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: 22 June 2005 by Stephen Bennett
To be fair, it does take a long time to get new medical schools up and running. My local university is now a medical teaching school and it took almost 6 years from financing to final opening. And it was filled with students right away. The new Pahrmacy school also took several years to establish.It's only since 1997 we've had this investment, so it's still eary days.

Hopefully, the situation should get improve as more schools come on stream.

Regards

Stephen
Posted on: 22 June 2005 by Berlin Fritz
What's a pahrmacy school John, a group of fish ? Cool


Fritz Von Get that prescription right & legibubble innit:
Posted on: 22 June 2005 by Stephen Bennett
quote:
Originally posted by Berlin Fritz:
What's a pahrmacy school John, a group of fish ? Cool



They've had to lower their entrance requirements.

Winker
Stephen
Posted on: 22 June 2005 by Berlin Fritz
Eary Nose & Throat Days I reckon Doc ? Big Grin
Posted on: 24 June 2005 by Steve G
Not only are there an inadequate number of places for student doctors there is also news today that the Scottish Executive has slashed the number of nursing student places for next year from just under 4000 to 3500, despite the highest number of unfilled nursing vacancies for years.
Posted on: 24 June 2005 by Berlin Fritz
Shocked & Stunned Confused
Posted on: 24 June 2005 by Berlin Fritz
On a rather more serious note, I was flabbergasted earlier to see a TV report of the occurances of the deadly brain disease killer in children 'Meningitis' in UK over the last 3 years at being something in the region of 600. Although I wouldn't in anyway attribute these figures in any way to the NHS, I was really under the impression that this horrible killer was actually virtually a thing of the past, and happened very rarely ?

Fritz Von Speechless for once Confused
Posted on: 24 June 2005 by Bruce Woodhouse
Sadly not a thing of the past.

Vaccination has helped though (along with prompt detection, better treatment etc etc). Meningitis c and Hib vaccines have chipped away at the total, meningitis B vaccine is in devlopment.

Some data
Posted on: 24 June 2005 by Bruce Woodhouse
...and another. (Wish i knew how to get these inserted as images instead of links....)
Posted on: 24 June 2005 by Berlin Fritz
It certainly does seem to have been reduced somewhat at least (isn't it highly contageous if I recall correctly ?).
Posted on: 24 June 2005 by Berlin Fritz
Posted on: 24 June 2005 by Berlin Fritz


Go into that little picture icon second on the right, paste code in, ok, then post it and hope it works, as I just did, innit !!!


Fritz Von It suprised me actually Big Grin
Posted on: 28 June 2005 by Steve G
The view that doctors are only in it for the money won't be helped by a report from the Scottish NHS today. It's about the cost of out-of-hours coverage by GP's. Now that out of hours support is no longer a compulsory part of their job almost all GP's have opted out of providing out of hours care. The NHS boards have then to buy back the GP's services for evenings and weekends.

Pay rates are particularly high in rural areas where GPs are in short supply.

One GP in Dumfries and Galloway earned £6,000 for one week's out-of-hours work over Christmas.

Even during a typical week, one GP in Argyll and Clyde is earning an average of nearly £2,000.
Posted on: 28 June 2005 by Bruce Woodhouse
Curious logic in that post. Pay rates are high (although not if you think of it as an hourly professional rate I'd argue), but doctors prepared to do the work are in short supply.

Basically you cannot pay the majority enough to want to do the work out of hours on top of the normal committment. In the market thus created pay rates have had to be set at a level where they can get someone (anyone) to do the work.

You might also bear in mind that doctors pay was docked a large sum per annum when the OOH responsibility was removed. Working sessions might replace this (and if you do plenty you'll make a profit on the deal), but most have taken a financial hit with the new rules because they do not do sessions. In other words most are deciding to opt out and lose money, perhaps in contradiction to your assertions about motivation.

Bruce
Posted on: 28 June 2005 by Steve G
Bruce - while I accept that a fair wage should be paid for those providing the service I think there is something wrong with a system that allows a doctor to be paid an extra £6000 for a weeks on-call, or another doctor to be paid an additional £100,000 for his on-call duties for a year.
Posted on: 28 June 2005 by Berlin Fritz
One for the arbitrator Parry I tally ! Big Grin
Posted on: 28 June 2005 by Bruce Woodhouse
I get your point but docs doing exclusively OOH contracts and earning sums up to £100k a a year are not also working as a GP, they will be salaried docs doing this and only this. It will not be additional to their other work. You might ask yourself if such doctors are the ideal people to provide GP OOH services of course. You might also ask how much someone should be paid for permamnent full time nights!


I do think their are issues of overwork here though, some greedy docs will be doing lots of extra sessions as well as full time work, and perhaps should be more responsible about their own health/fatigue etc. In rural areas where many have dropped out some may simply feel responsible because 'somebody has to provide the cover'. the new contract does not address this.

The govt is very happy to persuade people that the growing grumbles about OOH quality/costs etc are due to GPs. Well frankly guys, you basically imposed the new contract, the problem belongs to PCT's now, not us. Watch this space over the winter.

Bruce
Posted on: 28 June 2005 by Berlin Fritz
That sems to have about summed up what I've read to date on the matter too Bruce.



