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View Full Version : The NHS - value for money?


Biggles Flies Undone
23rd May 2005, 13:40
I’m not noted for starting serious threads on JB, but today’s experience has left me fuming.

Background: got tripped up when ice skating a few years ago and jarred my back. Symptoms were muscular pains in both upper arms. A chiropractor sorted it out in about 5 sessions. The prob has recently returned firstly with my arms, then neck and finally three days with a severe pain in my shoulder/sternum.

I get a bit of cover under my PHI for ‘alternative therapy’ (chiropractor) but I need a referral, so I saw my GP this morning. He made me describe every symptom and then told me (in almost as many words) that the spine wasn’t designed to take vertical loads, that you have to put up with pain as you get older and that doctors are there to sort out illnesses, not aches. When I finally got a word in and said that I just wanted a referral to use my PHI his whole attitude changed – of course he would be happy to refer me, but there would, of course, be a charge for filling in the form. All of a sudden I had moved from being a cost to a profit for his practice.

My dentist, along with virtually every other one in the area, withdrew from the NHS about 12 years ago when the Government tried to impose cost reductions on them. So, now I have to pay for private dentistry and have to rely on PHI for my healthcare – yet I pay a very substantial NI contribution every month.

Is there another way? How does the American system compare? How about France? I understand that they pay more but get better service – is this the answer?

It seems to me that the so-called Welfare State is making a lot of people lazy and a whole lot more people are getting very poor value for money.

airship
23rd May 2005, 14:24
Well BFU, the system here in France is in flux. Within 2 months, I shall have to "choose my GP". After which, it will be the GP that decides if it is worthwhile consulting a specialist. Until now, everyone could address themselves directly to a specialist. So the French system appears to be moving towards the UK one?!

Everyone in France (over 80 or 90% I imagine) also subscribes to a private insurance scheme in addition to, in order to "top-up" the "free" one. Like UK dentistry, anything more involved than removing completely, or filling a bad tooth with cancerous materials has to be paid for extra. Likewise, if you have the extra "private-insurance", you can have the tests done by your GP or other very locally-convenient laboratory, otherwise you have to go to the central "free" laboratory which is often on the outskirts of town and 5 or 6 km distant...?! Also, if hospitalised, there are everyday charges which are not included "free". Without the "private insurance", you would soon find yourself "running a big tab" after just a few days... :rolleyes:

No, the substantial difference between UK and French medicine in 2005 is that in the UK, if your life is not in "imminent danger", the treatment can be "put off". Whereas in France, the suffering of someone who is "waiting for an operation" is also taken into consideration. That they may not be able to work, that they may lose vital everyday abilities to see, to talk, to walk etc., all those "quality of life" aspects are also considered important. Though not exactly "life-threatening", to a UK specialist, they are nevertheless very important here. Maybe that is why there are longer "waiting lists" in UK? Also, UK surgeons will take a break in the middle of an operation because it's time for a ploughman's and a pint at the pub. Not that this reduces their earnings, considering that by all accounts, even UK GPs have doubled their salaries in the last few years. So much so, that many French specialists wonder if they wouldn't like the "ploughman's lunch" these days...instead of "un verre de Bordeaux when conditions permit"?! :}

Mac the Knife
23rd May 2005, 14:33
"Also, UK surgeons will take a break in the middle of an operation because it's time for a ploughman's and a pint at the pub. "

Nice thought - but never done it, never seen it done and never heard of anyone doing it.

I suppose you guys get these imaginative ideas from the same place we get ours about airline pilots lounging around in luxurious idleness, pausing only to be fed another peeled grape by your adoring hosties.

airship
23rd May 2005, 15:40
Dear Mac,

This is from the Berkley paperback edition of Tom Clancy's Red Rabbit, Chapter 16, page 281: "THEY DID WHAT?" Jack asked.
They broke for lunch in the middle of surgery and went to a pub and had a beer each!" Cathy replied... Now, we all know that Clancy is a best-selling author who researches stuff really thoroughly. Half of America bases their opinions of the rest of the World on the basis of what he writes. So do the current occupants of the White House.

Just because you never heard about the Russian submarine that is currently sitting in a Virginian drydock somewhere doesn't mean that it doesn't exist you know, just like everything else you might be ignorant about... :rolleyes:

The Invisible Man
23rd May 2005, 15:57
Had reason to use NHS today and found the experience very good.
My dear MIL tripped and fell. She had bruising and swelling to her left ankle. Her GP suggested Xrays to see if any bones were broken.
Arrived at local hospital, seen by Nurse Specialist withing 10 minutes. Relevent details then taken by Admin staff. Doctor arrives and confirms broken bone but needs Xrays.
Xrays taken and result immediate, one broken bone.
Into Minor injuries unit where support bandaged applied, instructions on how to use crutches given. Appointment with fractures clinic tomorrow, all within 30 minutes.
Cannot complain at the service received today

airship
23rd May 2005, 16:11
Had reason to use NHS today and found the experience very good.
My dear MIL tripped and fell... As Jerricho is not in a position to comment at the moment, if that had been his MIL, would he really have been pleased or else...?! :E ;)

The Invisible Man
23rd May 2005, 16:15
Just goes to show what a caring SIL I am, and what a wretch he is.
(This should be on other thread but never mind)

flyingbee
23rd May 2005, 18:43
For me, yes the NHS is value for money.

