NHS cuts – you're in charge – what services do you get rid of?

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?

Does this mean you’re saying my idea doesn’t/shouldn’t create effectively longer waiting lists?

Great to hear from people with partners or experience in the NHS and some excellent informed opinions.

I would:

– Figure a way to get out of all poor value PFI deals/services.
– Create centres of excellence as opposed to several trusts in neighbouring areas providing similar services. Studies have shown that this works better when based on patient outcomes. E.g: Paediatric heart surgery.
– Get rid of the current IT contracts and use someone with actual technical experience delivering a similar product to evaluate what’s required and put it out to tender. They’re getting rinsed by the private sector for a poor product at the moment.

DrP

If I came along with my car to your car wash emporium would you wash it or ask me to go away, see if it gets cleaner during the next two weeks and, if it doesn’t then come back to see you again 😉

When you are dealing with the same patients then it must be a conflict of interests. If you had the same patient on your waiting list on the NHS then how can it be ethical to see them privately for a fee which you benefit from.

NHS only available to people born in the UK!

If I came along with my car to your car wash emporium would you wash it or ask me to go away, see if it gets cleaner during the next two weeks and, if it doesn’t then come back to see you again

Depends doesn’t it.
If my fee was to come from a centralised pot, Realistically I would discuss with you that it’s nice to have a clean car, but not necessary. I would maybe explain that your elderly neighbour needs her fuel pump fixed, so in terms of prioritising my time and skill, it’s better to do that so she can drive her car again, as she needs it to socialise. I could put in place a system where we discuss ways that you could keep your car clean in the first place, so we don’t have to rely on washing it so often.

However, if you explained you really wanted me to clean your car, and you were willing to pay yourself, then i could clean it for you. i would still explain it’s not 100% necessary, though agree it looks nicer to have a clean car…..

DrP

EDIT: If I were a rather scrupulous group of ‘practitioners’, I would insist to you that despite looking clean after the initial job, you need to return every 2 weeks for a ‘top up’ clean, that despite there being no need for such an affair, I was still willing to charge you….

@DrP – but surely a very long working day with another job on top would have a detrimental effect upon performance.

..yet ‘the general public’ want us to cover out of hours 24/7….

You can’t win can you.. 🙄

DrP

Dr P

can you explain what happens when private care goes tits up please.

what happens when private care goes tits up

You get transferred to an NHS hospital/into the care of the NHS and your care continues.

That doctor in Hollyoaks seems to be able to manage a nightclub in his spare time well enough. But then again he is a bit of a psycho.

Sorry drac, but some ambulance services could do with some better management

No shit Sherlock.

As for comparing NHS to a Supermarket and the NHS can’t run anything 24Hrs. Really was that a serious post?

Anyway time for Star Trek b

Charge people for missed appointments to avoid cuts?

I missed a 11am apointment . Totally my fault . Offered to wait the rest of the day incase someoen else didnt turn up /was late. Was told not to bother .

I would not employ convicted armed robbers on £200k a year to ‘manage’ a £12m budget .

I would follow up verses idea of a top up scheme where , if you are financially able to pay to go private you can.

I would employ a team of people to go through every invoice with a rather fine toothecomb to see if anybody is charging £8 for a plaster , £9 for a bandage . And those people would be paid a living salary ,plus bonuses on any savings made.

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

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

Sorry drac, but some ambulance services could do with some better management Just some?

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.

Not 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:

http://www.thebureauinvestigates.com/2011/07/03/revealed-the-gp-property-scheme-that-costs-the-nhs-more-than-600m-a-year/

– 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

stop nhs tourism,
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 🙄