massively outweighs the contributions from employees - which effectively means tax payers are picking up unlimited future risk. You don't have to look too many years out (about 5 in fact) to reach the point when the cost of providing pensions for the additional 480,000 nhs staff added under the last Govt. can no longer be met by current contributions - creating an annual deficit that will get significantly worse year on year. They were forecasting a £960B UK public sector pension deficit as long ago as 2008 when incidentally it would have taken all paye tax for c33m working adults in the country for 4 years to balance.

http://www.telegraph.co.uk/news/uknews/1544058/NHS-pension-black-hole-rises-by-61bn.html

Employ less female staff

http://www.telegraph.co.uk/health/healthnews/10101276/Female-doctors-who-work-part-time-after-having-children-put-NHS-under-strain.html

🙄

As with all things it is complicated. I would actually suggest taking a step back. Look at what the NHS does, what we need it to do, what we would like it to do and what we can afford it to do. As someone above suggested I'd take it out of the hands of elected politicians to get some long term stability and future planning rather than having the latest Minister in the office decide something to make it look like he is doing his job.

Well according the info I got it's been abolished it's now a career average. Maybe that's why you had to find an article from 5 years ago.

Wow thjs thread is ace. Can we have one on education today please 😯

I would increase spending on health education in schools, school and grassroots sports and local council sports facilities. would lower speed limits in towns, introduce more pedestrianised streets, better walking/cycling/public transport provision. Possibly also increase driver education/speed awareness, and maybe reduce speed limits on dangerous roads (and enforce the limits if they were introduced!) I would also give people the ability to end their own lives. I I would see all of this as a long term investment rather than a short term fix.

I'd probably also cancel Trident.

I've missed a hospital appointment - the letter turned up a couple of days after I was supposed to be there. Would not be happy about being charged!

And my point was not that consultants didn't deserve £100k+ it is that the NHS simply cannot afford to sustain such huge salaries

Um, you've not really thought that through at all have you?

Yes I have. At Christmas my business told 120 skilled IT contractors they were taking a 10% pay cut. This was not due to them not deserving more / working hard / studying for a long time etc... it was down to affordability and the budget - simply there was not the budget to pay the current salary bill. The other option was to fire 1 in 10. A small % left and have been replaced. Most remained as they understand [i]why[/i] the cut was needed.

@DT78 Pay cuts in place since just before the last general election (yes labour started it iirc) in the form of pay freezes for staff over I forget what salary, and increases in pension contributions. Last year I earnt near just shy of £25k before tax/deductions etc, and even on £1500 below national average salary, after tax, pansion contribution hikes and generally accepted RPI/inflation, I am £850 worse off a year than I was three years ago. Obviously those 'savings' look better/bigger the higher up the payscale you go even if it is not 10%. Hopefully nurses working for 5% less in their pockets, for between three and eight years longer before they draw their gold plated pensions (depends on current are and service area), and with 10-20% fewer colleagues working alongside them will make you feel a little bit better.

FWIW the contractors you speak of would more than likely already be paid >10% less they if they [i]employed[/i] to do the same work within an NHS trust: IIRC, IT is one of the areas with the biggest disparity between private and public sector salaries. (Notwithstanding the contractors of IT and other flavours that seem to milk public sector contracts for all they are worth, but that is another far more complicated way to talk about saving money and seemingly not on this or previous government's agendas. 😕 )

And to make some positive suggestions many would be about staff, since in most areas staffing is the most expensive part of healthcare.

1) Career average pensions definitely A Good Thing. There are too many burnt out dinosaurs working inefficiently in high-up posts because of their pensions.

1.5)So remove the financial incentive to stay at the top until retirement and provide a framework within HR/recruitment procedures that easily allows the dinosaurs to volunteer to go back to lower paid posts (obviously for less money).

2) More rigorous performance managment: it is sooooooo easy to get sacked and indeed prosecuted for your actions or omissions as a clinician, but in puiblic service if you are just A Bit Crap or lazy, it is almost impossible to get sacked. In my work, you'd only need to sack one or two people before everyone else that was underperforming pulled their socks up a bit.

2.5) So introduce probationary employment contracts and some kind of 'try before you buy' mechanism that allows staff to take leave from one job, work a couple of weeks (paid of course, or you could pay the place they already work in for their time) in new job before they are interviewed and/or offered a job.

3) Overhaul sickness and absence managment. FWIW this is already happening where I work and this includes changes (well, restrictions) to sick pay, for example if you work shifts and are off sick for a month you don't get the pay you would have had for the three weekends you would have worked in that month, and if you are off sick on a bank holiday it gets taken off your bank holiday/leave entitlement rather than sick time.