I take several medications on a daily basis. On the NHS I can buy a prescription pre-payment certificate for around £100, works out at £1.77 a week, that then entitles me to get as many presriptions as prescibed for no further payment for 12 months. I break even within 3 months. Elsewhere in the world, for example the US, even with medical insurance, these drugs would cost me tens of pounds every month.

So I'm happy. Plus if I took out UK private medical insurance now it wouldn't cover me for my pre-existing medical conditons, which quite honestly are the reasons I would want it for! I personally have no NHS complaints.

flyingbee

Onan the Clumsy
23rd May 2005, 18:50
TIM Next time remember to wait till she's at the top of the stairs before you trip her up :ok:

The Invisible Man
23rd May 2005, 18:54
Onan,

The problem with Inheritance is on my side of the family, but point taken:E

XXTSGR
23rd May 2005, 18:56
airship, do you really get your supposedly thorough and reliable information about the conduct of doctors within the NHS from a Tom Clancy novel? :ooh: :rolleyes: :eek: :confused:

If that happened in any British hospital, the doctors concerned would have been struck off so fast it would make your eyes water.

Hoping
23rd May 2005, 19:19
The USA has many merits. The health service is great, the best in world, if you have money.

I remember going to the doctor in the USA for a test for an unpleasant skin condition. He didn't do the test, there was a student doctor present and he diagnosed me just incorrectly just by looking. He charged me $70 for the 10 minutes it took to do this. I had to spend 30 minutes filling in forms prior to the appointment giving the details of a US citizen willing to pay the bill in case it turned out that I did not want to pay the bill. Of course, it would have been highly inappropriate of me to ask how much it was going to cost in advance :)

I was later diagnosed, by means of a proper test, for free, by my GP in the UK.

I think the "system" in the USA is not as good as ours, all things considered...

CUNIM
23rd May 2005, 19:34
Having lived in Belgium for seventeen years, I have had much to be thankful for with their health system. Coming back to the UK on retirement, I have seen the current state of the NHS. I have no problem with the professionalism of the front line staff, but why does it need more managers than front line staff to run the system?

We retain our independence by continuing with our Belgian links, my wife returning there for her six-monthly check ups.

This is the system - Go to the Doctor, pay £20, receive a receipt, go to the insurance office, receive £17 rebate. Result, no time wasters in the queue. Have a serious problem? go to hospital, insurance pay 100%. Not life threatening - they pay 85%.

Sorry but I prefer their system - saved my life when I had double pneumonia. Would probably have been in a box with the NHS.

XXTSGR
23rd May 2005, 20:23
It doesn't require more managers than front-line staff to run.

It does, however, require more administrative, ancillary, managerial and other non-clinical staff than it does clinical. This was always the case. However, recent government changes in the system mean that, while they can point to far fewer civil servants involved in "running" the NHS, many of their functions have been passed over to SHA's, RHA's, PCT's and Hospital Trusts, requiring an increase in other staff at those units. Remember GP's being told they had to run their own budgets? They had to take on staff at both PCT and practice level to do this.

The line about "more managers than doctors and nurses" is a lie on the part of those with an axe to grind. It's not true.

Astrodome
23rd May 2005, 21:06
Just two days before the 1997 general election, Tony Blair declared that just 48 hours remained to "save" the National Health Service. The implication was clear - only Labour, the party that had brought it into being, could be trusted with the jewel in the crown of Britain's public services.

A series of emails and documents obtained under the Freedom of Information Act graphically display how, under Labour, political interference has reached unprecedented and, in many cases, unacceptable levels, particularly in the past few months as an election loomed.

Michael Barber, the civil servant who heads Mr Blair's much-trumpeted "Delivery Unit" at 10 Downing Street and who often appears alongside the Prime Minister during monthly news conferences, has effectively taken charge of the process of enforcing the key target that 98 per cent of patients must be seen within four hours of arriving at a hospital's Accident and Emergency Department.

Trusts struggling to meet this target are ordered to make "presentations" to Mr Barber all-powerful unit.
As documents from the Barking, Havering and Redbridge Hospitals NHS Trust, the Royal Cornwall Hospitals NHS Trust, and the Epsom and St Helier NHS Trust show, hard-pressed managers, doctors and nurses are forced to cut corners and go to extraordinary lengths to ensure that the four-hour target is not breached.

Patients nearing the end of a four-hour wait are routinely moved out of A&E departments and into adjacent holding areas, often dubbed "Clinical Assessment Units", so that they can be officially classified as having been dealt with during the target period. Sometimes these areas are little more than rooms next door to A&E units. Sometimes, they are corridors. In many instances, patients' health is put at risk.

While doctors struggle to cope with rising numbers of cases, they are shadowed by hospital managers whose sole task is to make sure that targets are not breached.

