i left the nhs in 2003, even then nurses were quitting on a friday and coming back to the same ward working for an agency on £5 more an hour, whilst the agency was getting a £10-15 an hour cut on top. it was very difficult to budget a ward. nearly 20 years later its snowballed.

the other bad practise i kept seeing was around pensions, one PA’s salary was bumped upto £36k a year to ensure she got a decent 2/3rds pension on retirement. even then the directors were earning big money

a lot of money in the NHS to be made, doctors setup a surgery with a few others, they then cream £200-300k each a year on top of their wages, my local surgery 3 docs on the board. in the limited info i can see, they increased cash £1.1m in the second year of trading.
is it any wonder doctors can retire younger.

its the lower levels HCA/nurses i feel for..
the UK needs a pipeline of future staff strategy

a lot of money in the NHS to be made, doctors setup a surgery with a few others, they then cream £200-300k each a year on top of their wages, my local surgery 3 docs on the board. in the limited info i can see, they increased cash £1.1m in the second year of trading.

That simply isn’t true anymore.
GP’s do not want to be partners, more and more are turning down partnerships and looking for salaried jobs

even then the directors were earning big money

If you want competent skilled people running the NHS then you have to pay the appropriate market rate.

The same flawed argument with charities, I won’t donate to Oxfam as their CEO is paid for than threpence happeny an hour!

As an ‘inside man’, amongst all the challenges facing the NHS I would certainly say the increase in the ‘frail and ageing population’ is one of the biggest, TBH.
Yes, the NHS is massively underfunded, but…
the impact this cohort has is significant – both on health AND social care.
Quite frankly put, they use a LOT of resource whilst nolonger contributing to the tax pot (for the most part).

Now don’t get me wrong, I’m not saying that ‘old people are awful’ AT ALL, but we’re just not set up to manage them well.
We need to be realistic about how and what we offer this cohort – in the same way paediatric patients aren’t just ‘small adults’ in terms of how we look after them, the very elderly and frail aren’t just ‘older adults’.

Care needs are a huge issue, and I agree a LOT of this cohort who are in hospital REALLY shouldn’t be. But where else can they safely go?

DrP

As an ‘inside man’, amongst all the challenges facing the NHS I would certainly say the increase in the ‘frail and ageing population’ is one of the biggest, TBH.
Yes, the NHS is massively underfunded, but…

Two valid points and combined, what you also get is rapidly deteriorating patients who because they can’t be treated quickly, go on to cost far more to treat when they finally get seen.

Loads of issues have been identified.

1. It’s costs loads to treat elderly people, and that’s only going to go up

2, we have more and more elderly people to treat, and that’s only going up and up

3. We spend a huge amount, and it’s still not enough, on both patients and treatment, but also buildings and managing it all.

4. Too many vacancies

5, We use too much private care to both provide services and to pick up the slack

6. Waiting times are getting worse

7 Not joined up with other services like social care.

8. Workload is unsustainable and burn out is getting worse, staff are generally unhappy

9 Too much and not the right sort of Regulation puts pressure on staff to treat important issues as tick box exercises

As DrP says, as a nation we are living longer, but not healthier lives, medicine and science are keeping people alive longer, with a larger cost later in life due to this, with a huge increase in the requirement for community care and social care across the nations.

The problem with healthcare in the UK isn’t a wholly political issue, or just an issue in the UK, it’s a worldwide issue, especially in the western world, we’ve also got the added issue of birthrates falling in places like the UK and Europe, which will mean we face an even bigger crisis in another generations time, with an even larger percentage of ageing population reliant on healthcare, supported by a smaller number of actual workers.

One of the biggest issues i see with the NHS is the same with almost every department, short termism, how do you get politicians and people to sign up to suffering a bit now to make sure it’s better in 10/20/30 years time?

