Is the NHS really underfunded?

[BobbyeinArkansas]

Curious to garner opinions on this.
Watching This Is Going To Hurt currently which has made me think.

I know staff are overworked. But is it really as “underfunded” as the media would have us believe or is it a combination of being inefficient, mismanaged and with too many “managers”.
I have no idea, by the way but I am curious as to what other think.

Firstly it’s MASSIVE and hugely more complex than most people imagine. There are over a million staff and probably thousands of legal entity organisations within it. There are millions of patient experiences every single day.

Everyone has a view on it based on their own experience.

I’ve worked in it and with it.

• Local executive boards lack the ability and incentive to truly scrutinise and constructively improve problems
• it’s actually not hugely management heavy. A lot of managers are also either clinicians or technical specialists. No way should a surgeon be involved in getting their patient to the operating table… that’s ultimately what management in there to organise
• there’s a vast misunderstanding of the true value of good management and a vast overestimation of the (non clinical) value of clinical staff. Doctors and nurses do not know everything, let’s leave them to looking after patients
• a lot of senior clinicians also do very lucrative private work which makes them inflexible in their publicly funded work
• a LOT of the workforce works part time. Therefore you train one HCP, but 5 years later you’ve got 0.6 if you’re lucky
• executive leaders are terrified of bad publicity, hence they’ll restructure and reshuffle instead of making redundancies where their needed and dismissing truly incompetent staff or those with a bad attitude
• therefore a lot of good/capable staff leave if they can
• a lot of NHS staff are NOT underpaid, and a lot of managers are not in fact grossly overpaid. But a lot of work is paid at too low a grade because of penny pinching in management
• there is a culture of ‘going off sick’. Given very generous sick leave, and the feeling of many of ‘be kind, what else can we do for our staff’ there’s a LOT of overly long sick leave that just doesn’t happen elsewhere.

Is it underfunded? Yes.
Is it, in parts, grossly inefficient and badly managed? Absolutely.

Managers will say it’s underfunded. Frontline staff will say that there are too many managers. I believe the ratio of manager (that includes all admin and support staff ) to clinical staff is about 6:1.
All NHS staff benefit from gold standard pension and six months full sick pay. Sickness is epidemic within the service even before Covid. In part due to abuse of sick pay entitlement, but also due to stress levels.
It’s not management who deal with irate patients who have been cancelled for the third or fourth time. It’s not management who have to tell a patient they cannot receive treatment because the funding has been refused by the bean counters.
I have no solution. I’m retiring in 2 yrs and although I will still be working in frontline health it will be purely private.

You could never fund it enough.

Because the demand is ever-growing

I believe the ratio of manager (that includes all admin and support staff ) to clinical staff is about 6:1

Published stats show that the proportion of NHS staff who are qualified clinicians is 53%

digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/january-2021

If you didn't have the managers, who would do the management? Wouid that be the right use of clinicians' time? Or do you propose just ceasing some current sctivity - if so, what?

And of course the portering, the security, the maintenance, the ambulance dispatch, the admin that doesn't really count as 'management', IT etc

massively inefficient, run by people that dont have a clue and dont care.(not the clinicians, who do an amzing job in horrendous circumstances)
also underfunded
so basically a total disaster that is going to get worse until it is broken beyond repair.
it is sooo much worse now than when that book was written

@Kylereese

Completely mismanaged and inefficient. Have t embraced and utilised technology. No accountability

This entire comment is so true! How much more money needs to be thrown at inept managers? More funds will just be swallowed up by incompetence

Yes it’s underfunded, but also mismanaged. Far too many managers.

No way should a surgeon be involved in getting their patient to the operating table… that’s ultimately what management in there to organise

And yet that is what happens in reality when the system constantly breaks down. A family member is a surgeon and on the days when the operating rooms are available but there aren't enough nurses, and patients undergoing quite complex procedures face the cancellation of their operation for the third or fourth time having travelled for miles, he and his secretary, literally run around the hospital, sorting out these problems, and making it all happen almost by force of will. He says it's a fight every day and very poor use of his time, but if he didn't get involved, bluntly, patients would die unnecessarily.

@Kylereese

Completely mismanaged and inefficient. Have t embraced and utilised technology. No accountability

Yes I agree. Lived in Germany / Austria for a long time, so much better.

