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'...

The drop outs and bottom set kids became managers and when I returned to work as a senior clinician it was clear they had no clue.

good managers go and earn lots in the private companies

I have worked in the NHS for years
My opinion is
Underfunded
Too many managers who can't manage
Not enough front line staff or respect for them
Wasted money on DEI, rainbow lanyards, crossings and so on
An honest conversation is needed about what the NHS can and should provide

And it is abused by patients and their families. We are expected to solve too many social problems probably due to underfunding in other sectors and people being unwilling to take responsibility for themselves or family members or pay for needs out of their own pockets ( not healthcare needs)

Thank you for this summary post.

The tabloids have pushed the line that the NHS is wasteful for so long.

This post nails it!

Do you have stats for: our population is bulging (at either ends of the age range)? Birth rates are falling, fertility rate the lowest ever.

We have all those things on the NHS where I live in London, though, so perhaps it's just that different trusts do things differently around the UK?

Good social care that enables consistent prompt discharge?

Anyone that works in the NHS can be truly and genuinely shite at their job but they won't get the sack as they cannot be replaced.

Maybe some of the armchair critics could come and do my job.

NHS management is really tough, with managers doing at least twice the work they were doing 10 years ago. Plus around 50% of NHS managers are clinical, so the 'Bring back Matron' crew can retire. The real problem is huge increases in demand without the funding keeping pace. Perhaps if people want a first class health service they would be happy to see an increase in general taxation.

I struggle daily doing a fairly fucking thankless job with around 15 unpaid hours every week. I could leave, but I really care about what I do. It's good to know I'm lumped in with someone's opinion of bottom-set dick heads.

I honestly think that systems are some of the issue- all our medical appts in our trust are managed by a central team across different departments.
No one system apparently talks to the other (unless you are the GP who gets copies of most things). Ages to get an appt or a follow up if needed. There's always some cock up about letters going to the wrong address or phone number not been ticked for reminders etc.
Yet there is one specific appointment that DC has- the appointments are entirely managed by the team of medical specialists who work in the department in that particular hospital. It has the lowest waiting list in the entire country for treatment (something ridiculous like 2 weeks). I can phone if DC has an urgent issue and we get squeezed in the same day- more importantly, I can actually speak to a consultant on the phone if needed! There is no fuss, if people arrive early but someone else is late they are simply swapped over and seen accordingly.

Other than that, I agree with what everyone has said. Underfunded, understaffed, mismanaged, abused and wasn't built for a population that is absolutely enormous and unhealthy. Until our general social care is sorted the NHS will remain as it is. And I say that as someone who is disabled and has had to use it since birth.

Wasted money on DEI, rainbow lanyards, crossings and so on

I have a rainbow lanyard from when I worked for NHS. I use it daily in my other job now. Other than being given a rainbow lanyard I can't remember any DEI initiatives when I worked for NHS.

Oops, sorry everyone, my rainbow lanyard is the Big Bad expensive baddy. Nobody told me that each lanyard cost ££ millions.

What is an NHS "crossing" ? Is that like a crosswalk?

An organisation trying to run with zero spare capacity will inherently be running inefficiently. It's like wondering why someone on a very low wage can't afford to get all their goods cheap, when the goods are only cheap if bought in bulk.

DH briefly worked for the NHS doing maintenance. The main part of his job was arranging contractors to do basic jobs he could do. The contractors charged inflated prices because it was the NHS. One job required three call outs with the associted charges, and the fault still wasn't fixed. DH did it himself and got pulled up for it. He couldn't believe the money he saw being wasted because 'that's the way it's always been done'.
Reform in all areas is necessary, at the moment the money is falling into black holes in many areas

Interestingly, in my last job (which was not in the NHS) our manager was replaced by someone who'd been a fairly high-level manager in the NHS.

Boy, what an eye opener! They seemed actually incapable of doing anything other than writing long (boring and mostly unnecessary) emails all day long. After about 5 years, they still didn't know anything about how things worked and hadn't pitched in to help with anything at all.

Sorry, not meaning to denigrate any hard-working managers here - but I really do think there's a problem in this country with 'managers' and their use and abilities. Far too many of them sitting up in the clouds without the first idea of how anything works or how to solve problems.

I used to be naive and think funding is the problem. I now realise that wastage and poor management are the main culprits. Far too many in very well paid positions making very expensive bad decisions.

As a NHS nurse I totally agree. We have a midwife in charge of CAMHS as it come under W&C as opposed to mental health. How on earth rhey can make clinical decisions is beyond me

That’s rubbish they are managed out the same way rhey would be in any public sector Union recognition job.

If you ask the staff, they will tell you that it has been mismanaged for decades. Which is why we shouldn't be pouring in more money!

The State...................dont smoke dont drink dont be overweight, get plenty of excersise, work full time, protect the NHS!
Also The State...................run yourself ragged caring for elderly relatives!

It's a bit of cognitive dissonance to say that managers who aren't clinicians or the right sorts of clinicians are the problem, but we need nonclinical business people to come in and fix stuff. Which business people? The ones who run Openreach? Price Warerhouse Cooper? I akso hear we spend too much on bysibess consultants, so where dies that fit?Tbh I've known GPs who are natural business leaders and an awful lot who aren't, and why should they be?

I think a lot of the NHS works pretty well if I'm honest. There's just so much of it that you can find lots of disastrous parts as well, and the disastrous parts are terrifying and unacceptable.

I do think we should be able to learn better from parts that work. There clearly are maternity services that don't kill babies on the regular. What are they doing right?

I'm an OT and I agree 100% with this

Both. Both my DS's were referred to a top London hospital, the best in the country for a genetic condition (it isn't a major condition but something that needs continual checking), and every appointment is a chasing battle. I feel very grateful that they are at this hospital and when I'm there they are great and the consultant will say (as an example) 'they need to come back for an appointment in 8 weeks at the end of November so please call in 2 weeks to book one' I call in two weeks and the reception say 'there is nothing right now, we'll call you in another 2 weeks when there are appointments available on our next round of bookings'. I then ask 'ok so I don't have to call and you will call me?' They say yes. So I leave it for about 4 weeks and nothing. So I call again and they say 'oh we can book you in at the end of February.'. There seems to be no communication between consultants and the booking system which admin organise.

primary care is woefully underfunded given that it has 95% of patient contacts for only about 9% of the budget.

I agree with most of your post, but this statistic is a bit misleading. Secondary care is where all the eyewateringly expensive stuff - surgery, ICU, radiology, trauma, chemotherapy etc. - happens. However, obviously primary care needs to be better funded.

I wish they would introduce a couple of things which to me are 'quick fixers'. I mean they wouldn't fix all the inefficiency of staff/rip off contractors etc but it would be a start at least.

Charge everyone a small fee for each gp or hospital appointment so non shows drop. You pay the fee, you get your appt. Don't chase people to pay. Pay or no appt given. Harsh but effective.

Set up a old people transition place where they can be discharged to. This can be staffed by people who can liase with social and set up care packages etc. Sort of like an NHS temporary care home. This stops all the bed blocking in hospital, frees up ambulances from hanging around for hours and generally gets things moving.

We had them They were called cottage hospitals. Thatcher shut them