As with a lot of public spending issues, there’s a failure/refusal to invest up front to make savings longer term:

Social care to free up beds
Tackling obesity and other factors to reduce demand
Active travel to reduce congestion and pollution
Children’s services to reduce numbers in care, with knock on with poor life chances
Education to produce a suitably skilled workforce
Social housing to reduce the housing pressures

And we don’t want to increase public spending as we then need to get people to pay for it* (you know the ones that can actually afford it and use it as much as anyone else)

We live in a fairly selfish society where people would rather keep there money that it be used for better social care, healthcare, education. At least until they start to use it or feel the impacts of the poor services

*Obviously having to get people to pay for it is in the confines of the last 50 years of lying about how the economy works

All those people nodding in agreement that it needs more funding probably felt the same when the nettle was finally being grasped on Social care .Now NI has been increased there’s a lot of shouting to get that reversed because of the economy. Same with the Green levy , great idea help save the planet now it’s scrap it and the NI increase .

We live in a fairly selfish society where people would rather keep there money that it be used for better social care, healthcare, education. At least until they start to use it or feel the impacts of the poor services

I think we always look negatively in the society we live in, but it’s not that bad, most people don’t really complain about paying more, the top 1% who pay a good percentage of the taxes tend to not use the NHS, similar with the next level of people who earn a good wage and pay half their wages to tax.

The big fact is what DrP raised, we are an ageing population that are frail and require significant medical attention, we’re also getting more unhealthy as a nation (and planet!), i can nip down a shop and buy 8 bars of chocolate for the same price as a punnet or strawberries, healthy food costs more, even if it’s just less of a portion!

I stand corrected Scotroutes. I was aware that NHS Highland and Highland Council had been cooperating since about 2010 but thought they had decided to revert to the old system a couple of years ago. I’m kind of glad to hear that they have not although as someone who works in social care I have not noticed any improvement. Just my personal view.

Strawberry vs chocolate, not really indicative of the healthy eating choices, more like takeaway vs home cooked from scratch, then the savings become significant.

i can nip down a shop and buy 8 bars of chocolate

Fun fact….If the UK population stopped buying chocolate and donated every penny to the NHS instead, the NHS budget would go up by 13%.

@gordimhor my wife joined the NHS Care service when we moved here 9 years ago. She’d been doing much the same role for the council in West Lothian previously. There are various private providers too but they struggle with staffing (low wage / high housing cost/ lack of labour pool) so the NHS team end up taking up the slack. Talk is now of a National Care Service but that looks some way off.

The NHS pre-op was more comprehensive with C19 PCR rather than LFT (private) and MRSA tests (none in the private pre-op)
My conclusion from that snapshot is that the NHS system is gold-standard medically and private is a more pleasant experience with lower waiting times
I’m not medically qualified to answer this, but is the PCR and MRSA necessary for a day case? It’s staff and lab time that the private system didn’t think necessary

To provide some balance, Mrs Poly had day surgery on health insurance in January. Covid PCR and MRSA were both done as part of the pre-screening. Given the use of separate rooms and higher staffing ratios there could be an argument that the risk of nosocomial infection should be lower in a typical private health setting than on a classic hospital ward.

Strawberry vs chocolate, not really indicative of the healthy eating choices, more like takeaway vs home cooked from scratch, then the savings become significant.

Ah, that was just an example from the last hour for me, nip down to Asda and bought some raspberries and strawberries for the family, it’s getting to be a hard sell to families that fruit is worth the cost over easier to buy and keep sugary foods.

As above as well, fast food is just a way of life now, not just a Saturday treat, how many people cook from scratch, and not sure unless they’re pretty good at it and have the time there are any savings over a 3 quid happy meal or the likes, there’s a reason we see more fast food outlets around, and the likes of uber eats and just eat are getting more business.

Ah, that was just an example from the last hour for me, nip down to Asda and bought some raspberries and strawberries for the family, it’s getting to be a hard sell to families that fruit is worth the cost over easier to buy and keep sugary foods.

As above as well, fast food is just a way of life now, not just a Saturday treat, how many people cook from scratch, and not sure unless they’re pretty good at it and have the time there are any savings over a 3 quid happy meal or the likes, there’s a reason we see more fast food outlets around, and the likes of uber eats and just eat are getting more business.