4) Big overhaul of targets and KPI's -so much time is wasted by relatively highly-waged senior clinicians and managers chasing KPI's that have little or nothing to do with how we actually perform as a service or whether we represent value for money.

5) Employ one person per trust to basically make links, phone round and drive harder bargains on supplies and contractors. Some of the stuff we buy through NHS logistics/EPROC is soooo overpriced, and some of the electicians/builders etc we have had over the years have been very rubbish.

6) Total ban on NHS staff seeing drug/equipment reps/lunches etc. It all comes out in the wash, and you end up paying for it in increased costs of medicines, dressings etc. Our old medical director felt very strongly about this. I know a couple of good honest reps who have helped us make better decisions about prescribing, but they are well outnumbered by some real greasy salesmen who care about their figures not your patients.

I am not talking about reducing nurses and support workers salaries. They are already low. I talking about reducing the already well salaried consultants who on their own are a significant proportion of the wage bill.

I too work in the Civil Service and have had pay freezes, pension erosion. It sucks and it hurts but I understand why. My other option if it gets to bad is to move to the private sector where regular culls and worrying about whether you will be in fact in a job next month are daily concerns.

Homeopathy should definitely be available on the NHS if it's been demonstrated to have a placebo effect.

But the practitioners should only be paid £0.01 for each patient.

😀 😀 😀

It would help immensely if suppliers didn't think of phone numbers to add to the cost of anything when bought for healthcare or medical devices. I've yet to see a rep. for a medical company pleading poverty.

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Personally I feel that consultants earn their money (generally), especially when compared with others earning way more in other sectors. How many lives can a bond trader, merchant banker, college principal, supermarket manager claim to have improved/saved.

Things I would be considering (if not done already) are:

More use of generics rather than branded drugs.
Tougher negotiations with suppliers, perhaps on a national level.

Also maybe:

Immunity from civil damages court claims.
A restriction on marketing spending by trusts.
Replace that 111 line (bag of S@@@) with something more effective in keeping people away from A+E like NHS direct used to be.

I don't think another complete reorganisation of the NHS makes much sense in that it will cost a fortune in the short medium term and the advantages are only possibilities rather than probabilities. Most internal markets seem to save less in operational spending than they cost in administration.

Of course the main problem is that we are living longer so we could have a "logans run" type scenario where everyone over say 50 is put down before they start costing the NHS loads of money. Alternatively, a series of "Battle Royales" for any group regarded by STW as a drain on the service; fatties, smokers, elderly, childless couples etc.

something more effective in keeping people away from A+E like NHS direct used to be

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It's exactly like Ambulance Indirect use to be.

It's exactly like Ambulance Indirect use to be.

At least you got someone to seemed to have an idea what they were talking about. I had the misfortune of trying to use that 111 service yesterday, in the end I got so frustrated with the obviously clueless operator I went to A+E instead.

At least you got someone to seemed to have an idea what they were talking about.

Call handlers following a protocol now you get a call handler following a protocol.

I was talking about reducing the already well salaried consultants who on their own are a significant proportion of the wage bill.

Sadly market forces at the moment mean that if you pee of a consultant too much then they will leave and you will pay a locum agency twice as much to replace them with someone about half as interested in the job. 👿 You also need some degree of consistency with consultants in order for them to be able to supervise less senior doctors and 'grow' new consultants.

YMMV, but where I work our doctors (consultant, ST6/senior reg and F2/SHO) make up a whisker less than 10% of our total wage bill. Despite us being very much a consultant led service! No one in the service besides the consultant and st6 is on more than 45k.

How much of a wage cut should the doctors have in order to make a signinficant difference to the overall staffing bill? In my team a 10% pay cut for the doctors would map out to about 1% saving on the whole staffing budget. I expect you could bump that saving up to a whopping 1.5% on the total wage bill when you factor in community/outpatient services which have a 'better' doctor to nurse/ahp/admin ratio.

Medical advancements have been amazing since the start of the NHS. There are now so many treatments available(and to spend money on) that were not even dreamed of and cures which have kept people alive even longer(to suffer other expensive illnesses). Sadly it's now becoming a victim of its own success and becoming unaffordable.

This (mostly), says MrsMM who is a management accountant within the NHS. Money going into the HNS is, apparently, roughly equivalent to what it was the days the doors open = something has to give.

