[quote=singletrackmind said]
but then i am not a manager , but i have met Gerry Robinson.
And he gave you a b*llocking IIRC 😉
Red Diesel for Emergency vehicles.
DrP - Member
..yet 'the general public' want us to cover out of hours 24/7....
You can't win can you..
DrP
I don't think they want each doctor to cover 24/7, perhaps they mean that they would like cover 24/7 by doctors (the key there being plural). Perhaps part of this:
If it possible i would convert the system to rolling 8 hour shifts to ensure all the expensive things like CAT scanners are not sitting idle for 2/3 of the time
Charge people for missed appointments to avoid cuts?
excellent tdo I get to charge them for every minute i sit there. Last time i went i was the fifth person with the 9 am appt to see the specialist who was ill so i got seen at 11. No idea what the others did
I also used to attend an eye specialist whose last appointment was 12:30 and the clinic shut at 4:30. They used to moan i was late when i rolled up at 3:15 and i would simply point at those still waiting and shrug
Some waiting is inevitable but I get the feeling they have got so used to it they dont care anymore and are no longer embarrassed to be doing this tbh.
Yes missed appointments costs money but i bet it is less than the combined loss of us all waiting and by a large margin
Just some?Sorry drac, but some ambulance services could do with some better management
The Trust I work for is highly regarded and is one of the best performing, according to the various indicators. That being the case, I shudder to think what the management is like in some of the others. 😯
singletrackmind said »
but then i am not a manager , but i have met Gerry Robinson.And he gave you a b*llocking IIRC
Correct, and then later on in the year he accpeted I was pretty much spot on with my assesment and apologised.
He earnt an awful lot of respect that day.
[i]Not[/i] embarking upon another (& utterly muddleheaded) reorganisation would have been a good start - the ConDems can't say they weren't warned about the likely consequences. It's almost funny watching Hunt play the blame game.
When it comes to one of the biggest 'costs' - the rapidly accelerating expense of caring for an increasingly-elderly population, many of whom find themselves in acute settings with nowhere else to go - I'm afraid there is no magic solution. It will probably require some kind of massive cultural shift.
Oh, and give Parliament emergency powers to bin PFI contracts. 👿
Seems ridiculous that you can go on a waiting list to see a consultant or pay to go private to be seen within days only to find its the same damn person
What would you think if it was the same surgeon, in the same theatre using the same kit as they would if the NHS was paying for it?
the same surgeon, in the same theatre using the same kit as they would if the NHS was paying for it
Who will probably send you straight to NHS ITU if things go south...
I forgot about the theatre staff, nurses and AHPs on the same ward as the NHS patients.
The 'run it all for 24 hrs a day' thing is often suggested by people who work Mon-Fri 9-5...
You could run it all 24 hrs a day, but you'd have to pay people to work at night; more Radiologists, more Surgeons, more Anaesthetists, more nurses, more radiographers, more porters and so on. Then, because they were working at night, they wouldn't be able to work during the day, so we'd need more of everyone to keep it working, and to enable discharges, we'd have to have teams in the community working at all hours, and ambulance crews and so on.
If you want to triple the NHS wage bill, it's a great idea.
It needs funding properly; a look at how much European countries spend on healthcare would be a start.
By the way, its hardly been mentioned here, but surely everyone knows that the big one is to stop concentrating on acute services like hospitals and spend a greater proportion on primary care services - less hospital beds, more community nurses!
whats so hard about hospital services being 24hrs.. staff dont get pai d premiums at most employers for 24hr shift working why would the nhs staff..?
why cant i book an appointment when its convienant for me.. not for the staff who work m-f..
one area i ve expereinced through out the north for the last 15 years is anti coag services.. why does the level std of care vary so much from two docs phlabotomists nurses and receptionist at one location to using a pharmacist at another i ve even had it done by fax.. from eastern europe and seen no one.
common standard would be an excellent starting point.. if a single community pharmacist can give me flu jabs, viagra, anti coag and the morning after pill.. why are there dedicated clinics in hospitals to do the same role..
Personally I'd start with a root to branch reform of NHS Culture and Leadership - both are spectacularly lacking and are a large contributor to the poor outcomes we get in England compared to other european health systems such as those in Netherlands and Germany (where interestingly the significant participation of the private sector is routinely cited as having helped to raise standards and constrain cost).
As for money saving, there's some low hanging fruit some of which is being tackled / about to be tackled:
- Clinical merit awards (don't call them bonuses!) for Consultants which can run into tens of thousands a year yet don't have any performance criteria attached to them. They are also pensionable so cost around 1/3 on top.
- The blatant scam run by many GPs on property whereby they purchase premises (some times with low cost loans from PCTs), rent them back for exorbitant rents, sell them on and pocket anything up to 7 figure profits without having paid anything themselves:
- get rid of underperforming staff and tackle sickness absence pee taking- it's almost impossible to get fired in the NHS and even when it does happen the staff normally pop up at another trust a few months later. More than anything the lack of this at present is a drag on the many hard working committed staff that don't do it, and despair at what their colleagues repeatedly get away with.
- change the pension from final salary (adding around 1/3 to pay costs to the taxpayer) to defined contribution.
