Page 5 | Is the NHS really underfunded?

BobbyeinArkansas · 2022-03-10T23:41:42+00:00

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.

Earlydancing · 11/03/2022 18:33

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.

I struggle to understand why these things get defended. It doesn't require extra staffing to put water where people can reach it, put crutches within arms reach, to put bedpans next to the bed, to do blood tests once instead of twice, to take equipment that you need with you. In fact if it had been done right the first time, staff wouldn't have to do it twice so their workload would naturally be decreased. Giving people water and checking they're drinking should be so routine that it requires no thought. And that's where leadership on the ward is so important. They should be modelling the care that needs to be given to patients.

And, actually, thinking that people perform less well if they're not paid much, is a bit insulting. I taught, where I got paid quite well, and I worked for a charity, where I got paid a lot less. But I worked really hard at both. I never looked at my wage packet and thought I can work less hard for this job.

WeddingHangover · 11/03/2022 18:37

@madroid

The real problem with the NHS is the 40,000 nurse unfilled posts and the 9,000 unfilled doctor posts.

That means existing staff are overworked and stressed and patient care is unsafe - leading to more staff leaving the service.

Not enough new recruits are trained to fill the massive staff shortages altho Boris says there are 60,000 nurses set to be trained in the next 5(?) years. But who knows with Boris whether that's true?

Funnily enough….. the Foundation programme ( where brand new graduates start) is oversubscribed by 800 people this year……and they won’t all necessarily get jobs!

Beachsidesunset · 11/03/2022 18:44

In 2020 the NHS cost £269bn. How much should it be receiving?

Blossomtoes · 11/03/2022 18:46

@Beachsidesunset

In 2020 the NHS cost £269bn. How much should it be receiving?

A percentage of GDP in line with other first world countries would be a start.

SorrelForbes · 11/03/2022 19:11

@VerveClique

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).

@VerveClique I've been an manager in the NHS since 2000 and I couldn't agree more!

knitnerd90 · 11/03/2022 19:11

I work on the administrative/policy side of the US health system. I assure you, what you think of as overpaid & inefficient is nothing. There are things I would change about the NHS, having studied international health systems, but £80K, £120K, that's not the big money you think it is. Perfect efficiency is impossible.

People think public sector workers should be underpaid, and they shouldn't. US salaries are absurd: hospital chiefs can make millions. But even in Canada, where hospitals are public, they make well into six figures, and their doctors and nurses are better paid too.

rwalker · 11/03/2022 19:24

@Stompythedinosaur
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.

Add on evening weekend allowance and bank shifts .

Motnight · 11/03/2022 19:29

Absolutely what @VerveClique says. I am also a manager in the NHS.

HermioneWeasley · 11/03/2022 19:34

Both things can be true - we spend less than other developed nations (though their models included a privatised element - only Denmark also has fully socialised medicine); and the NHS is so poorly run and broken than to get any more gains out of it you would have to throw disproportionate amounts of money at it - it’s a black hole. It needs a complete review but no politicians are brave enough to say this and tackle it

VerveClique · 11/03/2022 19:38

I’ve found my people!

Re efficiencies under Labour. IME what got measured got done… so 4 hour target in A&E, 2 weeks for cancer, 18 weeks for pretty much everything else, waiting list initiatives, return to practice targets. This did radiate out into support services somewhat. But in areas where there weren’t these initiatives, the same old story was still happening.

I’d go back to the NHS in a heartbeat if I thought there could be genuine and through-going change. I don’t think there will be though… too many people massaging their egos and protecting their pensions.

Fordian · 11/03/2022 19:51

Today my B7 managers sent out their weekly staff comms (meeting together, in one space, has long since been impossible as that would mean a) Not Imaging Patients, for 30 mins, gasp-and b) allowing staff to collectivise their legitimate grievance).

Point one- 'hey, everyone, there's an increasingly high level of sickness, look after yourselves, take breaks, be mindful of the amount of overtime you take on!'

Point two - 'so, this week we have the following overtime available' (lists 1/5-1/4 of shifts that can't be staffed).

🤔

Kazzyhoward · 11/03/2022 19:54

@VerveClique

I’ve found my people!

Re efficiencies under Labour. IME what got measured got done… so 4 hour target in A&E, 2 weeks for cancer, 18 weeks for pretty much everything else, waiting list initiatives, return to practice targets. This did radiate out into support services somewhat. But in areas where there weren’t these initiatives, the same old story was still happening.

I’d go back to the NHS in a heartbeat if I thought there could be genuine and through-going change. I don’t think there will be though… too many people massaging their egos and protecting their pensions.

