NHS - safe in Labours hands?
Posted by: Steve G on 07 June 2005
After two full terms in office and throwing loads of cash at the issue I think Labours blaming all the woes of the health service on the tories is wearing a bit thin. Fortunately (and fingers crossed) I and my family haven't had a great deal of cause to use the NHS however recent experiences haven't looked very encouraging.
My wife is a science teacher and yesterday at school she got a small piece of glass from a microscope slide lodged in her thumb. The school told her that as it was glass she'd have to go to the casualty department at hospital to ensure it was all removed ok. So after school at 3pm or so she headed off to hospital to get it looked at. On arriving there the casualty department was posting an average 4 hour wait time and that turned out to be approximately how long she had to wait for 5 minutes with a doctor.
4 hours average wait at casualty on an average day (from what I've heard 4 hours is about the best that can be exected at that particular hospital) - is that normal elsewhere?
After the doctor had seen her she was told to go home, not to eat anything after midnight and to return to the hospital (not casualty this time) at 8am this morning for the glass to be removed. Well it's 11am now and she's sitting in the ward, taking up a bed (for a bit of glass in her thumb!) and they can't tell her when she'll be seen - or even if she'll be seen today (someone mentioned 11pm tonight as a maybe!). Is that a sign of inefficiency, overwork, underfunding, incompetence or that they really couldn't give a shit?
Where on earth is all this extra funding going because from this limited exerience it's not to front line services? We used this same hospital 13 years ago and 9 years ago when my kids were born and it seemed better run and in better condition then than it does now. At that time there were other hospitals with A&E departments servicing our area but now, as part of the labour led Scottish Executives restructing plans, it's the only one.
Posted on: 21 June 2005 by Stephen Bennett
quote:
Originally posted by Steve G:
What kind of fascist state are you hoping for?
*sigh* Such a lazy, inarticulate response.
Rather than falling back on the old cliche, why not try and put forward a coherent argument? Perhaps you think it's OK for the NHS (and thus tax payers) to subsidise the private health sector? I've no idea from your knee-jerk response.
Stephen
Posted on: 21 June 2005 by notMatthew
Bruce said "I suspect very few out there understand how GPs are funded"
I certainly don't and would appreciated an explanation. Since becoming a diabetic and thus hugely more dependent on the NHS I have noticed a certain implicit tension that exists between the Diabetic Clinic at my hospital and my local GP and this is somehow related to funding and NHS politics.
Specfically, the decision to prescribe expensive long term drugs like, in my case, Lantus, seems to be slightly problematic in that the hospital had to establish a clear clinical need over cheaper alternatives and that this was in some way related to the fact that the GP ended up paying for my prescriptions so they couldn't just prescribe what they liked.
I understand the need for clinical justifications of things but my initial period on old style mixed insulin (forget the name) was entirely unpleasant and seemed really about "proving" that I would be better off on Lantus.
Matthew
PS FWIW I am obliged by my employer to have expensive PPP healthcare but as Diabetes is expensive and unprofitable they basically didn't want to know and sent me packing.
Posted on: 21 June 2005 by Derek Wright
Bruce I follow your argument but the issue is the way the NHS is dependant on the whims of politicians - if it was funded independantly of the Government by a seperate insurance premium (and an appropriate reduction in central govt taxation) then resources would be put in place to meet the need and a funding levy imposed to the users to ensure that the resources were available - politics would be removed from the whole process. The Funding organisation would be required to support or rebate people who could not afford the levy.
RockingD
Re isssue of the NHS training the staff - the hospital based training process does obtain work from the various levels of trainees. The only part of the education process that does not involve work is the University element which more and more is funded by the individual with some central govt funding - but that is very similar to all proffesions - shooula all proffesionals be banned for going into private practice - or non state sector just because they have been to a public university or college
Because all hierarchies are pyramid shaped it follows that as people mature that some will not progress witihn the state system - ie no places/funding at a higher level for their skill - so they will want to move into the private sector or move abroad to progress in their career.
Posted on: 21 June 2005 by Bruce Woodhouse
Mathew.
quote:
Bruce said "I suspect very few out there understand how GPs are funded"
I certainly don't and would appreciated an explanation. Since becoming a diabetic and thus hugely more dependent on the NHS I have noticed a certain implicit tension that exists between the Diabetic Clinic at my hospital and my local GP and this is somehow related to funding and NHS politics.
