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.

The amount of band 7 and 8 "managers" in most hospitals who achieve little and are grossly incompetent for they (good) pay they get is staggering.

Yes it is underfunded. Deliberately.

@Flapjacker48

The amount of band 7 and 8 "managers" in most hospitals who achieve little and are grossly incompetent for they (good) pay they get is staggering.

Can you show evidence for that? The Kings Fund research disagrees.

Thank you @Youally. From a heartbroken former NHS senior manager.

"massively inefficient, run by people that dont have a clue and dont care.(not the clinicians, who do an amzing job in horrendous circumstances"

What utter bollocks and so offensive to those non clinicians working in the nhs. I have over 22 years service in the NHS and care about it and patients just as much as my clinical colleagues.

I've seen many many inefficient senior clinicians who care more about their own egos and empires than their patients and who CAN'T be managed.

My mum had to have an emergency admittance into hospital last year for an iron transfusion because the GPS failed to check her iron levels whilst doing her blood tests - despite a history of low iron. 3 days in hospital is much more expensive than an add-on to routine blood tests.
Fast forward a year. We request blood tests to check her iron. She has them but I query that her blood sugars and cholesterol haven't been done. Two days after the results were back, the gp calls to say she needs her annual blood test doing. So she has to go back to have her cholesterol and blood glucose done. She's 86 with dementia and really doesn't want to be going into the doctors for repeat tests. I queried why they have used two slots and doubled the cost. I was told they are catching up and the way they are doing it is faster and more efficient. (Well, its not, is it?) And that they have had strict instructions not to tie treatments together. (Seriously?!) So, they took two nurses apps instead of one, they wasted money, they lie, and they treat me like I'm stupid enough to believe their lies. It's infuriating.

nobody is ever held accountable for decisions

having sat in on performance management meetings, I would say that was untrue. People get sacked, moved sideways, barred (clinical), contracts broken if providers fail to perform, CQC rains down like tonnes of bricks never mind journalists and Patient advocates, financial penalties are levied against poorly performing providers, and people simply leave because they can't take the stress -- that's all the management side. Clinicians get a different pile of stressful problems.

I want to echo whoever said the NHS is massive & can't be defined by simple personal experiences, too. I dunno which if any reorganisation initiative has helped. Reorganisations just seem to undermine morale; people are the most important NHS assets. There should be no doubt that investment in creating new clinical staff has been under-funded for decades.

I want to echo whoever said the NHS is massive & can't be defined by simple personal experiences, too.

I totally agree with this but I have tons of examples of wasted money and time (which ultimately results in a waste of money). Lots of people have examples. Every time I tell someone one of my tales, they can match it with one of their own. Surely this must make people with any say curious as to what's going on? I can't say about reform, but poor staff management /organisation and practices could be improved for very little cost really.

I suppose question is... does NHS "waste" money more than any other huge organisation (keep in mind NHS is largest employer in western Europe).

US Dept of Defence? Apple? Some huge food producer? Amazon, mcDonald's, Walmart, Indian Armed forces? Do we think those organisations don't waste much money? Or are hugely more efficient?

i honestly don't know who relatively wasteful they are, I assume they ALL sometimes make terribly wasteful decisions.

Simple answer Yes.

You know wards do fundraising for basic equipment?

Also wards have to buy paper clips for £3 from the official supplier. When they can buy them for Tesco for 20p, so alot of wards fundraiser that way for not paying overpriced shit.

Also HR will pay locum agencies twice what they’ll pay their own staff. They refuse to increase the rate of pay slightly for own staff and would rather pay double to outsource

@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.

Yes it is under funded.

And anyone who bleats on about managers etc has no clue about running a massive series of organisations.
Per head it works out at about £3k per year. When you think what that covers, it’s incredible.

@Earlydancing

I want to echo whoever said the NHS is massive & can't be defined by simple personal experiences, too.

I totally agree with this but I have tons of examples of wasted money and time (which ultimately results in a waste of money). Lots of people have examples. Every time I tell someone one of my tales, they can match it with one of their own. Surely this must make people with any say curious as to what's going on? I can't say about reform, but poor staff management /organisation and practices could be improved for very little cost really.

Unless you’ve done it, I very much doubt it 😂

It takes time and effort to make things more “efficient”. You have to

• define what you actually mean by efficient
• identify where inefficiency lies and why
• work out if making things more efficient has unintended consequences
• give people the headspace to do the above, which takes resources = money

Having worked in a massive local authority, I realised this. People kept saying about how much more efficient things could be but it took a lot of effort and time to try and do it - which is incredibly difficult when they’re also doing their day job.