Exactly – people are wilfully poisoning themselves and their children. It’s no different to smoking. The facts are everywhere constantly.

Anybody who is obese (or a smoker for that matter) should forfeit their right to free NHS treatment. Why should the people who look after their health pay for others to live a life of gluttony? I am very happy for my taxes to fund the NHS but I have no desire to help people who will not help themselves.

I feel the same about folk injuring themselves while playing on bicycles.

whilst no longer contributing to the tax pot

My mum paid income tax on her pensions whilst she was alive and her estate has paid inheritance tax now she’s dead.

My mum paid income tax on her pensions whilst she was alive and her estate has paid inheritance tax now she’s dead.

This is true and you can’t write off what the retired pay entirely but they don’t pay the bit of income tax we like to hive off and give a different name to(national insurance). And a very small number of pensioners have £325K (or £650K if you we the last to die of a couple) left at the end for their estate’s to pay taxation on.

When you add up their incomings and outgoings to the state (income tax going in, state pension and health care going out) most people beyond state pensionable age are a net burden rather than a next contributor). That’s not to say the longevity some of us can look forward to is a bad thing, but it is still a burden on the state that needs accounting for. Once the dust has settled and the last die, looked at as a generational cohort across their entire lives it would be interesting to know if the baby boomers have been fiscal net contributors or a net burden on the nation.

Exactly – people are wilfully poisoning themselves and their children. It’s no different to smoking. The facts are everywhere constantly.

I’d not say they’re wilfully doing anything, we just live in a time where fast food and confectionery is available everywhere and people work longer hours and more shift patterns, it’s not an easy issue to manage, nobody wants to risk their families health n reality.

I feel the same about folk injuring themselves while playing on bicycles.

I sort of understand the point you’re making about choices, but here’s the thing, the cyclist’s overall health will be improved by the exercise making the cyclist less likely to need the NHS and the rarely serious one-off injuries that MTBer’s sustain are not that difficult or expensive for the NHS to repair, even if they involve a bit of physio and a ride in an ambulance.

Eating too much over a sustained period has some very serious side-effects, from all cancers, heart failure, to back pain, to diabetes to asthma etc etc and the long term treatments and management (including eye tests) are time consuming  and expensive from a GP perspective and often poorly understood and managed by patients.

@Scotroutes Very familiar story I work for a third sector provider in Fort William.

Good to see the ‘unsolvable problem’ being tabled again.

From me – the NHS is overstaffed, but staff could be better deployed/re-trained.

There are pros and cons of each model. I don’t like the US model, where everyone pays or is left scrambling.

Free-up-front engenders a care-free attitude so our A+E’s/ambulances are stacked up everyday.

I quite like the French model where the state covers a %, the rest you make up personally (usually from insurance), but there is a baseline of free healthcare for the poorest (means-tested, I think).

There are more general questions around longevity and boundaries of public healthcare and lifestyle choices.

“But ‘inefficient’ is not really a fair argument here.”

Oh but it is!

The same flawed argument with charities, I won’t donate to Oxfam as their CEO is paid for than threpence happeny an hour!

Probably the reason they are still collecting for water projects in Africa.We(the public) have been donating to that cause since the 70’s. 50 years, in which time they’ve likely collected hundreds of millions to provide water, standpipes, wells etc and still the job isnt done.

I’m sure with that amount of income towards that project we could have supplied water infrastructure across the entire continent. So where has it all gone ?.

