I think what farmer john has done is added the worst case possible scenario for future pension deficits over the next 50 years and added it to this years budget. I am also interested in the 31 billion the NHS spends onother things according to him that does not appear in the budgets for it.

Nicely put Stoatsbrother. Somewhat of a change in your position

The thing is new empires are being built up, by management, look at all the new signs that own the new departments/units,then there are the trusts,and care providors, thats without looking at PFI, and such stuff as the new integrated health centres for GP,s.

….and if any one wants to bring this back to the patient (?), the US comes out particularly badly – high cost of health care and low life expectancy etc…

Sorry FJ – but dont think you’re correct there. But before we sit on our laurels and argue that no reform is necessary, the OECD points out:

There is room in all countries surveyed to improve the effectiveness of their health care spending. On average across the OECD, life expectancy at birth could be raised by more than two years, while holding health care spending steady, if all countries were to become as efficient as the best performers.

THM, what do you want instead?

Last thread on this crikey he wanted a service with the patient at the centre driven by patient choice.

How much choice are your patients capable of making crikey?

Not much TJ, it has to be said.

What’s most interesting is the panic apparent when people are in need of critical care abroad. Paid for by insurance companies, it turns out that it is cheaper to fly a jet from Germany to England, keep said jet sitting on an English runway, then fly to Thailand, fly back again, deliver patient, then fly back to Germany, rather than pay for a week in Intensive Care in Thailand.

Who’d a thought it?

Crikey – a debate based on facts and, as the OECD says, a system that is managed better for the benefit of patients. Radical stuff?

BBC1 now. Shocking. Health is a choice! Fookin norah.

What system do you want instead?

Simple question. See if you can answer it without weaselling like Professor weasel from weasel university.

Don’t hold your breath waiting for an answer crikey.

Crikey – very simple really…(and to repeat)…one that is managed better for the benefit of patients. This is not weasingly, it is merely a different perspective with different terms of reference.

Like most aspects of economics/politics/businesses the “system” is massively over-stated as the reason or cause of both good/bad performance. Worse than that it obscures the real issues – but when has that ever stopped the headline makers? Its comes down to the people involved. Too much debate comes down to polarised views, so yes I will counter the argument that central planning is the only solution, not because the opposite extreme is necessarily better (although always happy to smile when other put those words into my mouth) but because that is not supported by the facts. Simple. Hence perhaps the most interesting part of the health care analysis for me is:

There is no health care system that performs systematically better in delivering cost-effective
health care. In fact, the efficiency estimates vary more within country groups sharing similar
institutional characteristics than between groups.

Comes down to having good people in the right jobs. Basic business/common sense.

And FWIW, as I have said before the current reforms are unlikely to achieve this.

Missed TJ’s barb in posting – you can breath out now 😉

So what system do you want? Its a simple question.

so yes I will counter the argument that central planning is the only solution,

Please do. I would be interested to hear it. So far all you keep doing is repeating platitudes that you don’t understand.

for instance the entire philosophical basis for dementia care is “patient centred”

So what do you want?

Most of these debates end up the same way; care is at the centre, people tend to argue about how to fund it, either through taxation or by insurance.

What do you actually want that is different?

See if you can be succinct, brief, perhaps get to the point?

Myself and my partner were in hospital for 5 days last week giving birth, and post natal care to our daughter. The care was extraordinary – the mid wife never left my partners side except to use the loo, she refused to even go eat in case something happened. In the end my partner had a c-section which went extremely smoothly with great communication and care by all the staff.

I for one am extremely proud of our NHS, sure it has it’s problems – but our we should support our doctors, nurses and midwives, and be proud of what we have access to!

told you not to hold your breath crikey. 🙂

Give the geezer a break TJ, he’s obviously putting a lot of effort into his reply. Stuff like that takes time. I know crikey said “See if you can be succinct, brief, perhaps get to the point?” but teamhurtmore likes to be thorough.

I’m getting quite excited – I hope he’s not too long.

One is tempted to assume that, like apocryphal warriors of old, they don’t like it up ’em.

Which is a shame, because the debate is not black and white, not NHS or not, not private vs public, its about finding out what the best way is, hopefully in an apolitical way.

Healthcare for a population is more important than politics.

So what system do you want?

I can honestly say that the vast majority of the public want the NHS left alone
it fairly obvious with the coverage that the bill is getting- very few folk want it so just **** off and leave it alone

Healthcare for a population is more important than politics.

And yet healthcare is always a highly political issue – always has been.
Here, in the US, ……. all over the world – everywhere.

It is, and of course we know it is. But…

We can argue forever about it, most far better than I can, thm is a case in point, as is ernie, but the outcome is more important than the argument, much, much more important.

