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.

Both, I would imagine

nepotism [is] rife

how ? Sincere question. I don't get it. Does PP mean to do with procurement, like Gordon Brown hiring his brother's cleaning firm (does that mean no relatives or friends can ever provide services?), or someone hiring the daughter of a friend to do a job? Where is evidence for that claim of nepotism?

Probably not nepotism in operational areas s as such, but certainly favouritism, and appointing ‘people like us’.

Anyone without NHS experience is overlooked for non-clinical roles, and the few who do make it through often don’t last long.

A lot of NHS managers and clinicians alike think that they’re ‘special’ and misunderstood asa class of employees/organisation, and it creates a massive echo chamber devoid of critical thinking and constructive challenge.

@MrsLegend

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!

Referrals have been electronic for at least 10 years.

Referrals have been electronic for at least 10 years

Indeed. But there are still trusts and depts that don't utilise that. DH goes into hospitals which still use faxes ffs. Many, many, departments still send out letters for appointments rather than emails, and then complain when patients don't turn up. It's ridiculous.

Also those figures for GDP per person spend by other countries. Don't forget these figures are inclusive of privately funded spend. Our figures are not, because we have a fully socially funded system.

As an aside to OP's watching This is Going to Hurt - it is set 20 years ago, in the era that some are saying was better. It really wasn't, and a lot of the things Adam experienced don't occur anymore due to legislation.

Also those figures for GDP per person spend by other countries. Don't forget these figures are inclusive of privately funded spend. Our figures are not, because we have a fully socially funded system

No, they are for total healthcare spend, both State-spending and private, in each country. They include private healthcare spending in the UK, which is about 21% of our total healthcare spend.

IME so many things are done badly the first (or more) time and then need to be done again properly. Whether that's because of underfunding or the cause of not being able to meet demand I don't really know, probably a bit of both.

Been hugely inefficient and mismanaged for decades. Many long-term staff would argue that the last thing to be done is to give it more moneyb- it would be like continually pouring water into a bucket with a hole in it! We urgently need a Royal Commission to look at a number of funding alternatives & preferably one that encourages both staff and patients to bear some level of accountability and responsibility.

It was pretty efficient and well managed from 1997 to 2010, it was also relatively well funded during that period. The additional money was linked with performance improvement and it worked. It went to shit completely with Lansley’s reforms and has never recovered.

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
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.

I suppose you could do an efficiency study or you could just tell staff that when they put water jugs out, they put it at a person's elbow instead of their foot. So when I had a back operation and was instructed to drink, it would have been a good idea if I could actually have been able to reach the water. Instead of having to summon the nurse. And my friends mother's tongue went black from dehydration because they kept the water at the bottom of her bed', which cost money to put right.

Or another friend had had both of his lower legs amputated and instead of putting his crutches by the side of his bed so he could go to the toilet, etc, he had to keep calling someone to get them for him. Or how about a lady next to my sister in bed with a stroke, she had to summons a nurse to use a bedpan. But instead of keeping them next to her bed so they could put her on it straightaway, they had to go off to a cupboard and return 10 mins later by which time she had wet herself. So then it took 2 nurses to get her out of bed, strip her, clean her, redress her, and change all the sheets. It was distressing for her (most important), wasted nurses time and cost money laundering the sheets.

To be honest I've got loads of these examples. They don't need an efficiency study, they require common sense and a good (actually, just adequate) leadership. My mum was only in hospital for 3 days and they lost her notes, accused us of dumping her at a&e and scarpering (she'd been booked in by her gp and we took her to the, and where they wouldn't let us wait with her - all written on her lost notes!) and tried to discharge her without her medicine. They came to her house to give an iron infusion a week later and the nurse, who does nothing but these type of infusions in the community couldn't get a vein. But she had a great piece of equipment that can see where the vein is and how deep so she can always access one. Except she'd forgotten to bring it that day. So my mum had to go off to the hospital the next day. I don't mind taking her to hospital but it seems to me that that was just a waste of a nurse's visit.

So no efficiency study required, no passing the buck to the next department, just doing stuff right the first time. I can't believe that it's only my friends and family that are unlucky so this must be happening regularly all over the country.

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).

I'm not a hero or anything but if it's more efficient to do something in a certain way, I'm glad to drive my mum round to do it. I value the NHS, and on the whole I've had great experiences with staff who couldn't have been lovelier to people in my family. But how is having two blood tests and taking two appointments in two weeks more efficient than just having one? When someone is 86, they all know they have an annual MOT. How is it efficient not to look up when it will be? The nurse doing her MOT said she'd have to come in anyway for her review. Er why? They told me I had to go get a blood pressure unit and do 3 BP readings, measure her waist and weigh her, and hand those details in. In fact they have a form for her to fill out and then they just transfer it onto the system. All the nurse did was take her blood and sent us on our way.
I'm of the opinion that every large organisation makes mistakes. It's inevitable. But it's the regularity of stuff that it frustrating and makes you lose confidence. And my gp surgery has been good over covid. It's been open throughout covid and according to my friend who manages a care home, they have been the best of all the local practices at looking after their patients during the pandemic.