On the other side - don't, whatever you do, get MrsMM started on Consultants (medical) and their contracts (&costs) or consultants of the 'management' style - why are management not capable of sorting things themselves....?

actually - just seen julianwilson makes the same comment re: consultants (medical)

One last thing - where she is, the cuts are impacting across the board. We're still waiting on her 'new' job. def. to be confirmed in the 'new structure' - a good few folk, at grades above and below hers, have lost their jobs / been re-graded - rarely is that an upgrade. I say this only to 'illustrate' that it is not just frontline staff who are taking the hit.

Personally I feel that consultants earn their money

I know I'm utterly biased, what with being his son and all, but when I think of the stuff my (my recently-retired) dad dealt with during his NHS career...

He was "public health" the whole way - a looong journey from army medic to consultant paediatrician (& PICU is pretty much one of the toughest working environments there is). IMO, his pay was very modest in comparison with those of his seniority in other professions - law, finance, whatever.

IMO, his pay was very modest in comparison with those of his seniority in other professions - law, finance, whatever

Look at the porter if you want to see a "very modest" salary

In what world is £100 k "very modest" ?

Very modest [b]in comparison[/b].

He wasn't getting £100k, though it was upward of £70 k. And note that I wasn't claiming that he wasn't well paid. He was - & he worked [i]fugging[/i] hard for it. His choice, for sure.

As for porters, of course they deserve better pay - hospitals would fall apart without 'em. And I don't need to look at a porter's payslip to see a "very modest" salary - I've done over fifteen years as an auxiliary nurse. 😈

That every modest salary puts him in the top 5 % of earners in the UK

How many of the other top 5% can say the same?

Simple. I'd cut mps wages to 35k a year ( it should be an honor to serve their country, not a lucrative job). Use the extra money to put gp's in 111 call centre's to allow easy public access. I'd also allow paramedics to staff the ooh service, administering antibiotics as required via remote prescription (from the 111 gp.) in one fell swoop, the public get the service they desire (and after all, pay for), I get a pay rise inline with new responsibilities and MP's get a pay cut as they deserve it.

Get real, 35k for a central London job! Even if you did that it would only save 22million

More than enough to implement my plan, and for most of the UK, their MP's aren't in central London jobs...

Ever heard or the House of Commons?

I'd also allow paramedics to staff the ooh service, administering antibiotics as required via remote prescription

Some trusts may be ahead of you there.

Once again. [i]It is what is affordable, not what is deserved[/i]. It is actually irrelevant what a banker/lawyer earns! If the country / NHS needs to reduce its operations budget, of which a big chunk is wages, then it needs to reduce salaries. I propose take it from the higher earning members who won't notice only buying one rolex a year rather than hit all staff. 1% of the labour bill is something like £500 million (according to my first hits on google, I thought it would be more...)

If doctors choose to leave, there will be more to replace them. And as I said, if they really care about the professional / people they would understand why.

The other option is to introduce an increase in tax for all those earning over a 70k odd. Maybe 60%. Which I'm also in favour of. Some people will leave the country, sure, but I seriously doubt it will be the mass exodus mps suggest. How about we give it a go and see?

It is what is affordable, not what is deserved.

What is "affordable" is completely arbitrary. For example some will say that we can't afford Trident, others will say that we can.

It's about priorities. It's always about priorities. And anyone who tells you that it isn't, is simply trying to get you to accept their own preferred priority without any debate taking place .... the old "there is no alternative" ploy.

If doctors choose to leave, there will be more to replace them.

The problem with this part of your theory is that it's just not true, at least not overnight. It takes 12-15 years to train a specialist from entry to medical school; partly because of the difficulties of NHS workforce planning there are some (mainly surgical) specialties where there are an excess of trained specialists; in others, eg. Emergency Med there is something like a 10-20% shortfall.

I propose take it from the higher earning members who won't notice only buying one rolex a year rather than hit all staff.

This is already happening. Locally, the proportion of consultant salaries for non-clinical work (which includes work for revalidation and therefore staying on the medical register) is being squeezed; I am aware of one trust who (publicly) cut all consultant salaries by 10%. There has been another effective cut due to the changes in the pension scheme where those on higher incomes pay double the percentage of those on lower pay in personal contributions - which goes straight back to the Treasury (don't kid yourself anyone in a public sector scheme, however generous it might be, has an actual pension pot).

You're all still looking at it the wrong way round.

This is healthcare, not selling bikes, or windows, or coffee. At some point in your life, you or someone close to you will need the best care they can get, so let's look at getting the best quality care that we can instead of trying to save a few quid.

What are we, the 7th richest nation in the world? ...and we can't afford it?