As a former rota manager I would say its management of money is terrible. I used to book long term locum consultants who were earning equivalent of £300,000 a year. They would then insist we pay for their accomodation etc. There are so many NHS doctors leaving to become locums because they only have to work a few months a year to get the same pay.

I agree with PPs, there are inefficiencies, but it’s also underfunded. The two aren’t mutually exclusive. If we could sort out the inefficiencies, it would still be underfunded. If we want a top notch health service, we’d need to pay what those in other countries pay for a good health service, either through public funds via taxation or an insurance system, and at present we’re not doing that. Most countries have a mix, and the spend per person through taxation plus insurance or additional fees is more than we pay per person via taxation. And in those countries with a mixed model of funding, the insurance/private fees aren’t like private insurance here btw, it’s not a nice to have add on if you can afford and choose it, it’s compulsory. Everyone pays for a GP appointment, but not for heart surgery for example. So in other countries with better provision, every single person is paying more for healthcare, just not all of it via taxation. If we had a insurance based system, we’d be paying more too (as in every other country with an insurance system), as insurance increases inefficiencies. If we increased our public funding via taxation to the same per person spend, we’d have a better provision too.

@carefullycourageous

It should go back to the core values of treatment that it was set up to provide in 1945 yes let's go backwards, what a great idea. Who wants progress anyway, down with progress!

Let's not use modern treatments and give out lashings of cod liver oil.

Ridiculous.

No your inference of @twinsetandpearl's post is ridiculous. They've said it should go back to core values, so life saving and medical need treatment/surgery. Not life style choices such as vasectomy etc.

Not life style choices such as vasectomy etc.

How is contraception a ‘lifestyle choice?’. It seems much cheaper than the alternative.

Why would anyone assume that it’s cheaper to fund live saving treatment down the line instead of helping people to manage their weight in the first place?

It is grossly understaffed and some who are employed in hospitals should not be.

Nursing and care is not how I remember it and not how I was trained either.

Community working and hearing horror stories of the sheer lack of care and often due to lack of staff.

The flip side is we in the UK have terrible lifestyles & expect the medical profession to wave a magic wand when it comes back to bite them on the bum.

“Abracadabra, you didn’t spend 40 years in a war of attrition with your own body & you don’t need major interventions, now off you go ya little rascal & have one on me”

@Merrymouse

Not life style choices such as vasectomy etc.

How is contraception a ‘lifestyle choice?’. It seems much cheaper than the alternative.

Why would anyone assume that it’s cheaper to fund live saving treatment down the line instead of helping people to manage their weight in the first place?

Condoms. Those are free, cost pennies, problem solved. Pay if you want to be able to ditch them. It's most definitely lifestyle.

It amazes me that the NHS still send old fashioned letters which often get lost or are sent to the wrong address. Also, so many appointments could be done over zoom, which would save millions.
They just need to embrace modern technology.

Condoms. Those are free, cost pennies, problem solved.
Pay if you want to be able to ditch them.
It's most definitely lifestyle.

And if somebody doesn’t use a condom and the consequence is a pregnancy?

‘Sorry love, your fella should have used a condom’.

I suppose you could cut 100% of NHS costs immediately if all births are just a life style choice.

Having worked in the NHS for many years ( not any more) this is my experience, it needs a massive overhaul ,nobody is ever held accountable for decisions ,, ridiculous decisions would be made such add refurbishing a ward at the cost of £1000,000, and then closing it down less than 12 months later ,managers just shrugged ,this happened several times ,being grossly overcharged for building work ,not enough support for staff working I clinical areas,I can only speak for the small corner of the NHS I worked in ,but if it's broadly the same everywhere ,it doesn't matter how much money you throw at it nothing will change in its current form.

The NHS is massively underfunded and burdened by underinvestment,
Also not helped by lack of community beds in community hospitals and difficulty sourcing care in the community.

Lack of investment in training nurses/ doctors/ AHPs.
Inefficient management which is so target driven and lacking in humanity that it reduces said health professionals to breaking point until many sack it off and choose to leave.

