NHS, a plea to get inolved.

What's a CCG?

Clinical Commissioning Groups. They hold the healthcare budgets and decide how the money's spent. Not an enviable task! As Bruce has mentioned, the current problems within the NHS are extremely complex and there is no easy solution. Unfortunately, any discussion invariably deteriorates into a political argument and the NHS has had a bellyful of ignorant meddling by politicians.

Strictly speaking they hold the budget (and therefore commission ie purchase, design and plan) for secondary and tertiary care plus urgent/emergency care and prescribing costs but not primary care. The key words are 'local' and 'clinically led' (GP leaders). They were the creation of the controversial 2012/3 Health and Social care act.

https://www.nhscc.org/ccgs/

link above gives a summary. It is of course hugely more complex than that!

They are locally accountable (hence the Tories say 'don't blame us for shutting xyz) and they must consult their local population as well as providers. about priorities and decisions. Our population is 180,00 but we are one of the smallest.

http://www.airedalewharfedalecravenccg.nhs.uk/

Bruce

I'm afraid that all of the noise and static being generated by the current plight is a prelude to "We have no choice but to let the private sector rescue it. If we don't there will be no kind of health service for anyone". Overly simplistic granted, but we get what we deserve.

Helen and I do get involved from time to time in activities which support and sometimes defend our local surgery and services. Even here, politics and ideology and, I'm sorry to say, greed and personal agendas abound. It's demoralising. As an aside,  one of my routes to putting food on the table is to work with CCGs to help them optimise resources. It is evident that we have slid into an era where the savings are no longer seen as big enough. That's the problem. The bigger the crisis gets, the more insoluble it appears. Cue the magic wand that will save us all (and make a relatively small number of people, including a number of serving MPs, very very rich indeed).

It's disgusting how we treat our NHS. We should be so proud of it. A "majority" of us have voted for this mess.  I can't believe so many people are so stupid and short sighted. There must be an appetite to destroy the NHS in the electorate.

Harry

I try to keep Politics out of these debates as it tends to just switch people off and lead to very negative responses. I can assure you the state of Health and Social Care is a result of multiple administrations of every political hue failing to invest in reform or long term planning.

I don't see the privatisation narrative locally at least. If anything private providers are dropping out because there is no money in the system.

We are embarking on radical system reform locally and other places are doing similar things, but we need the population alongside as there are some hard choices now and more ahead.

Bruce

Sincerest best of luck. Healthcare is not an easy issue anywhere. 

I suppose Government could always try easing the financial burden on the NHS at least, perhaps by raising some more funds by increasing NIC's for example.

Oh, wait...

Last thing you need on the front like is politics. Trouble is the NHS is nothing but politics. It shouldn't be. And it always will be. Until we haven't got it any more.

I'm talking with some GP Federations who are hoping to get a slice of the budget. Fundholding anyone?

It just goes round and round. It shouldn't. And it always will. Until we haven't got it any more.

The NHS has to be Britain's greatest institution. Since my accident I have received care of the highest order from really lovely people. I was saying to my neuropsychologist just yesterday how I am amazed how happy all the staff seem despite the huge pressures on them and an ever increasing shortage of resources. Perhaps it's a siege mentality, I don't know. But the positive atmosphere at the hospital is very marked, unlike in local government which seems downtrodden, negative and almost in terminal decline. 

Perhaps if I recover more I'd be able to volunteer in some way: it would be great to repay in a small way all the support I've had. 

Commendable. But you do pay handsomely for your NHS already. Unless you evade tax, which I'm sure you don't. This is a tricky one where emotion should be separated from logic. Emotionally, Helen and I help out now and again. It's not much in return for the dedication and superb professionalism we have received. But logically there is no need. We pay our taxes and lots of them. The system is not so much failing as being allowed to. It should not have to rely on the support of volunteers. We are mugs if we do, yet mean if we don't.  And it's this perception of meanness that's played on.

There are too many people getting sick and injured and now not dying of their ills like they used to. Medical advances, cures and care to prevent people dying and keep them alive longer are expensive.

It seems the NHS also provides substantial levels of care to people who don't need NHS care specifically, yet they still provide it. This is also expensive.