We can afford it, and we should afford it, and we should stop treating the money that we pay for healthcare like some massive piggy bank that 'the nation' can dip into when bankers mess things up.

I said earlier that at some point in your life you will need the best healthcare available, and I stand by that...

crikey for PM.

“We are not here in this world to find elegant solutions, pregnant with initiative, or to serve the ways and modes of profitable progress. No, we are here to provide for all those who are weaker and hungrier, more battered and crippled than ourselves. That is our only certain good and great purpose on earth, and if you ask me about those insoluble economic problems that may arise if the top is deprived of their initiative, I would answer 'To hell with them.' The top is greedy and mean and will always find a way to take care of themselves. They always do.”

A quote from Michael Foot, which drives me to do what I do as well as I can.

Michael Foot is awesome.

we spend a lot less per capita than the US on healthcare and have free to all at the point of access healthcare - and with better outcomes for patients

it's gonna cost 3 BILLION quid to design the subs to carry trident, that's not build or maintain/service or redevelop the rocket/warhead....

enough polemic here's my idea

if the government wanted to work some efficiencies they could have stuck with the existing framework of PCTs but just do some merging of the trusts, which would drive some cost down and also reduce the instances of postcode healthcare division (by the fact that more people will be in the same provider, and bigger providers have the scale to share resources more efficiently) - actually you could still do this regardless of the current fundholder GP privitisation cockup

Anyone mentioned prisoners getting tattoo removal on the NHS yet? Or the two guys walking round the grounds of the Glasgow Royal Infirmary to stop people smoking?

I don't think the nation would be worse off if those services were cut.

No free NHS for smokers, morbidly obese or alcoholics.

No NHS for immigrants who haven't worked in the UK for at least 2 years.

No vanity "healthcare" from the NHS, ie tattoo removal, nose or boob jobs etc.

What about "depression" sufferers ? I would put them in the same category as alcoholics, overweight people with eating disorders, and vain bastards who worry about the shape of their noses. Sort yourselves out and cheer up ffs.

And anyone who chooses to do something that potentially puts them in a position of hurting themselves/getting hurt: sports, crossing the road, picking up heavy objects etc. Of course don't forget anyone with a hereditary illness that was caused by their irresponsible parents choosing to procreate. 🙄

No free access, you should have to pay something, say £10min. The French health service isn't free, the state provides basic stuff and citizens have to pay something and most have a private top up to cover what the state doesn't pay.

I'd stop all new recruits having state pensions.

Some interesting points above - no state health care for smokers or alcoholics - not an equivalent test is it, should we ban smokers and everyone who has a pint ?

Not being able to sue the NHS? Just think where that would end ? Public services already have too much leeway to dodge responsibility

No IVF ? That's very harsh and a definite vote looser, less UK citizens and more immigration then ?

So finally what about sports injuries ? Should the NHS really pay for us when we go OTB ? Shouldn't we have insurance for that ?

So finally what about sports injuries ? Should the NHS really pay for us when we go OTB ? Shouldn't we have insurance for that ?

That works in NZ, I believe - there is a compulsory accident insurance paid for by the government which picks up the tab for any resulting medical treatment.

I'd stop all new recruits having state pensions.

Hasn't the law just changed to compel all employers to make pension provision for employees?

How about the Locum consultants who are paid quite honestly 'out of space' wages who are also partners in private practices. I know some conduct fantastic work, of which I can only dream of but when you see the 'coin' some are pulling, alongside their peers and other healthcare professional working extended/out of hours it is disproportional - made even more painful when the situation arises where they consultant/reg ect consistently relies upon the 'blue-collar' workers when the pressure is on!

Not everyone, but I can assure you their are jaw dropping wages being paid out, and other areas stretched to DANGEROUS limits - I have evidence to back that up!

@ratherbeintobago, no problem with the state paying 8%-10% into NHS employees pensions which should be defined contribution like everyone else. If staff want the same benefits as they enjoy now they can top up the rest, my guess is that's another 20%-30%, a defined benefit/final salary index linked pension guaranteed by the state is extraordinary valuable, ie expensive

Not being able to sue the NHS? Just think where that would end ? Public services already have too much leeway to dodge responsibility

I was not saying that the NHS should not be accountable, bad/dangerous practice could have some criminal recourse. What I was meaning was removing the incentive for legal bottom feeders to consider the NHS as some sort of cash cow. Commercial radio is full of adverts encouraging people to make claims against the NHS, the bill was £15bn or so last year and I bet in 90+% of the cases the medical service was doing its best to help the patient.

no problem with the state paying 8%-10% into NHS employees pensions which should be defined contribution like everyone else.