@Earlydancing

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
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.

I suppose you could do an efficiency study or you could just tell staff that when they put water jugs out, they put it at a person's elbow instead of their foot. So when I had a back operation and was instructed to drink, it would have been a good idea if I could actually have been able to reach the water. Instead of having to summon the nurse. And my friends mother's tongue went black from dehydration because they kept the water at the bottom of her bed', which cost money to put right.

Or another friend had had both of his lower legs amputated and instead of putting his crutches by the side of his bed so he could go to the toilet, etc, he had to keep calling someone to get them for him. Or how about a lady next to my sister in bed with a stroke, she had to summons a nurse to use a bedpan. But instead of keeping them next to her bed so they could put her on it straightaway, they had to go off to a cupboard and return 10 mins later by which time she had wet herself. So then it took 2 nurses to get her out of bed, strip her, clean her, redress her, and change all the sheets. It was distressing for her (most important), wasted nurses time and cost money laundering the sheets.

To be honest I've got loads of these examples. They don't need an efficiency study, they require common sense and a good (actually, just adequate) leadership. My mum was only in hospital for 3 days and they lost her notes, accused us of dumping her at a&e and scarpering (she'd been booked in by her gp and we took her to the, and where they wouldn't let us wait with her - all written on her lost notes!) and tried to discharge her without her medicine. They came to her house to give an iron infusion a week later and the nurse, who does nothing but these type of infusions in the community couldn't get a vein. But she had a great piece of equipment that can see where the vein is and how deep so she can always access one. Except she'd forgotten to bring it that day. So my mum had to go off to the hospital the next day. I don't mind taking her to hospital but it seems to me that that was just a waste of a nurse's visit.

So no efficiency study required, no passing the buck to the next department, just doing stuff right the first time. I can't believe that it's only my friends and family that are unlucky so this must be happening regularly all over the country.

That’s all very well, but everyone is full of these tales and I bet your bottom dollar you’d still have to review everything in the round. You can’t react to every single minor event, that’s ridiculous, and you’d end up with a mess of an NHS.

Which is exactly what politicians do and then they keep meddling/tweaking and we end up with a cluster fuck.

And I’m not sure why you think that these incidents are to do with efficiency? Maybe staff did those things because they were over worked and under paid, rushed off their feet so had no time to stop and think.

Which requires more staffing to fix.

It's been about a week since one of these threads popped up.
But I understand why, the NHS and its staff are on their knees, patients aren't getting the care or experiences they expect/deserve and it has catastrophic consequences. And people want answers.

There's been some excellent posts debunking the "too many managers" myth (less now than ever before) and the sort of duties expected of them that are best done by a lower paid admin person than a highly trained highly expensive clinician who has better things to do - ie seeing the patients. There's also been excellent posts affirming the fact the NHS is a hugely complex number of organisations, no two trusts work the same and use different systems which whilst can be a nightmare also prevents big companies that get paid a small fortune to provide the recruitment, patient access system, finance system, rostering system, electronic records system, dictation systems from having a monopoly and keeps the prices more competitive.
I also really appreciated the posts that detailed the difficulty and complexity to enable change to improve efficiencies.

I have another example of underfunding from my experience in work today, our junior doctor on call for the night shift called in sick at 1pm for his shift starting at 9pm (to lay 12 hours) there are no agency docs we can use for this level/type of doctor so have to use of of our staff, everyone who was off on a day off refused to come in for a night shift tonight when asked (understandable) so we had to ask one of the staff working to go home and come back in tonight for the might shift (after the 11 hours of rest they need by law). The usual shift rate for someone wanting to do an extra shift at this level is £40 an hour. The person we sent home refused to do the shift for anything less than £80 per hour. This is obscene but due to patient safety we need this shift covering, so I had to bother the medical director and then the coo to get them to approve the rate. That's £80 an hour for a 12.5 hour shift, double the usual rate.
But now it's been done once you can bet that every time we have a shift uncovered at the last minute the docs will ask for this rate.

For context, for budget purposes my junior doctor budget is for the exact amount of doctors required on ward and on call at any time. Absolutely no accounting for any annual leave/study leave/sick leave or even to back fill when someone is on call. So at any point I have 20% (sickness/leave) to fill plus the back fill of 4 levels of oncall. I have challenged this and spent hours writing complex papers to ask to be properly funded so I'm not always running at a deficit, however it's deemed to expensive to fund. So instead of being funded appropriately for the amount needed, im just in the red and massively over spent and told to think creatively about backfilling the gaps.....
That's just one shifts example in one department in one hospital, but guaranteed it's happening everywhere!

I love the nhs and am massively defensive of it, but my god we do some stupid things.

agreed ^^VitalsStable

@Blossomtoes

It was pretty efficient and well managed from 1997 to 2010, it was also relatively well funded during that period. The additional money was linked with performance improvement and it worked. It went to shit completely with Lansley’s reforms and has never recovered.