At Epsom and St Helier, a whole team of "emergency pathway co-ordinators" has been created, operating between 8am and 9pm every day. The term appears to be unique even in the jargon-obsessed NHS but the function which the managerial staff perform is all too common.

It is not just A&E target times that lead to the cutting of corners.

Documents show that the East Cheshire Hospital in Macclesfield is refusing to take referrals of neurological patients from local GPs because, if it did so, waiting list targets would be breached, such is the caseload the trust is facing. If a patient is not referred, no target can be broken.

Here and across the country, the meeting of targets is closely linked to the future funding that a hospital trust can expect, as well as playing a key role in whether much-prized "foundation status" - another Labour NHS innovation - is granted.

The starkest picture of all, however, is painted in an email written by a junior doctor who has just completed a posting at an NHS hospital in the North West.

She writes: "I am increasingly dismayed and terrified by current political targets … I am worried because the four-hour A&E wait is used as a way to maintain and increase funding. This is affecting patient safety, especially in some trusts.

"I have just finished working in ********* Hospital and the situation there is dangerous and intolerable. The trust is under-bedded and has a substantial number of blocked beds. A&E will not breach the four-hour targets under any circumstances - when a patient gets to three hours they must be moved to hit target.

As a result, A&E patients are poorly assessed and then sent to the MAU [Medical Assessment Unit] to sit in the corridor or day room. Since Christmas, there have been more than 10 extra patients on the corridor on a regular basis. I have, over the past two months, had a patient with severe DKA [out-of-control diabetes requiring emergency treatment] sent up and admitted to ICU [Intensive Care Unit] from a chair in the day room. I have a dossier of cases not fit for the corridor [these include heart failure, severe pneumonia, a heroin overdose and an epileptic fit lasting at least 30 minutes]. The wait for a bed is then often more than four hours. A&E remains empty.

"They cannot be cared for safely and it is only a matter of time before someone dies. I am not advocating a return to the old days with massive A&E waits but don't see why patients should move from an acute area to an unstaffed corridor to hit targets. I can even tolerate 'well' patients sat in a corridor but some of these are critically ill." The registrar's words, and in particular the example of a patient with life-threatening, out-of-control diabetes sent from casualty to sit in a day room to meet a target, and then admitted to intensive care, are shocking.


In another email Dr Rod Storring, a consultant physician based at King George Hospital in Goodmayes in Essex, part of the Barking Havering and Redbridge Hospitals NHS Trust, wrote to Mark Rees, the chief executive of Harold Wood Hospital, about a meeting held on January 10 this year: "Dear Mark, Re - Meeting Trolley Wait Targets. We were told at the Senior Medical Staff Meeting on January 10 that you had had six separate phone calls from the Department of Health congratulating you on having done better than any other trust in the North Thames.

"Did you feed back to the ministry the cost of this? Do you know what the cost is? Here is some of it.

"At the end of that weekend our team had more than 100 patients. This is more than twice as many patients that we can safely look after. Patients were therefore at risk and indeed there are many examples of this.

"Patients are removed hither and thither around the hospital, one patient visiting seven wards in six days! A consequence of this is that the whereabouts of patients were not infrequently unknown to the doctors who were supposed to be looking after them!

"The juniors were totally exhausted and a number of them were in tears.

"The sickness rate amongst juniors is unprecedented - the morale of the juniors is lower than I have ever seen it …

"The organisation that you use for us to look after our patients is at best of times inadequate and now is, of course, hopelessly stretched. I came across two x-rays without the patients' names on them - I cannot remember when I last saw that.

"With all this extra work, of course, the efficiency with which we can manage patients is obviously reduced and the turnover of patients slower.

"I appreciate that the NHS is a hierarchical organisation, but in my view there is a duty in a democracy to feed back the consequences of following the orders of our political masters. The Medical Director's contribution to this discussion was that we would have to continue to do what we are doing until the election regardless. This coming from a fellow director I find disgraceful."


Dr Storring's observations were supported by Mark Sedgwick, consultant in accident and emergency medicine at Blackpool's Victoria Hospital, part of the Blackpool, Fylde and Wyre Hospitals NHS Trust.

He wrote last month to Dr Peter Ritchie, president of the Hospital Consultants and Specialist Association: "Political targets, it seems to me, are taking greater priority than clinical risk management, and this is being compounded by a pronounced deterioration in the quality and experience of up-and-coming junior doctors."


At the Royal Cornwall Hospitals Trust, Paula Friend, the director of delivery, alerted her colleagues by email earlier this month in somewhat stark language: "All elective patients who were not urgent, cancers or long waiters who will breach nine months at end of March [another apparent reference to a government target] have been cancelled. All others are on standby and decisions on admission will be taken this morning."

In January she wrote: "If we do not get this movement today, then the A&E performance will be poor and the more electives we are forced to cancel, the greater the risk to the elective target." Meeting one target appears to put another at risk in the Downing Street-driven world in which the NHS now finds itself.