Those on high salaries are already paying 20% for career average (definitely true of GPs, who have to pay employer as well as the larger employee contributions), and the pension scheme was revised in 2005 to make it sustainable & self-funding (allegedly) - IIRC the agreement was that if costs or projected costs rose these would be met by increasing contributions. Of course, we all know there is no pension fund as such, and all public sector pension contributions go straight back to the Treasury.

You also have to remember that the majority of NHS staff are not well paid when compared to the private sector.

Better questions would be why some public servants eg. judges (IIRC) have a [b]non-contributory[/b] final salary pension scheme, and why senior NHS staff pension contributions are being disproportionally increased when compared to other public servants on similar pay and similar defined benefit pension schemes, eg. MPs and senior civil servants.

How about the Locum consultants who are paid quite honestly 'out of space' wages who are also partners in private practices.

Not sure who you mean. Majority of locum consultants are people who have just finished specialist training and haven't secured a substantive consultant post; these are on standard pay & T&C's.

Agency locums cost a fortune, but a huge chunk of this goes to the agencies; while the individual [i]might[/i] be on more money than someone directly employed by the Trust, it won't be that much more. Because of the costs, most Trusts are extremely reluctant to employ agency locums in any case.

So far as I am aware (and I'm not hugely conversant with how PP works) there is no such thing as a partnership in a private practice, as it's an individual thing. In any case, and this is one of the potential iniquities of the system, I don't think any of the large private healthcare providers would take on someone who did not or had not held an NHS consultant post.

Get rid of the whole management structure and start again
But keep the actual ground staff and make the experienced staff up as managers
and make everyone accountable for there failings and wasting of monies

But keep the actual ground staff and make the experienced staff up as managers
and make everyone accountable for there failings and wasting of monies

This is a good idea; empowering staff and making them accountable for new services might work well. A period of stability without endless reorganisation would be needed to make it work though, and I can't see the politicians going for that.

Actually, thinking about it, one of the biggest causes of waste and inefficiency in the health service is the endless politically-driven reorganisation.

Some of the tosh spouted here is very ill-informed. Yes, there is fat to be trimmed as there is in any business. But the vast majority of professionals in the NHS and allied organisations whose staff are on NHS T&Cs work their arses off. Funding is being cut back, despite what the DH and SoS says, we're currently looking at cuts for the next two years already. A lot of my staff are paid well, so am I. But we carry a lot of responsibility. Most of us have been moved to DH and are now civil servants so performance related pay will apply in future too.

Contracts for goods and support cost a fortune IME, we are tied to everything from stationary, travel, hire cars, printer cartridges. All on central contracts that at point of purchase from a budget cost us, the taxpayer, more than if I used a credit card and bought direct. Apparently it saves money in the long run, I've not seen evidence of this and neither have procurement staff I've spoken with.

As for pensions, mine has gone up at 2+% pa at the same time as wages have been frozen (cut). At the moment I pay c£600 pcm into my scheme and work slightly more. I could move to Civil Service T&C at some point in the future. The equivalent scheme for me at the moment would see my contributions drop my three quarters and work go up by 100%. It's not all public sector staff with pensions that have a gold-plated deal. My contributions will be nearer £750 a month next April and then in April 2015 most of us move to a new public sector pension. I have no problem paying my way, but much of the increase is to support those on the lower pay grades. Also I've yet to meet a friend in another sector who'd pay the same contributions willingly pcm.

My personal view is that the NHS and most of the public sector is being dismantled by the current government. It should be protected and resources targeted better.

Skimming through this thread is depressing. Essentially call me Dave and Co seem to have won the "debate".

So many seem to have accepted their terms without question.
Cost is unquestioningly put before the wider value of the NHS even in the minds of its potential patients.

The STW majority (as a reflection of wider society?) seems awfully keen on pointing out who the "undeserving" in are... Mostly fat people it seems, how imaginative.

So yep the bastards must have won because the majority seem to be adopting their ways of thinking...

Which is all well and good, but I doubt all of you lot have the same private resources as those leading us down this road do, to fall back on when you're refused treatment due to you"lifestyle choices" and I'm sure none of you lot could possibly become overweight...

I think we should cut childrens heart surgery units
actually no we shouldnt
erm yes we will
ok we wont
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I have no problem paying my way, but much of the increase is to support those on the lower pay grades.

The Ambulance Service. As no one takes themselves to hospital, there would be no patients in the hospitals!