The only bit of tory policy I liked seems to have been forgotten. to take control out of the hands of politicians and to set up an independent board to run the NHS.

TJ my view hasn’t really changed. I think there could be some very good changes made to the NHS, and the private sector has a role to play. Not everything which involves it is bad. And there are GPs who have been involved in this stuff for 20 years now. I think your previously expressed views are a bit too polarised.

But the way it is currently being configured is doomed to fail. From a pragmatic point of view it sucks.

jota180 – Member

So what system do you want?

I can honestly say that the vast majority of the public want the NHS left alone
it fairly obvious with the coverage that the bill is getting- very few folk want it so just **** off and leave it alone
People are generally resistant to change anway but that doesn’t mean they don’t want better healthcare.
Not a supporter of the bill or the Tories for that matter but having been on the wrong end of “our envy of the world/fantastic NHS” I want,in fact, demand better healthcare.Anecdotal stories are only part of the evidence but I can assure you that if you had experienced some of the appalling “care” first hand that the NHS dished out your views would be influenced by that.IME the poor care was nothing to do with lack of funding but systemic failures and the whole complaint process was farcical.We eventually got an apology but by then my father was dead…..

and that is a very fair comment.

One becomes rather unpopular by complaining about poor service patients get. About to do the same with a department which is letting my patients down. There is some real complacency. 🙁

TandemJeremy – Member

The only bit of tory policy I liked seems to have been forgotten. to take control out of the hands of politicians and to set up an independent board to run the NHS.

To an extent I agree but would a board set up to run the NHS ever advocate it’s dismantling even if it was in the best interest of the patients?
There are many areas of public policy which should stop becoming political footballs-pensions ,care,education even defence where more or less everyone agrees on what the outcomes should be for the benefit of the nation. It’s the delivery and cost question that keeps it political.

As front line staff, I am intimately aware of these kind of problems, more than I would ever wish on anyone… Nut… these kind of problems are not a function of the NHS, they are a function of any healthcare organisation, anywhere.

This kind of points out the issue I was alluding to; healthcare at the point of delivery, at the bedside, at the operating table, at the GPs desk is the same, however it is organised…

We can argue forever about it………. but the outcome is more important than the argument, much, much more important.

I agree, I would say the same thing also concerning the economy, and most other things for that matter. We don’t however live in that sort of society – every issue is treated as a political football. It’s all down to vested interests – on all sides. If you want everyone to sing from the same hymn sheet you’re going to need a very different sort of society. That’s not going to happen any time soon…..so just carry on.

nick – while its obviously wrong to get poor care I really doubt it would have been any better dealing with shortcomings from the private sector – more likely worse. People with a financial interest in protecting their reputation are not good at disclosing fault

I am a strong believer in no fault incident investigations so full disclosure is made allowing lessons to be learnt.

there was an avoidable death in Lothian which has resulted in a complete overhaul of ways of working across the entire area. something that could not have been done had we had a foundation hospitals and the fragmented system the tories want to impose in England

…and just to try to even up the balance, I and many of my colleagues have sat with the relatives of our patients and helped them, even insisted that they complain about treatment that patients have received. Poor treatment is poor treatment, and we will call it so whenever we see it.

the nhs is being wrecked. not by dave and his mates but by the tens of thousands of incompetants, shirkers and pocket liners it employs. many are genuine caring professional talented people but alas an increasing number fall easily into my first description.

i ve had strokes heart attacks heart surgery so have reason to be grateful for the second group but no tinkering from dave and herr clegg will threaten them nor regrettably the former group.

the physio who insists i have a twisted muscle in my shoulder that i should self treat with heat and ibuprofen ( which could simply kill me) without even touching me and in the first two sesssions of physiotherapy has yet to touch me other than to hand me pre printed sheets of excercises ( unlike the private consultant and two physios who are actively and physically treating the trapped nerve revealed by x rays and touching my back..

the trust management team who may lose thier ‘roles’ in any new proposal who are now spending 1 day a week networking to agree / position thier new roles in a future reorganisation and a second day each week preparing another trust for the same reorganisation..

the nurse who would nt remove the drain from my chest when asked by three doctors to do so and left at the end of her shift asking a student to do it ( i was her only patient in an hdu)..

the consultant who diagnosed my stomach condition without speaking to me or doing any investigations as he was too busy to see me..

the a and e doctor who when handed a letter from a prof. of genetics with clear instruction on how to react when presented with my daughter who decided to ignore our pleading and the instructions so that contary to the instructions he could run some tests which would lead to her death.. until my wife removed the daughter from him and contacted the prof. who had to scream down the phone at the dr to get him to do as it said in the letter..

the 12 nursing staff who ignored the plight of a blind deaf man in considerableain for 12 hours as other patients asked them to care for him and finally the priest had to feed and change the chap.

the nurses who paraded and made fun of a now senile famous former MP in his soiled underwear..

the nurses who made fun of a former tv star of the seventies who could no longer care for himself

angels there are some and i owe my life and eternal gratitute to several.. shamefully there are many who are not.