The NHS is staffed by people who naturally expect to be recompensed in wages, pensions etc. and expect these to increase through the years through career progression. This is hugely expensive.

The Government of the day tests the water by raising NI costs very slightly for a small number of people and get slated for it, to the extent they cancel the plans. And get slated for that too.

So costs vs NICs just don't add up and they can't raise NICs. What to do? Spend the money more wisely? Who decides how? Cut some services to benefit others? Keep everything in house or sub contract? Allow some hospitals to perform better, because they are better and just acknowledge you cannot have all care being equal all of the time? Who knows?

As noted above, there is no perfect solution, especially not an apolitical one. At least no palletable ones. I'm certain if the budget were doubled, it still wouldn't be enough. So while some may feel Bruce's post shouldn't be needed, we are all in this together so why not help out? Now where did I leave my forceps..?

This is slanting towards the pharmacoeconomic view point. Increasingly popular in the 80s/90s, in regression past the turn of the century. Now gaining ground again. It all sounds very logical and in context has a voice. The danger is when it is the leading voice. This is an issue with anything political, and like it or not this is politics more than treating the sick. A balance seldom exists for long if at all. We always seem to swing too far one way or another.  A sprinkling of pharmacoeconomics can sometimes pull a big picture into focus. Too much of it and people emerge who think it's better to let people die because it costs less. I wish I had just made that up. These people exist. Some of them work in the DoH/NHS.

Tricky.

Fwiw maybe they should cull it, let people get ill and die a bit more, everyone will realise that NHS mk ii is required and we can try again, necessity is the whstnot of the thing and all that.

Hard to change and adapt things sometimes, can be easier just to bulldoze it and start again.

I think that particularly I want people to contribute to local debates about what they want their NHS services to cover-and what not. This is explicitly rationing, although politicians shrink from the word. We can all debate the Politics but I'm keen people engage at grassroots away from the ideological issues. .

For example we have forums debating various services with patient groups. Our experience is they know that things are not free and that if we do more of one thing we have to take other things out of the pot. For example we offer just one cycle of IVF treatment not the nationally recommended 2 cycles. Some areas offer none. We are going to stop or restrict a number of procedures that are both expensive and lack an evidence base. This will be contentious. We closed a stroke unit in one hospital to fund a better one in another. In all this we tried to engage local opinion.

We have invested in preventative services that may not pay back for years yet we are under huge pressure to change services to deliver results now (less people in casualty or in hospital). How do we manage the demands for both types of ideas when money is tight? These things are being decided at very local levels.

Patients (ie all of us) need to contribute to these dilemmas that CCGs are battling with daily. Despite all our efforts to get people engaged with advertising, social media and the like our AGM was attended by less than 30 people and public meetings are often in single figures.

Everyone says how much they love the NHS. Well get your voice heard.

Bruce

Well, I have discovered that the next governing body meeting of the South Eastern Hampshire CCG is on 26 April. It would be interesting to go along, at least once. 

My Partner is a Sister having worked in Neurology and Endoscopy for the past 10 years or so and knowing first hand what pressure our health service is under and how hard the Nurses, Health Care Assistants, Cleaners and Doctors all work it always makes me both sad and angry when I read and hear politicians using our NHS as a point scoring opportunity.  Therefore it is so nice to hear such positive comments regarding peoples personal experiences, as we all get a little older and our interactions with health service professionals become more frequent it is important to let them all know what a fantastic job they are all doing because as my partner always says it can make an extremely hard job a little easier when you hear it.

We do. And sadly over the past few years we have increasingly had occasion to. We will always have gratitude and good will. If only good will paid for services.

Having much of my family and Mrs SinS as active practitioners within the NHS, all I can say is I feel  it it is too politically controlled and therefore regrettably doomed in its current form . It was conceived politically and that was its greatest strength and now its greatest weakness. It's crying out for out for  real structural reform and change to meet the challenges of now as opposed to the 1940s, and unfortunately such desperately  needed reform becomes polarised into an appalling political toxic  mire of private enterprise vs state control. Our NHS needs rto rise above these 20th century doctrines or it will continue to regress. Let's look at other services in the world and learn from them.. let's leave the tokenism and politics outside the door and let our NHS evolve...