I work for an mental health trust within the NHS, I left my position in January to focus on the last 6 months of my degree, and picked up bank shifts as and when it suited, my position has “just” been filled, circa 6 months later, we have also had a massive influx of refugee staff in the last 4 months, some of these staff have “very” limited English, and when this is brought up with management, they are seen as a “body on the ward” it would be easier without them there, some of these are apparently trained nurses, trained staff given band 3 healthcare jobs, they do not know what they are doing,

Staffing levels of “shop floor” staff is critical, on any weekday the car park is full of numerous levels of management, come 5pm or a weekend, it’s empty, are all these people needed?

during covid there was a 50% uplift on wages for people picking up bank shifts, but it didn’t really help, that was removed on 31st March, since then staffing has become worse, you turn up for work and staff are being moved around daily to plug gaps on other wards, or you are working short staffed, newly employed staff are allowed on the wards prior to been PMVA trained and on a night shift a couple of weeks ago, there were 2 PMVA trained staff on the unit, which is 3 wards of 15, so circa 45 patients, it’s not if a critical incident happens, it’s simply when at the moment

the cycle riders overall health will be improved by the exercise making the cyclist less likely to need the NHS

It’s possible to stay fit by riding a bicycle without participating in the more “extreme” end of things. How much fitter are those who need some sort of uplift to get to the top of a hill?

And then there’s e-bikes… (just joking, honest)

Poor dietary and other bad health choices are intrinsically linked to poverty. Let’s not demonise everyone who doesn’t fit in with some sort of ideal.

There are pros and cons of each model. I don’t like the US model, where everyone pays or is left scrambling.

It is somewhat controversial, but I worked with a Medi-care based  Insurance Group in the US who had a payment scheme from a state based on time taken for patients to get treatment, the obvious thought being that the sooner patients have their issues addressed then better it is for them, and cheaper the cost is overall to both state and Insurance provider. It was in their interest to make sure that pts were seen and treated v quickly, and the way that happened was a system that could easily be applied in different healthcare settings. The Spanish have some interesting ways of funding healthcare through private companies and they’re doing some interesting work getting hospital outpatient things like audiology and ophthalmology into community settings. The way the Dutch treat mental illness in an entirely separate system to acute and chronic care is interesting   There are lessons from everywhere that  could be applied to the NHS, we shouldn’t be shy from looking at heath-care systems that we otherwise think are a bit rubbish by comparison.

it’s getting to be a hard sell to families that fruit is worth the cost over easier to buy and keep sugary foods.

Live longer and have a better time while doing so? I would have thought that was quite the incentive. Apparently not for some people, but it takes all sorts.

Sadly, all of us will die of something. Most of us now will die in hospital. Avoiding heart disease in your 70s so you can die of cancer in your 80s isnt really helping the NHS at all.

I work in a hospital pathology department. I just learnt today (unsubstantiated as yet) that the guy in charge of a project to merge several pathology departments across our region is being paid £200,000 per year (£50k each from the four trusts involved.)

I think he’s been involved for two years, the project in it’s current form has existed for 6 years and the idea as a whole has been floating around for 10-15 years at least.

The current iteration of the project has cost £20m so far.

They’ve achieved nothing. Literally nothing. Nothing at all has happened so far. Not a jot. Nada.

Twenty mill.

And I work in a laboratory with single glazed windows which don’t close properly, no air con and a leaky roof.

Yes, there are pros and cons of each model – as I said. Some of the big private companies in the USA have developed drugs/treatments/machines the rest of the world could only hope for. It’s the ethos in the USA to me seems to be ‘dog-eat-dog’ where the more resources you have, the better treatment you get. I prefer something more equitable where the strongest help the weakest.

 I prefer something more equitable

Oh without a doubt, this was still US healthcare, so still paying through the nose for treatment if you can afford it. Apart from the pretty good system they had for managing referrals it was shocking if you’ve none (or very basic) insurance

My wife is a GP in a 10 partner practice. She has reduced the number of sessions she works due to the pension trap issue. If she earns any more money, she will be penalised heavily. She would be happy to work more hours but to do so will cost her money (she will have to pay many, many £k’s for crossing threshold). Four other partners in her practice are in the same position. They cannot recruit new GP’s and are all being forced to work less hours than they could.