In the East Cheshire NHS Trust, in Macclesfield, managers have refused to accept GP referrals of neurological patients simply, it appears, to keep their waiting lists down. Gary Raphael, the director of finance and performance at the local Primary Care Trust, emailed colleagues in January: "I have asked managers at East Cheshire Trust if that organisation will consider the continued acceptance of all referrals, even if the result is that waiting times rise above the national target (resulting in breaches) in the interim between now and a longer term solution. The trust has decided that it cannot do this and will only be able to take about half the number of referrals that East Cheshire GPs are currently referring."



Mr Barber and his delivery unit have taken a keen interest in the affairs of the Epsom and St Helier NHS Trust, which covers largely prosperous sections of south-west London and Surrey. It is under intense pressure for a combination of reasons, including the closure of a neighbouring A&E unit. The Department of Health and Downing Street appear not to have made any allowance for this, however, and have subjected doctors and managers to the most intense assessment process imaginable.

Documents obtained under the Freedom of Information Act show that up to 16 managers have been taking part in daily meetings to monitor progress in achieving the four-hour target.

In January notes from an "emergency access target executive debrief" reveal that Sue Nunney, a health strategy consultant for the South West London Strategic Health Authority, "advised that the DoH are requesting daily breach meetings" and that a "bed census" would be undertaken.

With pressure mounting earlier this year, managers even reopened an area of the hospital scheduled for building work and labelled it an "escalation area" in an attempt to get more patients out of casualty within four hours.

Another debrief, in January, noted: "Escalation area (old CAU) has been in use throughout the past week. This will not be an option in future weeks due to building works within the area."
The hospital also began using its Day Surgery Unit as an overflow for the A&E Unit, a decision that prompted a furious email from Sharon Chambers, the hospital's specialist in infection control and a leading microbiologist, to Patricia Wright, the director of clinical operations, in February. Her words are clearly designed to be a sharp wake-up call over the dangers of target culture. "Dear Patricia, I'm sorry to say there have been further incidents of the day case unit being used as a ward area. Last night and today there have been four patients spending long periods of time on the unit - two medical and two surgical.

"One of the medical patients was admitted with severe diarrhoea and … it is simply not acceptable to be nursing a patient with copious foul-smelling diarrhoea in an open area with no sluice. This constitutes a serious clinical risk …

"One of the surgical patients had an infected wound with cellulitis. IVI bags are being tied to lamps as there are insufficient drip stands.

"Cleaning, clinical waste collection and linen are insufficient. We cannot allow this to continue. I do not think it is safe to admit patients other than day case patients to this area and would therefore ask that you intervene to prevent the area being used as a ward."

In February the trust was forced to admit that it was cancelling operations in its Day Surgery Unit because of pressures elsewhere. This was also the month when the trust made its "presentation" to Mr Barber and his delivery unit in Whitehall.


Last month, the British Medical Association published a survey in which eight out of 10 doctors insisted that pressures to meet the four-hour target had produced threats to patient safety. Two out of five doctors said that patients were not "adequately assessed or stabilised" before being discharged. Yet the response of John Hutton, a health minister, was to insist that "A&E is better than ever".

Source : Daily Telegraph investigation.

BenThere
23rd May 2005, 21:23
It's a question without a good answer.

In the US I now pay about $150.00/month for comprehensive health care for my wife and myself. The company used to pay it all. If I want to see a doctor, I go to my doctor, who I chose, and pay $10. If I need a prescription, I go to the pharmacist and pick it up and pay another $10-15. If I need major care, I pay 20 percent of the first $2,500. So all together I generally spend about $2,000-2,500 per year for all the medical care my wife and I want, and we get it on the day we want it. I don't see this as unreasonable and like the system pretty much as it is.

I'm leery of my income taxes going way up to pay for national health care, and I don't want to have to get on a waiting list to get treatment. I also like having my doctor familiar with my health and medical history.

About 25% of US healthcare costs go to lawyers. I'd like to see that go down.

The very poor in America have health care fully covered by the government through Medicaid. The lower to middle class working poor without employer-provided health care are the ones who need help. In their case, the system doesn't do its job and needs to be improved. My guess is about 15 percent of Americans fall into this category.

It's important to note that no one need go without emergency medical care. If you are uninsured, you may lose all your money with a catastrophic condition, but when it's all gone, you go on Medicaid and will get care. I think it's ironic that some of our hardest workers cannot afford regular care, but those who don't or won't work get it at no cost to them.

Blacksheep
24th May 2005, 05:34
Last December I accompanied my (adult) daughter to the local hospital. We waited one and a half hours in an overcrowded waiting room (some people are standing) to see a doctor who did a series of eye tests, then referred her to a specialist surgeon. We returned to the receptionist and made an appointment. My daughter will see the fellow next month.

My wife needed a routine blood test so she went to the local GP practice as usual. The receptionist booked an appointment for her to attend the clinic in another two week's time. After two weeks she went to the clinic where a nurse took a blood sample. Mrs B then waited for another two weeks for the results to come back. She assures me this is the normal course of events, although they once took the sample straight away. Then lost the results and had to do it all over again.

I need a blood test for my routine six monthly check-up so I go to the haemotology clinic at the local hospital. I take a number and sit down. Seven others are in the queue. After about ten minutes I am called forward and a nurse takes the blood sample. The results are already in my medical record ten days later when I go for my routine check up.