Trouble with the entire NHS revolving around waiting list targets was that they no longer cared when a target was breached as there was no difference between a 5 hour A&E wait or a 10 hour wait, it still went down as a failure, likewise, as with my father, the 2 week cancer referral was missed, as was the (I think) 18 week deadline for his cancer surgery, so once the targets were missed, he just went into a "black hole" within the NHS were there was simply no urgency at all - he finally had his cancer operation after around 10 months - so probably twice as long as the "target" but that didn't matter as it was "recorded" the same as if it had been done at 19 weeks. Instead of a binary "tick or cross" against such targets, there should have been some kind of graduated scale, i.e. points added/deducted for doing it quicker than target or later than target, so it would still have mattered and there'd still have been an incentive to do it as quickly as possible, even if a target hadn't been met.

Fordian · 11/03/2022 19:57

@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.

Yes

Namenic · 11/03/2022 22:20

It’s a vicious circle. The most pressing problem is RETENTION of experienced staff rather than getting more new staff in. Basically, you need to make sure enough staff are employed so that they have enough time to do all the stuff on their list (taking into account sickness rates etc) - basically staff wards more than you think is the minimum.

This means staff can do their tasks even if one of their colleagues is off with covid or has to look after their sick child. This means less burnout and less people leaving after a few years. The pay may keep a few people, but most workers would rather be on a well staffed ward than have an increased salary.

Oh - yeah and stop doing more PFI…

justjuggling · 11/03/2022 23:11

I work in a mental health service. Our caseload has almost doubled in the last 3 years and funding most certainly hasn’t. Chronically under resourced.

Jux · 11/03/2022 23:45

Of course it's underfunded. It would actually be impossible to fully fund no matter whether the coffers were full to overflowing or not - the NHS is the sort of thing which will use all the money you can possibly give it and still need more. However, at the moment it is indeed seriously underfunded.

Now, I have a question. Why the inverted commas in your op? what are you trying to say?

HRTQueen · 11/03/2022 23:47

Yes it absolutely it

Also wastes ridiculous amounts of money

Nat6999 · 12/03/2022 04:14

I've been an in patient in both NHS & private hospitals via NHS choose & book & I know which one I prefer, the private one. They are more efficient, everything happens when it should, no waiting for drugs to be dispensed, they are done before you go to theatre, discharge letter is done & signed well before discharge. The staff aren't rushed off their feet, you get the consultant doing your surgery, not a registrar. Pain relief is top notch, no waiting hours in pain, an ensuite room to yourself. Having had 5 operations at the same hospital the staff know me, the nurse treating me knew I was very nervous & preferred to get done & discharged home ASAP, she spoke to the consultant & got me first on the list & last time I was back home by 1.00pm done & dusted.

mellongoose · 12/03/2022 05:43

@Beachsidesunset

In 2020 the NHS cost £269bn. How much should it be receiving?

All tax payers' money and still we are told it is underfunded.

I would argue it is oversubscribed. Personal responsibility for health has gone out of the window. This is an unpopular opinion, I know. NHS staff can do wonderful things but we should be spending more of this budget on lifestyle changes and preventative care.

FixTheBone · 12/03/2022 05:52

@Cumbercat

Charts from the King’s Fund. Our spending is average for comparable nations. Real terms funding has not been cut. Demand outstrips supply.

A little care is needed with blunt data like this.

Without context of the size of the population, the numbers of sick people, relative cost of wages, etc the %gdp data is fairly abstract.

FixTheBone · 12/03/2022 06:00

@Nat6999

I've been an in patient in both NHS & private hospitals via NHS choose & book & I know which one I prefer, the private one. They are more efficient, everything happens when it should, no waiting for drugs to be dispensed, they are done before you go to theatre, discharge letter is done & signed well before discharge. The staff aren't rushed off their feet, you get the consultant doing your surgery, not a registrar. Pain relief is top notch, no waiting hours in pain, an ensuite room to yourself. Having had 5 operations at the same hospital the staff know me, the nurse treating me knew I was very nervous & preferred to get done & discharged home ASAP, she spoke to the consultant & got me first on the list & last time I was back home by 1.00pm done & dusted.

Which is fine in isolation, but if the NHS was exactly the same, there would be no registrars being trained and therefore no surgeons at all in 20 years....

The NHS is forced to take on all the work the private sector doesn't, so if you were ASA 3+ (higher anaesthetic risk) chances are the private sector wouldn't have taken you on at all. Need a HDU or Icu bed afterward? NHS. Postop complication at the weekend? NHS. Need emergency care? NHS. Had previous mrsa +ve swab? NHS.

All of that high acuity, unpredictable, complex work is why the NHS seems more chaotic.... Because the workload actually is. In order to mitigate that, you need a huge amount of slack in the system - 10—20% more capacity to deal with the peaks. Problem is when there's a trough and empty beds or unoccupied staff, it's seen as wasted resource, so it's run on a knife edge as though efficiency was the be all and end all of hekathcare.

postitnot · 12/03/2022 08:58