Sorry to hear that totallshell -there is no excuse really .

London / south east?

This is not an NHS problem, this is a people problem, and you should complain and make it stick. I see a number of ‘it should have been different’ cases, and I ask and push for each and every one to be looked at.

It’s not professionalism, its not any kind of high minded stuff, its because I’ll be there one day, and I don’t want to be treated like that.

nick1962 – Member

I can assure you that if you had experienced some of the appalling “care” first hand that the NHS dished out your views would be influenced by that.

So sure of that? Without going into too much detail, the NHS totally fumbled treatment of a condition of mine and the result will leave me in pain every day for the rest of my life (managable pain, most of the time). But it was a situation that could have occurred just the same under private care, right, mistakes happen? Except, except, I’m diabetic on insulin and I couldn’t afford health insurance under the US model. So in all likelihood I’d actually be much worse.

Only an idiot says the NHS is perfect, or couldn’t be improved, or couldn’t be more efficient- nothing is perfect. But on balance it provides mostly decent care, for a hell of a lot of people.

That’s a rather long post totalshell, which according to you, isn’t relevant to the issue : “no tinkering from dave and herr clegg will threaten them nor regrettably the former group“

Since you don’t think that the Health and Social Care Bill will deal with the issues you’ve highlighted, why mentioned them – just fancied have a dig at the NHS/medical professions and thought this would be a good opportunity ?

And, I’m going to risk the big ban hammer now, if you know of a way to make things better, for **** sake, say so. It’s OUR healthcare system, let’s make it as good as we can?

totalshell
Sadly there are too many similar tales. 🙁
TJ

I am a strong believer in no fault incident investigations so full disclosure is made allowing lessons to be learnt.

+1

People with a financial interest in protecting their reputation are not good at disclosing fault

Isn’t that still the case in the NHS though,professional reputations,jobs/pensions all at risk if fault is found?
Do NHS trusts not try and defend their reputation as much as BUPA or whoever would?
An independent complaints system outside of the NHS or relevant private healthcare provider could mange this surely?

Northwind

Only an idiot says the NHS is perfect,

And only an idiot would advocate us adopting the American system of healthcare 🙂

Want the TJ prescription?

1) remove all vestiges of foundation hospitals, internal market, fundholding and so on. Been done up here and immediate and obvious improvement as it meant rational planning could be done and information shared.

2) a moratorium any further restructuring for 5 years at least bar getting democratic accountability at regional level returned and an independent board to run the NHS

3) strengthen NICE, have a rational debate about rationing.

4) Be prepared to use more and better quality management

5) share best practice and use meaningful quality indicators to pinpoint poor practice

6)Make care of the elderly nursing a speciality in its own right and work to increase kudos and give a higher priority to the sector. Remove dementia care from mental health services

7) no fault incident investigations

Longer term integrate health and social care – the interface is rubbish and leads to a lot of issues.

Look to other countries and compare and see where we perform less well and look to why

Overhaul training of healthcare staff – a common foundation year for all perhpas.

TJ

Do we get the English to pay for your prescription? 😉

An independent complaints system outside of the NHS or relevant private healthcare provider could mange this surely?

No – It has to be “no fault” otherwise you do not get full disclosure People being scared of being blamed leads to over up. worse in the private sector but happens all over.

This is the recent case in Edinburgh where a woman died. One thing that is apparent is there was no one fatal mistake – indeed a lot of mistakes occurred over a long period of time from the nurse who asked for training and did not receive it to the doctors rota that meant no one with specific knowledge was on duty to a series of errors and omissions during her care. However several people gave incomplete evidence or attempted to shield themselves from blame which makes it harder to see what went wrong

This case has meant major changes to the way things are done and every member of care staff medical and nursing has been retrained and tested on assessing unwell patients and a system for reacting to incidents of this nature is displayed everywhere. SEWS and SEBAR. Displayed by every phone

I have no doubt at all that the changes in care could not have been made as eaily under a system of competing hospitals and fragmented care – this involved 3 major hospitals in two different towns and a significant number of subsidiary units. All ahd to co opertate to make the changes
http://www.scotcourts.gov.uk/opinions/wightman.html