I have a blocked nostril for several weeks and mention it to the doctor during my routine check-up. He refers me to an ENT specialist. The same day. I see him after a twenty minute wait, he looks up my nose then orders a CAT scan and sends me to X-Ray. They book me in for a CAT scan. Tomorrow. The results are ready three days later for my follow up examination at ENT.

Which of us lives in the third world?

Scumbag O'Riley
24th May 2005, 10:59
Have seen surgeons so drunk they nearly killed the patient. Have seen a consultant surgeon get so frustrated that he couldn't stem the blood flow after 18 pints were transfused on the table, that he downed tools and said "I'm off to the pub". Off he went too. Both in the UK.

Not for the reasons above, but if you have the money - like most of us do - the health care in the US is considerably better. If you don't have the money, the health care in the UK is better. That's only because you won't get it in the US unless it's an emergency, and if you don't pay they will take your house. Doctors are better trained in the UK, but that's changing fast, not for the better.

AirYard
24th May 2005, 11:33
In a one word answer.

NO.


I live in a country that, thankfully, has an incredible system. get seen in minutes, if no room, send you off to the adjoining country, to get seen in the same day.

Amazing service, best technology and all paid for by a tiny dent in my salary.

More than happy :E

Mac the Knife
24th May 2005, 12:19
"Have seen surgeons so drunk they nearly killed the patient. Have seen a consultant surgeon get so frustrated that he couldn't stem the blood flow after 18 pints were transfused on the table, that he downed tools and said "I'm off to the pub". Off he went too. Both in the UK."

Sorry, don't believe you. In more than 30 years as a cutting surgeon (as opposed to an academic) I worked most places and seen and done most things and I've never seen anything like that.

BenThere
24th May 2005, 12:25
Air Yard,

It seems you have the best system. But does that tiny dent in your salary include the taxes allocated to medical care? What are they, and what is your overall tax rate?

got caught
24th May 2005, 13:56
Worked for the NHS for many years.

I've worked with thousands of clinicians, and I can say with hand on heart, that the number who don't genuinely want to improve the quality of care for their patients, can be counted on the fingers of one hand.

Of course there's scope for improvement, but its sometimes difficult to move on an organisation who's size is dwarfed only by the Indian Railways, and the Chinese Army.

I should imagine most clinicians will continue to strive to improve things for our patients when the eventual privatisation happens !

AirYard
24th May 2005, 14:04
Ahhh,,


but I live in the little grand duchy of Luxembourg:p


But it basically works out, that not married, no kids, works around 20 %.

Includes, social care, medical, everything.


However, it does so happen that this country has the highest amount of money flowing through it in FDI. Basically because of tax breaks to companies.

So the goverment take all the money from the companies, well tiny bits of it, just so happens that they take a tiny bit from a very very very very large pie.

end result, is that a lot of money is available for all things here, construction, roads, education, medical etc.


But always a point to remember, the population here is a little smaller than the average country!, aswell as the size, so does make things easier!.

On the good side, if you do get married and have kids =

1 kid, the highest salary between your partner and yourself, gets taxed at 2 %, other normal rate.

2 kids, both salaries drop to 2%.

3 kids, never pay tax again:D (unless you get divorced!)

Biggles Flies Undone
24th May 2005, 14:20
Adding to my personal experiences:

My Mum’s sister died of cancer because her GP insisted for years that she had a bad back. When my Mum got the same symptoms, the same practice let her down. Despite my vigorous protestations, Mum (as did the majority of her generation) just said “Doctor knows best”. She was lucky – Dad paid for the op and she survived another 3 years before the secondaries got her.

Before Mum died, she rang me up one day and said Dad was down on all fours trying to ease the pain from what the doctor told him was indigestion. I told her to call the doc again and went round. The guy was just telling Dad to drink some indigestion medicine when I took him aside and told him that if he was wrong, I’d nail his balls to the tree outside. He fixed up a hospital check ‘just to set my mind at rest’. Two hours later, after the check, Dad was in intensive care – minor heart attack.

Mum made Dad promise to have a proper medical every year. He paid for a BUPA one and it saved his life 5 years ago. ECG showed change, angiogram arranged, it was so bad that they did the triple by-pass the next morning. Thankfully, he’s still around – but no thanks to the NHS.

I agree that the NHS is very good at dealing with accidents and trauma, but, in my opinion, it is rubbish at providing proper day to day care. I get the impression that, if you stripped out the fat layer of bean counting, box-ticking, target-meeting, politically correct numpties, we might get better value for money.

Some of the other countries’ solutions sound better to me as a wage-earning, concerned individual – but it would be interesting to hear more views from inside the NHS.

got caught
24th May 2005, 14:28
Some of the other countries’ solutions sound better to me

I'm all for moving to a "better" system, especially if it improves the outlook for patients. I'm not sure that it will though.

XXTSGR
24th May 2005, 14:43
I agree that the NHS is very good at dealing with accidents and trauma, but, in my opinion, it is rubbish at providing proper day to day care. I get the impression that, if you stripped out the fat layer of bean counting, box-ticking, target-meeting, politically correct numpties, we might get better value for money.Biggles, you are largely correct. But the biggest problem does not lie with the NHS - it's down to the politicians.