It was pretty efficient and well managed from 1997 to 2010

OMG. No it wasn't. Yes, Labour put in money and got down waiting lists. But the day to day care was exactly the same. The crap stuff that happens today, was happening then as well. Ultimately care isn't just about the amount that's put in, it's about how patients are treated whilst they're in there.

Yes. Next question

Yes, Labour put in money and got down waiting lists

Indeed. Cutting waiting times was a massive improvement and it’s the measure most people care about.

All the trivia you’re complaining about is just that - anecdotal trivia. I could tell you things that would make your hair curl but they don’t reflect the efficiency of the NHS but the incompetence of individual HCAs - just like your examples.

Yes,
Chronically underfunded for decades
Mismanagement is there, along with lack of investment in new technology...but the root cause of that is again, lack of funding.

What the NHS needs is strong leadership and good management skills everywhere.

It needs intelligent Board members who can see patterns, and get to the root-cause of issues, and then provide realistic action.

It takes bravery - where there are two Chief Execs or senior leaders in two services or organisations that would be better off merging - then like it or not, one needs to go.

It needs courage to say - no, we're not having 4 or 5 levels of escalation in our sick leave policies (when we only need two before potential dismissal), and no, we're not having someone off sick for ANOTHER fortnight because their union rep isn't available for a meeting, and no we're not putting up with John in medical records speaking to people like that because that what he's always done, and no we're not having our HCAs complaining about making beds because they could get paid more at Sainsburys. We're not sending staff away to 'sort out disagreements between themselves'. We're not having people suspended on full pay for 9 months whilst we find an investigating officer. And we're not letting that manager piss about for another 3 years because they're due to retire then. We're not going to let our very expensive Consultant whatever to be unavailable two afternoons a week because that's when they do their private work next door. And we're not having that PA type up that manager's emails for them because they've never really got the hang of it. And then to say no, we're not writing to the Treasury to get permission to pay someone to leave - sometimes people have got to leave and make room for new people.

The whole purpose of all of this - is not to be nasty, or to put people out of work - but to have an NHS full of content and productive staff who have the skills and support to do their jobs.

There is so much that could be done and that's just the staffing.

With the right staffing, all of the other changes that are needed can be changed.

Also I'm not convinced things really were any better between 1997 and 2010 - but there was a LOT of cash sloshing round in those days to fix all sorts of things (in fragmented ways).

The management are paid huge amounts.
I read that hundreds of them are paid more than the PM.
And that thousands of them are paid from £80,000 - £129,999.
Bonkers

I used to know someone who was management level, he literally didn't have a clue what he was doing, he was paid a very generous wage.

I'm not convinced things really were any better between 1997 and 2010

I guess that was dependent on where you worked. I worked in a trust that was heavily committed to meeting targets in that time. Innovative managers were recruited from other industries to drive change. There were entire days when the A&E waiting room was empty because triage was so slick and the four hour target was rarely breached. Because support services were crucial to achieving that, work was put into streamlining their processes.

Having said that, the rest of your post resonates strongly with me @VerveClique.

@Blossomtoes

Yes, Labour put in money and got down waiting lists

Indeed. Cutting waiting times was a massive improvement and it’s the measure most people care about.

All the trivia you’re complaining about is just that - anecdotal trivia. I could tell you things that would make your hair curl but they don’t reflect the efficiency of the NHS but the incompetence of individual HCAs - just like your examples.

Trivia. 🙄 OK. Giving people water is trivia, letting people wet themselves, losing their notes, releasing patients without medication. All trivia. Yes, it's anecdotal. But the more you have to do with the NHS, the more systemic you see things to be. You too have experienced bad things. Do you think it's just you and me? It's not just the odd practitioner.

There's no point doing the great operations they do, if they don't receive basic care on the wards. My sister had a spinal tap and the doctor told the nurses to make sure she had lots to drink for the rest of the day (because it closes up the puncture hole) and she should stay flat on her back. Within an hour the nurses had my sister out of bed and they gave her one cup of tea and they didn't fill up her water jug. As a result she was ill and had to be kept in longer. Now I get that's trivial in the big scheme of the whole NHS but that one instance took a bed from someone else for two days. These are people with degrees given an instruction by a doctor so how can they get that wrong? And my sister kept telling them they were wrong but they wouldn't have it.

I could tell you a whole long story of how my dad died of sepsis because basically the cardiac dept couldn't arrange a meeting with the dept that dealt with the rheumatoid arthritis he had. But it's just anecdotal. However all these anecdotes add up. I'm not saying I don't admire or that I want to do away with the NHS. But efficiency isn't just about spending by those at the top, it goes all the way down the system, to the lady who wheels the trolley round with the files on and who fails to notice as shes busy chatting while pushing, a piece of paper wafting out of a file and onto the floor. My BIL had to point it out to her.