The last change would at a stroke enable the NHS budget to be sustainable and would only put NHS staff on the same footing as the majority of the working population.
I'd cancel Trident
whats so hard about hospital services being 24hrs.. staff dont get pai d premiums at most employers for 24hr shift working why would the nhs staff..?
I think you're talking rubbish; night work has always carried a premium, take that away and why would anyone work at night? Also, if you work at night, you can't work during the day, as I said... You'll be a 9-5er then..
if a single community pharmacist can give me flu jabs, viagra, anti coag and the morning after pill
What you get up in your private life sounds a wee bit taxing!
The last change would at a stroke enable the NHS budget to be sustainable and would only put NHS staff on the same footing as the majority of the working population.
Hurrah for dragging everyone down to the lowest level, that's just what the country really needs; if private pension provision is crap it needs sorting out. The way to do this is not making people who work for the NHS poorer in their old age.
I don't know what to cut from the NHS: I'd need to know first where the money was being spent. Then you could prioritise. If you can't measure it, you can't manage it.
Though I would put money into the NHS out of my own pocket if they could grab the tories/libdems that are causing the NHS to be sold off and castrate the lot of them, with a big warning to labour what to expect if they carry on in the same vein.
I think health spending as a percentage of GDP is lower in the UK so I'd perhaps stop stupid ego-based wars and reallocate the money. I'd also stop being idiotic in government and try to 'nudge' the population to healthier options, such as tax-breaks for local area gyms, tax high-fat crap, try to minimise smoking (or at least nudge people towards electronic ciggies), that kind of stuff, instead of getting MaccyD's onto the food health forum thing they have.
In fact, just vote me in. The world will be a better place. Don't worry about the gay national service thing, I'm sure it won't affect you. 😀
You could run it all 24 hrs a day, but you'd have to pay people to work at night; more Radiologists, more Surgeons, more Anaesthetists, more nurses, more radiographers, more porters and so on. Then, because they were working at night, they wouldn't be able to work during the day, so we'd need more of everyone to keep it working, and to enable discharges, we'd have to have teams in the community working at all hours, and ambulance crews and so on.
In addition to which, surgery is a relatively small part of the acute workload; the acute medical/paeds/O&G work goes on 24h already, with the required backup. Furthermore, there is good evidence that doing non-life/limb saving surgery between midnight and 0800 is associated with increased morbidity/mortality - the National Confidential Enquiry into Peri-Operative Death which generated this evidence is one of the great achievements of UK medicine.
Andy
AdamW, The uniforms would be the envy of the world though! 😀
I'm with Crankboy, cancel Trident plus,
troops out of Afghanistan, stop poking our noses in other countries' affairs,
stop nhs tourism,
no more ivf,
let people die if they want to,
no more final salary pensions (this is the way most firms are going now)
fewer managers, more nurses/beds/doctors
bring back Matron
get people into good eating/exercising/lifestyle choices
stop immigration. dead. unless it's people we need. like Australia.
Oh, and stop blaming the soon-to-be-elderly. It was all well and good while we baby-boomers were working and paying lots of lovely tax. But no-one thought to save any, did they? No, the politicians didn't even ringfence our NI contributions so they're in deep doo doo over making pension payments. Oh no, and now we're all getting older and would like some pension money and perhaps to be looked after a little bit suddenly we're a burden. How typical of the short-sighted governance we are burdened with. (Said lightheartedly but with a serious undertone).
I'm with Crankboy, cancel Trident plus,
troops out of Afghanistan, stop poking our noses in other countries' affairs,
stop nhs tourism,
no more ivf,
let people die if they want to,
no more final salary pensions (this is the way most firms are going now)
fewer managers, more nurses/beds/doctors
bring back Matron
get people into good eating/exercising/lifestyle choices
stop immigration. dead. unless it's people we need. like Australia.
You need to check you profile settings, you seem to have turned into the daily mail
[i]stop nhs tourism,[/i]
There's not actually that much, and if you're not registered with a GP you will get charged.
no more ivf,
IVF is a tiny weeny cost for a massive amount of joy; leave it alone.
let people die if they want to,
We do, but it's up to you, the people to make your wishes known, and your relatives to be sensible.
no more final salary pensions (this is the way most firms are going now)
As above, don't drag us down because private pension provision has been messed up.
fewer managers, more nurses/beds/doctors
We actually need lots of managers, because otherwise I'd have to do it, which means time out of clinical work. Yes to more Drs and nurses though, but you have to pay for them.
bring back Matron
They've already done that, not that it's made that much difference.
get people into good eating/exercising/lifestyle choices
Oh yes, that's really easy....NOT.
stop immigration. dead. unless it's people we need. like Australia.
Hurrah, it's time to blame the darkies again 🙄
let people die if they want to
Hey, with the Liverpool care pathway, we don't even need to worry whether they want to 8)
Hurrah, it's time to blame the darkies again
You must have worked quite hard to misinterpret my comments as racism, well done.
I'm off to read the Daily Mail - good old Singletrackworld 😆
😆 😆
Hey, with the Liverpool care pathway, we don't even need to worry whether they want to
That shows a complete misunderstanding of what the LCP is (and isn't), and what it's for 🙄
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
🙄
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 salariesUm, 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.