Hospitals generally have a very good idea of how to run themselves. They know the particular character of the area they serve, and how best to provide for the needs of the demographic make-up of their community. They've been doing it a long time. But when politicians get in on the act, everything gets skewed. They are given new "targets", new priorities, they have to change this that or the other and doing so costs time, takes resources, and patient care suffers in consequence.

Where beancounters are installed, they try to run the hospital at as close to 100% utilisation as possible. It doesn't work. I'd love to tell one "Ah - that computer of yours - I see you're not using all the hard drive. So we'll take away all the spare capacity and see how long it works." If you have no spare beds for stays that are longer than anticipated, you have to postpone operations. If you have no spare beds because someone contracts MRSA, you have a bed (and significant resources) tied up for a long time, and operations get postponed again. If you have no spare capacity among your staff and a surgeon gets a cold, you have to postpone operations. (Would you like someone with a cold to be dripping over an incision in your body?). If you are told to contract out hospital cleaning to the lowest bidder, what happens? The lowest bidder (who has to show a profit to his shareholders when the hospital did not) employs all your old cleaning staff that you just laid off, except they are now employed on a far lower level of pay and are now thoroughly demoralised. Their time on shift is short with far more to do, so all they do is slop a dirty mop around where it is most likely to be seen, and move on to the next bay in the ward. The wards are no longer anything like as clean as when a matron oversaw what went on and insisted on proper cleanliness and MRSA flourishes. No sh1t, Sherlock!

Much the same goes for GPs. They got on quite nicely, treating their patients, visiting them at home when needed, until the politicians got involved, who told them they had to be more "productive", they had to manage their own budgets, etc. etc. What happens? Doctors spend longer in paperwork, have to employ "practice managers", check whether they are allowed either by the rules or the budget to prescribe this, that or the other drug or treatment, thay have to ration the time spent with each patient to a certain number of minutes, and, mirabile dictu, the level of care suffers. No sh1t, Sherlock!

What the government needs to do is put money into the Health Service and end it there. No "initiatives", no "targets", no "changes of emphasis", no "policy directives". Stop interfering. Let them get on with it. They are public servants, with the public service ethos well-installed already as regards not wasting public money. Every time you change the rules, it costs money to implement. Leave it alone. It worked very well in the past. Stop interfering and it will work again.

PilotsPal
24th May 2005, 14:48
My migraine medication costs a small fortune (Imigran). A £6.50 prescription charge is therefore a bargain.

What I don't understand is that contraception is free and still the kids get pregnant.

Biggles Flies Undone
24th May 2005, 14:57
XXTSGR - that echoes my feelings exactly. If we could go back to the way hospitals were run in the 50's and add in the extra funding, knowledge and clinical techniques, we should be looking pretty good, eh?

So, Government meddling and wasted money are the problem :mad:

BenThere
24th May 2005, 14:59
Airyard, you are very fortunate.

XX,

The problem government health care has is controlling cost. If there are no market forces or charges for access, costs rise enormously out of control, or services get limited.

The politicians who sold the system to the electorate have to make the system look as good as they can, but if they provide a truly excellent system, the higher bill ultimately has to come to the taxpayer. And when the bill becomes intolerable, the taxpayer blames the politicians. It's a vicious circle and difficult to remain ahead of.

Nothing's for free, even 'free' health care.

got caught
24th May 2005, 15:02
I,m sure there is a potential joke between pregnancy and headache medication, I just can't think of one.

I'd certainly agree with the capacity argument, and as far as I can see, the latest management ethos suggests things run "best" at about 80-85%

As for managers and beancounters, I can't help thinking that some accountability is a positive thing. The best (most effective) initiatives I've seen, happened when managers and clinicians (and admin staff, and porters, and cleaners etc), all started talking to each other. Some of the best "fixes" I've seen, have been the simplist.

Were things any better in "the old days?" Should we put clinicians in overall control? our past morbidity and mortality rates for dieases such as heart disease and cancer would suggest not. Its a joint effort.

Scumbag O'Riley
24th May 2005, 15:06
If we could go back to the way hospitals were run in the 50's and add in the extra funding, knowledge and clinical techniques, we should be looking pretty good, eh?

No. Thatcher famously asked how much a certain operation cost, nobody had a clue. That's no way to run a health service. There was no control in those days, it's a lot better now that doctors are concentrating on what they do best and what they are trained to do - manage medical/surgical conditions.

Sorry Mac, I was there. Could name places, persons, dates (to nearest 3 months), but the "I'm off down the pub" boy is still alive, and doing excellent work. (Luckily he had a great SR in the room, and the anaesthetist was an amenable chap)

Curious Pax
24th May 2005, 15:29
In my opinion not enough is made of the capacity argument. It stems from the days when cost cutting was in vogue, and budgets were slashed to meet those targets. However although it was undoubtedly correct that there was a large amount of waste, I have a theory 50% of a budget cut removes waste, and 50% removes justifiable spare capacity. After there have been a few rounds of cuts then the spare capacity has all but gone, and as XXTSGR says that is when the problems start. This argument applies in anywhere with a budget (eg BA last summer).