How long have you got? Sadly I've not got long enough-I'm far too busy on my day off! Just for now let me clear up a misconception your post suggests.
Do not confuse two (almost) entirely separate areas of funding. 'We' (primary care) have budgets to purchase drugs/services etc. The management and control of these has a bearing on your Lantus issue.
We (the practice) are also a business, we have NHS income dependent on volume, performance and the services we provide, we also have income from the private sector (such as an writing reports for your mortgage lender). We have costs that we carry such as staff, buildings etc. My pay depends on the balance of profit and loss, I do not have a salary. This model is the traditional one but it applies to a majority still.
The profit of the practice depends to a small degree on hitting performance targets based on principles of good care (Hba1c levels for example). I may chose to spend more on specialist staff in order to hit these targets, gambling that the extra wages I pay are made up by hitting the better score. I might use more expensive drugs, although the PCT may put pressure on me to avoid this because the cost is from their budget.
The key point is that spending from the drugs or hospital services budget is nothing to do with the profit/loss account of my partnership, it comes from a totally different 'pot'.
This sketch contains a variety of simplifications about a horrendously complex subject. It'll have to do for now!
Bruce
PS Derek, I like the sound of a de-politicised NHS. Pigs might levitate.
Posted on: 21 June 2005 by Steve G
quote:
Originally posted by Stephen Bennett:
quote:
Originally posted by Steve G:
What kind of fascist state are you hoping for?
*sigh* Such a lazy, inarticulate response.
It's nowhere near as lazy and inarticulate (in fact downright fucking idiotic) as suggesting staff slavery to the NHS as any kind of solution.
Posted on: 21 June 2005 by Berlin Fritz
Although not diabetic myself, I've taken a daily dose for some 20 years now. The first few years experimenting with various cocktails until the right one came along as such. About four years ago when I changed to a new GP, my first point with her was that I required exactly the same medication as I'd had for years and if she couldn't supply it, then I'd find a Doc who could. The point being as well as afore-mentioned business changes in practices here (same Doc for many Insurance companys, though 80% relate to one: AOK). Drugs were de-regulated in that GPs could find cheaper versions etc, and plug them (first time)´. I was fine for two years, then she tried it on with me, I refused, offered to pay the difference myself (amazing what this shit costs when you see the real bill), and I won the day, fortunately with no problems on a personal level so to speak.
Fritz Von Wake up. he's finished
Posted on: 21 June 2005 by notMatthew
Bruce -- Thanks for the reply. This in part explains why whenever I ask anyone about this subject thier eyes glaze over and they quickly change the subject.
All of which rather leaves me with the gut instinct that a sort of ground zero reform is required and we basically start again. If you can't explain it without an afternoon to spare one assumes by definition it is too complex.
Matthew
PS I note a rash of "GP Weekend Cover in Crisis" style headlines recently as predicted by (I think) yourself and other forum doctors at the time of the last big contract change.
Posted on: 21 June 2005 by Steve G
quote:
Originally posted by notMatthew:
All of which rather leaves me with the gut instinct that a sort of ground zero reform is required and we basically start again.
That's my impression as well. Up here in Scotland there is absolutely no doubt that a lot more cash is getting thrown at the health service but, unfortunately, also absolutely no doubt that the service is getting worse.
Up here there are a couple of health related headline stories today:
a) Grampian Healthboard, currently £11 million in debt, has been told to cut £20 million from next years budget.
b) 5 kidney patients from Orkney have a weekly 500 mile round trip to Aberdeen at a cost of £300 per person (paid for by the NHS), because there are no nurses on Orkney trained to use the dialysis machines.
One 62 year old woman has travelled 26,000 miles for dialysis treatment in the last year. She leaves home every Tuesday and returns home on the Saturday.
Posted on: 21 June 2005 by Stephen Bennett
quote:
Originally posted by Steve G:
It's nowhere near as lazy and inarticulate (in fact downright fucking idiotic) as suggesting staff slavery to the NHS as any kind of solution.
You have such a charming way with words, haven't you? Are you this rude to people you don't agree with in public or is it 'behind the keyboard only' behaviour?
If you'd read my post I'd also suggested another way to overcome the effective subsidy of the private sector.
The easiest way to solve the problem of course would be to get rid of the private sector altogether. Too
socialist for you I assume?