Fritz Von Self-Medicating Roll Eyes


P.S. Mind you considering they're still only practicing it does seem an awfully lot of dosh, though it's those bloody MP's Surgery's that really get me worried, innit Cool
Posted on: 28 June 2005 by Steve G
quote:
Originally posted by Bruce Woodhouse:
I get your point but docs doing exclusively OOH contracts and earning sums up to £100k a a year are not also working as a GP, they will be salaried docs doing this and only this.


Both the £6K week doc and the out-of-hours £100K doc in the report are GP's and the earnings (and workload) would be on top of their usual stuff.

quote:
The govt is very happy to persuade people that the growing grumbles about OOH quality/costs etc are due to GPs. Well frankly guys, you basically imposed the new contract, the problem belongs to PCT's now, not us. Watch this space over the winter.


The government definitely fucked up over contracts to doctors because apparently, in Scotland at least, virtually all the increased NHS spending is going direcrly into the pockets of doctors - allegedly for providing a lesser service as well.
Posted on: 28 June 2005 by Bruce Woodhouse
quote:
virtually all the increased NHS spending is going direcrly into the pockets of doctors - allegedly for providing a lesser service as well.


That is unsubstantiated, vague and I think wrong. Which docs, what peformance? I think Primary Care can point to better standards of care-beyond simplistic access times. The new contract has raised GP incomes a bit more than infaltion, although it is early days yet, and the picture is pretty variable. Some Consultants have definitely benefitted from waiting list initiatives. Doctors in training, at all levels, have had no change beyond the agreed payscale uplift.

Rather a lot of the money in hospitals locally has gone into the pockets of managers. Rather a lot of the money in Primary Care has gone into the pockets of nurses who are doing more sophisticated work.

I'm not sure about the Scottish situation being very different.

I think you are swallowing the government spin rather wholeheartedly. When the NHS is good, the Govt will claim the credit. When it groans it will blame the employees.

Bruce
Posted on: 28 June 2005 by Steve G
quote:
Originally posted by Bruce Woodhouse:
I think you are swallowing the government spin rather wholeheartedly.


What government spin am I buying? The Scottish Exec says that waiting times are down, A&E service is better, the SNHS is providing value for money, the SNHS is providing a better service since Labour came into power - I don't buy any of that because I've seen the figures and they say that as taxpayers we're paying a lot more for a substantially reduced service.
Posted on: 28 June 2005 by Bruce Woodhouse
My point is the same in a way, I'd watch out for most of the figures produced to 'spin' lower wait times etc etc. Many are manipulated at both hospital and Govt level. As ever I note you are concentrating on hospital provision too.

Judging if the SNHS is 'better' or not is frankly nigh on impossible, not least because the demands placed upon it and the nature of treatments available change all the time. You'll note i'm not saying it is better or worse, just that using a few crude target stats is almost totally useless.

The bit I'm challenging is your assertion that the docs in the system have been the main beneficiaries of the increased funding. I wonder if the costs of medical staffing overall have risen because they are actually addressing manpower issue rather than gilding the pockets of the few as I think you suggest? The NHS copes with far fewer docs per capita than almost every developed nation if I recall correctly.

Incidentally my wife is a hospital specialist so I have some insight into the flow of funds in hospitals!
Posted on: 28 June 2005 by Steve G
Some quotes from the article:

One midwife, who wished to remain anonymous, told BBC Scotland: "A GP doing a night a week on call will earn £25,000 a year, that is more than a lot of health care professionals will earn full-time plus the on-call during a year.

"I think there should be more effort to put this into the public domain, but the problem is it is too late, everything is signed and sealed, it is history."

Nearly all mainland Scottish doctors have chosen not to provide out-of-hours care, and now health boards are having to buy back their services at evenings and weekends.

Andrew Walker, a health economist at Glasgow University, said: "I think GPs are starting to look like the footballers of the health service.

"We hear about footballers earning hundreds of thousands of pounds a week. The GPs are not quite at that level but certainly to ordinary people, the sums will sound very high."

"Earlier this year, a survey of 10% of GPs suggested that their earnings had risen from an average £85,000 to nearly £100,000. "
Posted on: 28 June 2005 by Bruce Woodhouse
The new contract was signed off and driven by central government, it placed OOH care in the hands of the PCT. It pulled back funds from primary care to do this.

It clearly had little or no idea that when they did this most GPs would vote with their feet and say 'I'm not doing OOH at any price'. Despite brave talk of nurse triage, paramedic assessment etc etc the truth is that OOH needs doctors to cover. The PCTs now are having to pay typically around £60-80 hour to get OOH cover done by anyone, any less and the system collapses totally.

Whose fault is that? I agree it is a mess, but not one driven primarily by greedy docs.

Does £80/hour for providing urgent medical coverin unsocial hours (in our locality that means covering approx 70,000 widely dispersed patients) sound expensive? Is it only me that thinks not?

I'm still waiting for an explanation that all these mythical docs have soaked up all the new NHS money. The reason that GP incomes have risen is partly because having been set clinical targets for good care and disease management (like diabetes control, smoking rates etc etc) in the new contract they actually hit them in far more cases than was expected when the budgets were set. Delivering quality-and being paid for it.

Bruce
Posted on: 28 June 2005 by Berlin Fritz
I recently had the pleasure of spending (20 minutes) with a lawyer for consultation. This little chat cost me €180 x 3 = € 540 an hour, I'd could start studying law myself for less.


Fritz Von I think £80 an hour (When taken into CONTEXT) is quite cheap at the price Big Grin