It would be interesting to see a study of the cost of constantly juggling tight capacity against the cost of having some spare. I would guess that there is an optimum load which would see greater capacity than currently in many places.

I do think that managers/administrators in hospitals is a good idea - surgeons running hospitals is as good an idea as IT technical whizzkids running IT firms and pilots running airlines! However in too many cases the admin side of things seems to expand until someone stops it. Maybe a good government target would be that a hospital should not spend more than 10% of its budget on admin/management (and that may be too generous).

One last point - in the same way as it is often unfair to label the quality of an airline based on a couple of flights, is it not also unfair to label the whole of the NHS on the basis of what sounds like one incompetent doctor?

hopharrigan
24th May 2005, 17:56
Been living in the US for ten years now, paying for my own health care, family of six.

In the state I am in now I pay $8,000 per year for the premium (cheapest of the choices) and if I go in the hospital I get 70 percent of the cost (which is 5 to 7 times higher than it would be in any other developed country), after I reach the deductible which is another $5,000 (I am on the highest deductible to keep the premium down, and it is based on $2,500 for me and $2,500 for one other, since it is a family policy). So I spend around $13,000 before I see a penny back, and that is for a year, starting each January so if I spend, say, $5,000 in December I start again at zero in January and have to spend another $13,000 before I get anything back.
Of course if I make too many claims they then toss me out of the health insurance company.
If I reach some higher figure of payment ( when the total spent reaches around $17,000), I then get everything paid for in the hospital, up to a life time limit of 1 million for the family (which would not be hard to do). After that I am on my own.

When I see a doctor it costs me $105-$125 a visit- that is with insurance, but my policy works on deductible, not co-pay and the money goes toward the deductible. If I am lucky I will see a real doctor (they use a lot of Nurse Practitioners here, but they won't tell you that and the rate is the same). They make the same number of errors in the US as elsewhere, in fact they say that nearly 100,000 people die in the US every year due to medical errors (the same as two 747s crashing every day). My family has had its share of incompetence.

If you have no insurance you can go to the emergency ward of the local hospital (if they are still there; because of the cost of the poor and illegals many are closing down) and it will be free, that is free after they take your money, your house, your car, your clothing and furniture and leave you in a cardboard box ($4.95 at Uhaul). It is only free if you are destitute and unless you live in the land of the free you will never know what that truly means). The service at a major hospital emergency room is atrocious, with people dying in the corridor and no-one realising it until the smell starts drifting. I promise- you don't want that.

And for all the money (the most expensive system in the world by far) the US has the worst rates of infant death, lowest life expectancy, highest drug, pregnancy, alcohol etc problems of the industrialised countries. In short, no matter how bad your system is, it is way better than the free enterprise system they have here.

One bright spot is if you have company provided health care, which is then likely to be a low co=pay or free. But remember you pay through your employer (money he would otherwise pay you) and they get the best cover because of numbers. You cannot change jobs, or you will lose the coverage, and if you lose your job you lose everything. When you retire, you will continue to get coverage if you are lucky - look at what is happening to the retired employees of United right now.

Everyone pays 14 percent of salary toward medicare (and Social Security), which kicks in at 65, and then for a small premium (around $500 per year) you get coverage at specified hospitals and doctors. I won't get it, because I am not a citizen and I have not been paying for the required ten years, and private insurance cuts out when I turn 65 so I don't know what I am going to do, if I am still here that is.

Drugs are outrageously priced, but most health plans get you lower prices. Those prices are still way higher than what you are used to. One of my kids needed Accutane for zits and it cost me $600 a month with insurance (would have been over $1000 without). Generic drugs would have been about 30 percent cheaper.

Without a good job to pay for the premiums and out-of-pocket I cannot stay here. I can only pray for good health for myself and family. More than half of all personal bankruptcies in the US right now are due to someone in the family getting seriously ill, and three quarters of those people had health insurance. The government, to help the insurance companies and hospitals, just passed a new law to make it harder for individuals to protect some of their assets in the event of bankruptcy (it used to be possible to save your house) and now you will lose everything, and be forced to pay back what you owe for the rest of your life. These are people who believed they were comfortably well off.

For those uninsured it is even worse. One fellow had his son in the hospital a couple of years back for four days, with a minor operation. The bill was $160,000. He was self-employed and had to sell his business, and was going to lose his house but he hired a lawyer who fought for a lower charge. The hospital settled for $60,000 and he is paying that off, but he found out that if he had had insurance the bill would have been $26,000 (that is what the hospital would have accepted from the insurance company for that procedure).

No matter how much trouble you experience in the UK or other places with National Health, you don't want what I have.

Astrodome
24th May 2005, 18:55
What a thought provoking and powerful post.

Thank you.

I feel that the crux of the matter concerning the UK NHS can be put simply into a number of key points, thus:-

1 People are now living to a much longer and thus represent a greater financialstrain on the NHS

2 Advances in medical science in recent years mean that once where a person would have died, that they now survive, sometimes the outcome of this being that they place a greater financial need upon the NHS as a result.