Stephen
Posted on: 21 June 2005 by Steve G
quote:
Originally posted by Stephen Bennett:
The easiest way to solve the problem of course would be to get rid of the private sector altogether. Too socialist for you I assume?
Not too socialist - too
stupid...
Posted on: 21 June 2005 by Steve G
quote:
Originally posted by Stephen Bennett:
You have such a charming way with words, haven't you? Are you this rude to people you don't agree with in public or is it 'behind the keyboard only' behaviour?
An idiotic idea is an idiotic idea - difficult to see what else you could call it, whether behind the keyboard or not.
Are you this stupid in real life, or only on internet forums?
Posted on: 21 June 2005 by Berlin Fritz
Steve Old Chap, You really shouldn't talk to the Chancellor like that, even if he is from that place beginning with G, innit
Posted on: 21 June 2005 by notMatthew
Steve -- I meant start again with respect to the way funding, budgets and financial management work as it has clearly got far too complicated. Origianlly it was a ideological system designed by the Tories to make the NHS work as some sort of psuedo-market and then Labour made it worse by grafting some even more byzantine layer on top.
So on that specific point I would start again but overall my impression of the NHS is that it provides an excellent service and gives good value. That's not to say it can't be better and is not in need of reform but that is surely ture of any reasonably complex organisation let alone one as complex as teh NHS.
And stories like your old lady and her dialysis trips dont actually tell you much. I can tell you stories of, say, a major Scottish retail bank that was lauded for it's management efficiency and generally being well run but somehow managed to buy a warehouse full fo IBM RS/6000s that it never actually got around to taking out of the boxes.
Matthew
Posted on: 21 June 2005 by Steve G
quote:
Originally posted by notMatthew:
I can tell you stories of, say, a major Scottish retail bank that was lauded for it's management efficiency and generally being well run but somehow managed to buy a warehouse full fo IBM RS/6000s that it never actually got around to taking out of the boxes.
I've got similar stories as well, although most of them relate to government or quasi-government bodies.
When I was implementing a system for one of the health-boards up here in Scotland it got close to the end of their budget year. I was asked what I could sell them as they had cash left in their IT budget - we didn't have anything they needed and I wasn't keen to sell them something they didn't need. Unfortunately other companies didn't mind so they ended up with a couple of rooms full of PC's, servers and network equipment. I was involved with them on and off for a few years after that and in all that time none of the kit ever moved from the store-rooms.
Anyway my view is that the NHS needs a really substantial review of it's structure in order to make sure that increased funding really delivers better services. To throw more cash at it in its current state really does not look like a good idea.
BTW another health related announcement up here is for an additional £50 million of funding for a scheme where MRI scans are being outsourced to a private company (doesn't look like Labour share Stephen's views of the private sector). Currently cancer patients can wait up to a year for a diagnostic test and this is supposed to reduce the wait to 18 weeks by the end of 2007.
Posted on: 21 June 2005 by Bruce Woodhouse
I do not know the specifics in the example you mention about scanners but a common scenario is this;
NHS trust has long wait for scans, partly due to lack of radiologist. Scanner sits unused 12hrs per day. Private hospital opens scanner unit. Radiologist from NHS hospital does sessions at private hospital with new scanner.
NHS scan times lengthen due to lack of said radiologist.
The piecemeal 'support' of a system that needs fundamental revision creates these crazy scenarios all the time. Part of the problem is an obsession with throwing resources at specific wait time targets for political expediency without actually planning the system any further than the next annual incentive calculation.
Bruce
Posted on: 21 June 2005 by Berlin Fritz
What's a scanner then ?
Posted on: 21 June 2005 by Bruce Woodhouse
Fritz, if they ever suggest having a scan, decline. Might prove things are not what they should be...
Posted on: 21 June 2005 by Berlin Fritz
Thanks for that sound adwice, where do I send the jack too old Son ?
Fritz Von Scannin & Scannin & scannin an ***
N.B. You don't honestly believe I'd allow the 'results' of one persons 'Scan' to dictate the rest of my life do you ? I'd ensure at least two other professional opinions (face to face) sod the expense, innit
Posted on: 21 June 2005 by Mick P
Rockindoc
You said
" I don't see how you are in any position to judge their motivation to work. I entered the NHS a long time ago and worked for years as a hospital porter and path-lab technician, before training in medicine. I have never seen a private patient or held any paid posts outside the NHS. I work in a deprived part of London, and am happy with my motives.