@Nat6999

The NHS is top heavy with staff, too many chiefs & not enough Indians. There are too many executive & management staff earning silly money salaries & not enough hands on staff. An organisation like the NHS should be built from the ground up, without firm foundations it will collapse, HCA, HCP, Nurses & Doctors are the foundations, they are the staff who care for the patients, the executive staff probably have no idea how the practical side of the hospitals work, chances are they were executives in another field before working for the NHS. More resources & money need to be pumped in to the practical side of the NHS, management & executive staff need reducing so the money saved can be used to increase staffing lower down the ladder, pay them a decent wage & improve working conditions, make the NHS a good place to work.

I think if you asked most NHS managers (certainly at my level, managing a clinical service), the problem is not too heavy management or not having the budget to recruit, the problem is recruitment of clinical staff.

To make efficiency savings needs change and improvement, which we constantly do, but what hinders it is the fact that we cannot fill our clinical vacancies, not enough nurses are being trained. As a result, clinical staff are treading water trying to keep everyone safe all the while not having enough slack in the system to make improvements and prove what difference they make (we need evidenced based practice).

It's often bandied about that the NHS managers are paid inflated salaries.. I'd be interested to compare my salary and responsibility to someone in the private sector- bottom of band, £47k ish / year with responsibility for approx 60 clinical staff, budget of £2-3m and also a clinical expert in my field (with all the education that goes with it).

I can only compare to my DH, who manages no one, no budget to manage and is paid about 1/3 more than me per year.

@spaceman1

It amazes me that the NHS still send old fashioned letters which often get lost or are sent to the wrong address. Also, so many appointments could be done over zoom, which would save millions. They just need to embrace modern technology.

It takes financial investment to introduce technology.

They do need to embrace modern technology (more but not for everything) but the word 'just' makes it sound really simple and cheap.

Do you want them to cut existing treatments to pay for the investment, or do you want the government to invest additional resources?

The NHS did switch to more digital appointments - the government has pressured them to go back because pensioners don't like it and we have to pretend COVID is over.

Inefficiency and mismanagement have always existed within the NHS and it's currently no worse than it used to be (my mum worked for the NHS for 40 years between approx 1960 and 2000).

The major problem is the ageing population. Life expectancy has increased dramatically since the NHS was set up and older people need a lot more healthcare.

@Merrymouse

Condoms. Those are free, cost pennies, problem solved. Pay if you want to be able to ditch them. It's most definitely lifestyle.

And if somebody doesn’t use a condom and the consequence is a pregnancy?

‘Sorry love, your fella should have used a condom’.

I suppose you could cut 100% of NHS costs immediately if all births are just a life style choice.

By all means, take my comments out of context and twist my words to fit your narrative

Mismanaged and inefficient. One example is walking aids, crutches, Zimmer frames etc. All single use as they don't have a process for cleaning them before reissue. What a huge waste!

@VerveClique

Firstly it’s MASSIVE and hugely more complex than most people imagine. There are over a million staff and probably thousands of legal entity organisations within it. There are millions of patient experiences every single day.

Everyone has a view on it based on their own experience.

I’ve worked in it and with it.

• Local executive boards lack the ability and incentive to truly scrutinise and constructively improve problems
• it’s actually not hugely management heavy. A lot of managers are also either clinicians or technical specialists. No way should a surgeon be involved in getting their patient to the operating table… that’s ultimately what management in there to organise
• there’s a vast misunderstanding of the true value of good management and a vast overestimation of the (non clinical) value of clinical staff. Doctors and nurses do not know everything, let’s leave them to looking after patients
• a lot of senior clinicians also do very lucrative private work which makes them inflexible in their publicly funded work
• a LOT of the workforce works part time. Therefore you train one HCP, but 5 years later you’ve got 0.6 if you’re lucky
• executive leaders are terrified of bad publicity, hence they’ll restructure and reshuffle instead of making redundancies where their needed and dismissing truly incompetent staff or those with a bad attitude
• therefore a lot of good/capable staff leave if they can
• a lot of NHS staff are NOT underpaid, and a lot of managers are not in fact grossly overpaid. But a lot of work is paid at too low a grade because of penny pinching in management
• there is a culture of ‘going off sick’. Given very generous sick leave, and the feeling of many of ‘be kind, what else can we do for our staff’ there’s a LOT of overly long sick leave that just doesn’t happen elsewhere.

Is it underfunded? Yes.
Is it, in parts, grossly inefficient and badly managed? Absolutely.

This. With bells on.

Senior manager in the NHS and this is all completely on the nose.