I was a senior manager in Social Care until Feb this year. I left as there simply isn’t a plan. The system is falling over the edge of a cliff and there isn’t a plan to even begin to fix it. I tried and tried but no-one is ready to embrace any meaningful, unpopular or risky change. I was surrounded by broken carers who were being placed under immense pressure who could then leave to work in retail or hospitality for more money and less pressure. It is a sector with no plan for any sort of turnaround. Instead there is blind hope that things will get better post covid, with better use of technology or new political administrations. That will not save things.

I’ll write a lengthier post when I have time.

They’ve achieved nothing. Literally nothing. Nothing at all has happened so far. Not a jot. Nada.

I used to do a role in the CCG where I was pain vast amounts to literally sit there and attend a few meeting.
I made suggestions, tried hard..nothing changed.

I would look at the CCG way of doing things compared to my ‘doctor brain’ way I’d do things – it jsut flabbergasted me at the daft order you’d do things in…projects simply beig scrapped because they’re NOT actually a good idea (which you could have realised BEFORE starting by asking the right people).

I quit.

Some kid probably wasn’t getting cancer treatment cos they were paying me, and I couldn’t havk that thought.

DrP

lots of poorly paid people in the NHS, and a lot of very well paid ones too

Perhaps they should phase out %age pay rises and make more equitable pay rises weighted towards lower grades. (ie. cost neutral but bigger raises for lower Paid staff and lower rises for those already well paid)

Back rot the charging idea in the original post – my suspicion would be that part of this is about back charging the accommodation fee to local authorities who are responsible for bed blocking?

My 2p and with the Cavet that my Wife is an NHS Nurse.

It’s not Hyperbole, the Tories are killing the NHS, and it started long before Covid. The scale of long-term sick for mental health reasons amongst medics is grossly unreported, as it the number leaving to do something, anything else. A pay rise might help in the short-term, but it won’t in the long-term. In fact, if the current plan the Tories have comes to pass – a 4.5% increase, but coming out of existing budgets, will only make things worse, because they’re not giving them the money from public funds, they’re making trusts pay them from the money they must provide services, which means fewer staff, longer waiting lists and more stress.

Nothing is perfect, certainly not the NHS, or the Labour Party, but the quickest and easiest way to save the NHS is to boot the self-serving greedy Tory **** out of Government as quickly as possible. Whether you believe in tactical voting or not, whether you are a Socialist, a Centrist or you care about the Environment or Scottish / Welsh independence more than any other political issues, if you want the NHS to exist as anything but the safety net for the very poor (if at all) then next time there’s an election, do what you can to get rid of them. We can, and do argue about Politics, and lord knows Labour voters can’t even agree, certainly not on Planet STW, but we have to take off the blinkers and see the real problem.

I believe the UK is staring into the abyss. Too big, too stubborn, and too proud to admit it. Our healthcare system is a ‘bad winter’ away from collapse. Our Legal system doesn’t work, from the Police to the courts, to the prisons. Our economy is on the thinnest of ice, we’re not food or energy secure and we’re in a de facto war with Russia and a Political one with the EU. Every day in Westminster should be a crisis meeting, but instead we’ve got this grotesque pantomime, our Government is currently on Holiday and all our ‘in all but name’ head of state is about to be decided by 200k Swivel eyed loons who’s only similarity to the average British person is they’re human, mostly.

Rather than just expanding and expanding the budgets, the problem could be tackled from the other end, to reduce from the incredible diversity of medicine offered down to core treatments. If you want anything that’s not considered core, then you or insurance pays for it.

I doubt there’d be any senior politician brave enough to suggest it, and I’d not want to be the person drawing the line in the sand of core/not core activity but it is an option that never seems to get considered or discussed.

I think he’s been involved for two years, the project in it’s current form has existed for 6 years and the idea as a whole has been floating around for 10-15 years at least.

The current iteration of the project has cost £20m so far.

They’ve achieved nothing. Literally nothing. Nothing at all has happened so far. Not a jot. Nada.

Twenty mill.

That seems to be basically a summary of every gov department, sadly. I’ve just packed in a role in gov after watching some idiot spaff a million quids worth of resource up a wall until he finally admited there wasn’t any users for it, then promptly walked off to another dept to do literally the identical thing.