Then you are very noble indeed.
The two friends of mine who are now working for the NHS, are in it for the money and the indexed linked pension. My attitude is good luck to them but it proves that the NHS is not staffed by angels.
The poeple who really affect patients are consultants and they do very well out of private medicine.
I am not criticising anyone, we all have to make a living, what I am saying is that most people in the medical field are just as mercenary as the rest of us.
Regards
Mick
Posted on: 21 June 2005 by Steve Toy
Shouldn't that last bit read
"...as mercenary as the rest of me."?
Posted on: 21 June 2005 by bigmick
I don't think that even the most ardent NHS fan would assert that it staffed by angels but I fail to see how the motivations of a couple of newly arrived admin guys proves anything about the motivations of highly trained medical professionals like Bruce and Rockingdoc. You and your mates might understandably be mercenary as the lot of a buyer doesn't appear to offer any non-financial reward, but speaking for myself, I wouldn't do any of the work I do if there was no significant satisfaction over and beyond the money.
Most health professionals I know enjoy the work they do and derive satisfaction from healing and helping people. They're all amazingly bright people who,financially,could easily have gained more in other careers but they're made of different, I would say better, stuff,and they've seen that, as rockingdoc rightly inferred, a life based solely on acquisition and consumerism is very empty. Doesn't mean that these people are not business minded or care about balancing the books, but considering the training involved in getting to the front line in medicine and the workload involved in staying there, it would seems like a very curious career route for a mercenary to take.
And yes, could you please not talk as if you are in way representative of the rest of us.
Posted on: 22 June 2005 by Rockingdoc
quote:
Originally posted by Mick Parry:
Rockindoc
You said
" I don't see how you are in any position to judge their motivation to work. I entered the NHS a long time ago and worked for years as a hospital porter and path-lab technician, before training in medicine. I have never seen a private patient or held any paid posts outside the NHS. I work in a deprived part of London, and am happy with my motives.
Then you are very noble indeed.
The two friends of mine who are now working for the NHS, are in it for the money and the indexed linked pension. My attitude is good luck to them but it proves that the NHS is not staffed by angels.
The poeple who really affect patients are consultants and they do very well out of private medicine.
I am not criticising anyone, we all have to make a living, what I am saying is that most people in the medical field are just as mercenary as the rest of us.
Regards
Mick
A very gracious reply, given my ranting, so I won't rise to the bait of your importance/status of consultant vs. GP taunt.
Posted on: 22 June 2005 by Steve G
Why is it still the case that, with a considerable shortage of doctors, there are so few university places available for medical students?
My wife teaches biology at a private school in Edinburgh and the vast majority of the students doing advanced higher biology do so with the intention of entering the medical profession (a lot of them have parents who are doctors). This year, despite straight-A grades the majority of them are struggling to find university places, which seems a real shame.
Posted on: 22 June 2005 by Rockingdoc
quote:
Originally posted by Steve G:
Why is it still the case that, with a considerable shortage of doctors, there are so few university places available for medical students?
My wife teaches biology at a private school in Edinburgh and the vast majority of the students doing advanced higher biology do so with the intention of entering the medical profession (a lot of them have parents who are doctors). This year, despite straight-A grades the majority of them are struggling to find university places, which seems a real shame.
I have some small involvement with the Deanery.Thankfully, we are still able to select on motivation and suitability for the job (usually based on interview) rather than academic achievement alone. This helps to weed out a few of Mr Parry's followers.
I am sure that you are also aware that universities are now having to select from state schools in preference to independent schools for a proportion of their intake (my wife is a teacher too). My daughter has just transfered from the private school she has attended since age 3 years to a state school sixth-form for this very reason. I am no saint, and don't expect my children to be disadvantaged for my principles
Posted on: 22 June 2005 by Steve G
quote:
I am sure that you are also aware that universities are now having to select from state schools in preference to independent schools for a proportion of their intake (my wife is a teacher too). My daughter has just transfered from the private school she has attended since age 3 years to a state school sixth-form for this very reason.
I was aware this case and it's definitely having an impact this year. Most of the kids in this 6th year group are planning to take a year out and apply again next year with the hope that they then won't be seen as coming directly from a private school.
It seems a shame to me that very bright, very highly motivated kids who've worked towards becoming doctors for years can't find places at university at a time when there is a clear shortage of doctors.