And invariably you’d get people with great ideas for savings, but they weren’t actual savings - they were just pushing costs and activity to another department which didn’t save any money.

Of course the NHS is inefficient in many ways - every organisation is, public and private.

Yes it is underfunded.

The deterioration of services has clearly been in line with the year on year funding cuts.

There are doubtless other problems too, but the funding is a huge, huge issue.

The PFIs are where the money is being wasted.

What @VerveClique said x 💯.

Yes underfunded when it was set up the never envisaged that 1 persons course of treatment could cost 2million plus .

This was confirmed by me friend who's a band6 and earn 43k last year

Also… the biggest misunderstanding of all…the NHS is NOT one organisation… so unlike a lot of the big businesses named above, it really does not have a centralised management structure. The large National and regional bodies are more like funders, planners and regulators than actual executive management teams.

GP practices are all private employers. Hospital trusts and community providers are all separate entities. Mental health providers and specialist centres are all separate again . Supply chain and logistics… separate. Social care… completely separate and not even within the NHS.

People think that because it’s generally ‘free at the point of accessI’d that it’s free. But they’d be shocked if then knew the scale of financial transactions that go on even in the public sector. Staff have to be paid, supplies, equipment, insurance…. It is a MONUMENTAL operation.

And having two separate blood tests might indeed be more efficient for the service (although clearly not for the patient, which should be the primary consideration).

@VerveClique

Also… the biggest misunderstanding of all…the NHS is NOT one organisation… so unlike a lot of the big businesses named above, it really does not have a centralised management structure. The large National and regional bodies are more like funders, planners and regulators than actual executive management teams.

GP practices are all private employers. Hospital trusts and community providers are all separate entities. Mental health providers and specialist centres are all separate again . Supply chain and logistics… separate. Social care… completely separate and not even within the NHS.

People think that because it’s generally ‘free at the point of accessI’d that it’s free. But they’d be shocked if then knew the scale of financial transactions that go on even in the public sector. Staff have to be paid, supplies, equipment, insurance…. It is a MONUMENTAL operation.

And having two separate blood tests might indeed be more efficient for the service (although clearly not for the patient, which should be the primary consideration).

Yep

I am a rapid response nurse in the community. I covered a 70 mile square radius on my own last week, 3 patients who are at the end of their life and needed pain relief and sedation had to wait between 2.5 and 3 hours for me… yes, it is terribly underfunded.

The average chief exec of a hospital is 106k.
They then have a number of managers under then between 80-95k.
There are a lot of managers compared to other service industries.
Yes the NHS is under funded. Health care is costly. However there is a huge amount amount of mismanagement in the NHS. Fraud, misappropriation of funds and nepotism are all rife within its system.
Unfortunately the good managers (and there are some bloody brilliant ones) often end up getting pushed out by the shitty bullying ones who are in it for feathering their only nest.
Also most managers in the NHS have been crap clinical staff, and clinical staff often don't have the skill set needed for management.
Again not all managers, I know a few fantastic managers who really do care about patients and their staff alike, but these ones are like gold dust.
I'm also not talking about clinical managers here, who again for the most part really do give a damn about their staff and patients, it's the non patient managers who very often leave a lot to be desired.

@rwalker

Yes underfunded when it was set up the never envisaged that 1 persons course of treatment could cost 2million plus .

This was confirmed by me friend who's a band6 and earn 43k last year

Not the point of the post, but the top pay bracket for a band 6 staff member who has more than five years experience is £39027 not 43k.

A huge amount of tax payer money goes to the NHS only to be wasted on mismanaged, over administered, out of date processes and business practice. It is hugely inefficient and adverse to change. We could double the NHS budget and people would still say it is underfunded and we would still have the same problems. Money alone doesn’t solve inefficiency, there needs to be the will to change and improve.

Having worked as a supplier to the NHS its not fit for purpose.

People expect so much more but arent necessarily wanting to pay more for it and often have illnesses that are due to their poor management of their own health let alone an elderly population with people living longer and longer often with no real sense of quality of life. Not everyone but a large %. I visit a private care home once a week and its heartbreaking to see people who are just existing.

They waste huge amounts of money and there are cottage industries all over the place. Fiefdoms with people taking months to make decisions to ensure that their job is safe.

We need to start a co payment system like many countries in Europe.

I wouldn't be basing any train of thought on a book written by Adam Kaye. Odious little prick.

Not only underfunded but hugely disorganised too.

A small example is, why do hospitals and doctors send each other letters when they could send confidential emails. That must cost a fortune and slows down communication!