NHS - underfunding or mismanagement?

[melonhead]

It's clear that the NHS is not offering a great service anymore, but is that because of the 'chronic underfunding' line that gets trotted out or more likely that the funding it gets is not spent very effectively?

The amount of NHS employees off sick at any one time is insane, yet it seems to be almost considered a perk of the job. Plus the lack of accountability for how the money is spent, yet saying 'there needs to be more'...

Starmer said no more cash without reform in acknowledgment that the system is not fit for purpose. So we shall see...

Both! My niece, senior nurse in specialist area, says they have managers with no clinical experience causing all sorts of mayhem and really not having any understanding of the needs of the patients.

Both, plus inefficient communication systems in the age of instant communication, wasted resources, insufficient clinical staff and a host of other things that require funding, but mostly, joined up thinking and fewer managers with no real purpose.

Too many management positions that are NOT needed getting paid a shit load of money to do absolutely nothing!!

I’m not sure but something needs to be done and quick. My elderly parents were in A&E for 8 hours recently. It’s not good enough. I wish some proper business people would go in and give it an overhaul. If it means we have to pay a bit more NI then so be it.

Definitely both

I still cannot work out why they can't have a centralised database so that they don't have to faff around with letters all the time for referrals or where the patient is currently in the hospital (ward & bed number).

Both.

Both. It's interesting as I'm no longer in the UK and currently in hospital so having first hand experience. No going to a ward before the op. You go straight to the theatre at an appointment time. Bed blocking isn't a thing. Good social care on discharge so no unnecessary stays. Excellent community care eg. I was discharged this morning but the nurses are coming every day to do my IV meds rather than stay In hospital. GPs, we take a ticket and go in when your number is called. Self referral for specialist service. Eg I book in for a gyny appointment whenever I need one. More efficient all round also our taxes are higher and healthcare is a priority so funded reasonably

That sounds good Maddy - where are you?

Both. But also lack of healthcare professionals of all types to fill vacancies.

Neither IMO.

The NHS isn't even a thing any more - nothing national about it. It's fragmented and huge and unwieldy. Different areas/ICBs/ trusts/funding streams.

It's gone way beyond whatever it was set up to do. It tries to be all things to all people and it's not funded adequately to do that. It's used and abused as it's free at the point of delivery and very generally speaking the heaviest users are the lowest contributors, so it's insufficiently funded and primary care is woefully underfunded given that it has 95% of patient contacts for only about 9% of the budget.

Our population is bulging (at either ends of the age range), and social care is a disgrace. Until that's funded and managed properly nothing in the NHS will change.

It needs depoliticising, stripping down and re-framed but no-one in power will ever have the guts to do that.

Expectations are much too high, from patients, public and crucially politicians.

Lack of vacancies too. When someone leaves they often don’t recruit, then when other staff cover they say the post isn’t needed, then the remaining staff burn out and it all turns to shit.

in the mid 90’s labour’s policy was actually to throw a shit ton of money at the nhs to “prove” it wasn’t funding but that the actual model was unworkable, this opening the door for privatisation. I went to several conferences on “social enterprise” and how departments could technically be privatised. Same with pfi buildings etc.

the money obviously got spent on pfi, computer systems (including the one that was a spectacular failure and never worked) conferences for management and staff like the above, and not on core services. In fact they stopped many services in that time.

having been staff I do think it’s mismanagement a of both funding and services. They need to start staffing properly so staff can do their jobs properly not just firefight all the time and burn out doing too many hours. Then expensive locums wouldn’t be needed and it would start to become more efficient - the old do it properly in the first place and save money compared to doing it badly and having to spend more money fixing it.

so yes, that’s my opinion. Throw a shit ton of core staff at it.

I agree with this and @Sidge .

The NHS was never intended to meet all the demands that are being placed upon it. The funding model just doesn't work to do this and no amount of efficiencies or tax rises will fix this.

Sadly I think one of the biggest legacies of the NHS will be a sense that we are no longer responsible for our own health. There is an assumption now that the state has more responsibility towards keeping us healthy than we do ourselves which is obviously completely insane and unsustainable. We need to follow the Dutch system and move away from the completely false ideal that we can all have excellent healthcare from the NHS in its current form.

Putting aside anecdata, my understanding of the academic reviews of international comparisons show -

The UK NHS significantly over-performs comparable nations based on the level of funding and age profile of the population.

The UK NHS is relatively under-administrated/managed.

The better-performing health systems such as France have long-standing higher levels of total spending/investment compared to the UK's 'stop start' adequate/inadequate funding levels.

The UK ruthlessly exploits it's monopsony to exploit HCPS.

This doesn't match the prejudices of tabloids and many PPs so ...

this basically.... too many chiefs and not enough indians

I’ve worked in the NHS and if I were asked to sort it out I’d start with overpaid managers and lack of discipline in staff. The number of staff who don’t adhere to uniform policy is staggering.

A bit of both but mainly it is expected to cover more and more stuff that it was never designed to do. A combination of an aging population needing more and more care with a hugely unfit middle aged population being much heavier users than could have been predicted in the post war era and advances in diagnostics, interventions and drugs meaning people get treated for things that they would have just put up with or died from in the past. Quite basic things such a knee and hip replacements and cancer diagnosis and treatment is being done on a scale that would have been unimaginable to us 70 years ago. It’s not a bad thing that we have the tech to deal with stuff like that now but it is a bad thing that a lot of the need for it is lifestyle related. A huge amount of the burden on the NHS is from lifestyle. Diabetes and obesity being the obvious ones but I see many more relatively young patients presenting with avascular necrosis of the hips due to drinking. When people are presenting with things that aren’t lifestyle related then it’s often complicated by lifestyle related comorbidities which make them more complex and more expensive to treat. I read the thread yesterday on small kids not being able to do basic stuff like turn the page in a book when they start school and a swimming teacher posted that small kids don’t have enough core strength to cope with swimming lessons anymore and even quite big kids aren’t strong enough to lift themselves out of the pool. The unfit gen x were starting from a much higher standard of basic fitness in childhood so fuck knows what’s going to happen to gen alpha when middle age hits them.

Well put . Completely true we get what we pay for, it's underfunded and underinvested

Both. So much money is wasted on inefficient practice. Some of the processes don't make sense at all. Also an ageing and increasing population isn't helping. It's almost impossible to get a routine doctors appointment, you have to be really ill and then it's still 50/50 so end up at he walk in centre or A&E where it ends up costing more to treat you. Needs completely re modelling.

Exactly this!

This is a good point. This expectation that we are all entitled to the NHS, yet people don't respect it and that encourages the huge amount of waste. For example, my mum said she'd missed a routine screening appointment because she hadn't got a letter to remind her, yet my sister in France just has to make her own appointment and pay upfront for it (it gets refunded through health insurance). No bloated system of needing reminders and blaming someone else!

Changes in systems that don't actually benefit anybody.
My mum used to walk out of her appointment, then go to the desk with her diary to make her next appointment on a date that suited her.
It all changed so she couldn't do that, she had to wait for an appointment letter, that on most occasions she couldn't make, so them had to call to change the date.

More a hugely wasteful organisation with terrible management.

I don't think it's underfunded.