3 These advances bring with them much more complicated equipment and monitoring systems, again placing a further financial strain upon the NHS

4 It is a fact beyond dispute (one hopes although there is always someone who will dispute) that there is now a considerable imposition upon the NHS from 'health tourists'. These are people who fly into a UK airport and then report to the nearest local hospital for treatment that is not available in their own Country. Invariably they leave for their home Country as soon as treatment has been given without contributing anything to the cost of their treatment.

5 The health problems brought about by those from less well developed Countries who come here either legally or illegally are placing an increasing burden on the NHS.

6 The relative ability for most people to travel to other parts of the world has brought with it an increase in health-related issues. TB which was eradicated in the UK has returned with a vengence.

7 The rise in people partaking in more risky sports is on the increase. They invariably partake without any form of insurance and then become a burden upon the NHS when they have accidents, which tend to be more serious than the normal.

8 Increases in road traffic have increased the numbers of accidents exponentially.

9 The various stresses placed upon the NHS have resulted in an increase in mis-diagnoses and clinical errors. The burgeoning 'Compensation' culture means that people are much more likely to take legal action, thus again increasing the costs to the NHS. In many cases it is possible that a simple apology and explanation may be all that is initially sought however the legal dictat that says any expression of regret/sympathy can be taken as an admission of guilt results in many people taking legal action as a means of gaining some form of acknowledgement.

The outcome of all the above is that the costs of the NHS provision are increasing far and beyond that previously.

As a nation we want lower or reduced taxes. WE want a first class service but we won't pay for it.

That said, a degree of efficiency was necessary to bring the performance of the NHS into some sort of perspective. This was necessary as despite what people will say they WILL object to paying ever increasing levels of taxation to support the NHS.

The Conservatives sought to take long term action to deal with the many points I raised earlier. At EVERY stage they were OPPOSED by the then Labour opposition.

This same Labour opposition now in power have with typical cynicism. lies and distortion have introduced a considerably greater degree of Privatisation and central control (Political meddling to achieve cheap political points) that was EVER envisaged by the Conservatives whilst at the same time spouting the tired old mantra about the NHS being safe in its hands.

After 8 years of a Labour Government the NHS is in deep, deep trouble as my earlier post revealed.

God help us all because we are in for potentially another 5 years of lies, distortions, spin, and political interference with our health system.

You commented on people dying on trolleys in A&E. That happens here as well, and indeed a recent case was publicised of a man who died in a Hopsital toilet and was not discovered for, I believe, about 2 weeks.

henry crun
24th May 2005, 22:00
hopharrigan: If what I read recently is correct, your quoted figure of nearly 100,000 people dying in the US every year due to medical errors is incorrect.

The true figure is over 200,000, made up of approximately 100,000 due to wrong dosage or incorrect prescription of drugs.
Another 100,000+ die each year from other medical errors by doctors.

All cases of medical error now make it the third cause of death in the US after cancer and heart disease.

Maybe this is why lawyer fees are 25% of medical costs.

Blacksheep
25th May 2005, 01:17
If you're looking for an ideal social welfare based health system, try the Singapore model. Now, Singapore may be a nanny state but, like Mary Poppins, you don't get just any old ordinary nanny.

Angiogram, CABG, 3 days ICU, rehab and first year's follow up cost me just under 7000 UK pounds all in, but excluding air fares and accomodation for relatives. The same price as for a local citizen, though they pay via deduction from their Central Provident Fund (CPF) account. There are no "Superbugs" in their hospitals and the wound healed by first intention - you can barely see the scar. Nursing care was first class, even in my second class ward (open ward, arranged in four-bed groups).

As far as I can tell - and a close family friend is a Nursing Sister in Singapore - the Singapore hospital staff are paid at least as well as their UK equivalents. Those running the NHS could well do with a bit of training from Singapore's health authorities.

PA-28-180
25th May 2005, 04:48
Is the NHS worth it? I have four simple words for you:
Charlotte Wyatt
Leslie Burke
You can check it out yourselfs via google, or simply visit www.savecharlotte.com
Always thought a single payer system to be a mistake - these two cases prove it! :(

Navajo8686
25th May 2005, 07:14
IMHO there is nothing wrong with the NHS that a bit of good management would not cure!

It's not the amount of money they get - it's what they do with it! There appears to be no common sense applied to make sure that the resources of the organisation has are used to best effect.

as an example my wife recently was referred by her GP to hospital (25 miles away) so that she could have some tests on her hand and arm.

That took four weeks to arrange and then was cancelled once before taking place.

She duly turns up and has the test. The lady doing the testing has to write a report which is given to the consultant (who did not meet my wife as the tests were left tot eh 'testing lady') so that he could do another report which could be sent back to her GP. It took fours weeks for that report to get to the GP (i could ahve walked it quicker!).

He then stated what was 'already known and obvious' and consequently she has now been referred back to the consultant for him to look at her arm so that an operation can be carried out 'sometime in the autumn'.

In fairness my wife's GP has been superb and is a frustrated as her that things just cannot happen in the NHS - everything is far to complicated.

The net result is vast amounts of money being spent in the wrong way!