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'...

@BareWallsNoMore I agree a charge per appt would be a good step but it will never happen as there will instantly be claims that, like prescriptions, some people should be exempt and by the time you take out the under-16s, the over-65s, pregnant women, people with certain health conditions, people on low incomes, etc it will be like prescriptions where only about 10% pay.
I can guarantee you that 10% are not the people who miss appointments

This totally, could not agree more!

My fault, I typed too quickly and carelessly. Rather than overall numbers I was considering NHS need.

The birth rate IS falling, but I was thinking of the earlier live births meaning more high-need very young patients due to disease and disability that wouldn’t have previously survived (and not a criticism, I have one of them) as well as that increased older population.

Of course, secondary care is obviously more expensive due to the nature of the equipment, care and staffing.

But patients can’t generally access secondary care provision without that primary care contact. Improve that and staff that better alongside public health and preventative measures and I bet the demand in secondary care would reduce.

Chatting with our pharmacist, he said that if everyone, with absolutely no exceptions, just paid a pound for each prescription it would bring in more money than the 10% paying a tenner.

As to the sickness piss-take, my cousin works with someone who spent four months in Greece with their 'sick husband'. No action taken. So she's repeated that at least twice more. That sort of crap is undermining the morale of the other staff.

Neither underfunding or mismanagement, but a service that worked when life expectancy was 70-odd years but cannot cope when life expectancy has increased to 82/84. The cost of that last decade is far, far higher than any other decade of your life.

No, good point, we certainly don't have good social care on discharge from what I've heard (though I've not experienced it personally, as not needed it yet).

I'm in social care and people/ politicians don't seem to realise that the NHS needs social care to be sorted out. Otherwise it's just like filling a bucket with a hole in. If you can't discharge people, then what hope do you have of reducing waiting times? Care homes are needed, carers are needed for providing care to people at home, suitable housing is needed.
If you get a chap who is street homeless, drinks himself into oblivion, comes into A&E every week, what's better? A&E to keep patching him up or we find the poor chap housing and support to get clean? This is attempted in hospital at the moment but there is no support. Essentially all the other services being financially run down for ten years of Tory rule is why the NHS can't function. And we're getting sicker as a nation.

A higher than average amount of piss taking in relation to sickness absence and poor performance which is never address.

This has been mentioned a few times lately and I’m not convinced.

NHS staff are by definition dealing with sick individuals day after day after day. Hospitals have recently been declaring critical incidents due to flu and it’s noroviris season. Yes they have PPE, but that does npt provide magic-levels blocking of all germs either.

Do you think NHS staff, magically, have more resistance to the much larger quantity of germs they are daily exposed to than the average person? The germs they’re exposed to are likely to be stronger strains too, to present in hospital. It’s fortunate more are not off sick imo.

Neither; too many old people being kept alive (before you flame me I’m old too).
I remember my grandparents era when you got to your 60/70s then had a short illness (heart/cancer/pneumonia) and you were dead shortly after.
Now people can be cured of most illnesses and kept alive for another 10/20/30 years. Unfortunately these extra years contain numerous doctors visits and hospital stay which cost thousands.

I like this idea.

I would also not give free prescriptions to those with diabetes 2 when my DD struggles to pay for her asthma treatment it seems unfair.

Although I guess this is promoted as they want people to take the diabetic medication due to the complications if they don't and the further strain this would add to the NHS.

This is the crux of the problem - demographic changes.

People are living much longer and expecting much more from the NHS than when it started.

People living longer is a good thing overall but it requires a sustainable funding model which we don’t have and it’s too politically difficult to change.

We want the best healthcare but think someone else can pay for it in a nutshell.

Having just done jury service, there is staggering levels of inefficiency in the judicial system. It's not too much of a reach to imagine similar scenarios in other public sectors... institutional incompetence. They can't even see it.

@haremscarem55 oh we can see it! We're just not allowed to do anything about it.
I would make huge changes,

• bring aftercare back in house so we reduce care agency fees. 7K a week fees are not that unusual anymore for someone needing specialist care. An RN does not get 7K a week. Someone is profiting massively.
• change sickness policy
• make it easier to sack for poor performance and that goes right the way up to consultants too
• stop paying band 7 salaries to non clinical staff to essentially do admin jobs such as circulating emails or checking who has done their mandatory training.
• make more nursing apprenticeships and allow staff to claim UC whilst studying nursing/ midwifery etc
• on-site hospital nursery's to allow parents to carry on working in the NHS after maternity. That is a big reason we lose staff.

These problems in the judicial system have been created by underfunding by the last government.

Running something well does cost a certain amount of money.

The cuts have affected everything - buildings get shut due to roof leaks, systems break down, there are cancellations due to lack of staff.

The inefficiencies you witness are due to being run on a shoestring.

Where I am there's a recruitment freeze so we aren't even allowed to recruit when there's a vacancy. Also there is no backfill when someone goes on maternity leave either

• Too many managers and not enough Band 2 / 3 / 4 admin staff.
• The NHS is now a business. One department has to pay another department for a service. Why?
• Sickness policy not being used correctly to identify the piss takers who regularly take 5 1/2 months off sick and go back to work just before they go down to half pay.
• They need to bring back the probationary period for new staff so they can get rid if it isn't working out.
• Workloads just keep increasing with no extra staff to do the work putting pressure on existing staff.
• Pay rises (on the odd occasion we get them) not in line with inflation.

We are both NHS doctors.
There is no easy fix but

1. reduced expectations from everyone - the NHS should do the basics/life threatening/urgent really well but providing everything is so unrealistic in this day and age. Sadly I know think we now need a system where some things require to be paid for / type of insurance as healthcare has just grown too big in scale for an ever growing population to be all for free
2. sorting out nonsense like every trust replicating work endlessly with their own policy in x,y,z and zillions of different IT systems - these could be the same everywhere

Have a relative who is close to 90. They were diagnosed with a terminal condition. They have been given very expensive treatment for the past 2 years which is currently ongoing and keeping them alive.
Given the NHS has to make treatment decisions every day based on cost, I really don't understand how this is justified or sustainable.
My Grandfather was diagnosed with the same condition 30 years ago, he was just 60, no treatment and he was dead in a matter of weeks.

Yes. And we had convalescent homes for patients recovering from surgery to free up the acute beds.

Spain ;)

Every time there is a spending review the kings fund and other healthcare think tanks model how much funding is required to enable it to meet key targets. Every time it gets a fraction of what is required but make nhs england sign up to unrealistic targets as a condition of receiving funding.

Then the politicians act suprised when said targets aren't met down the line.

To this end there could be some benefit in the nhs england abolishment albeit not sufficient to justify the effort required to enact it

When I worked on digital transformation in an nhs trust funding was also incredibly inconsistent. For example funding for a national initiative to improve the ability of providers to access care records was cut despite the obvious benefit then some because available in tbe last 3 months of the year but there was no time to use it and then no funding the following year

Workforce shortages are the biggest issue and successive governments have failed to increase the pipelines of trainees.

Chronic missmanagement, waste and dire incompetence are the norm. And I say that from experience. Unfortunately all the posturing the govt is doing is just that. They are not doing anything of value. Last labour govts did the same. ever 2-4 years massive expensive reorganisations, putting lipstick on a pig. Nobody cares, jobs for life for people who will not manage to get a job somewhere else, abuse of public funds, corruption at all levels. I felt sorry for the poor clinicians, at least some of them

I've worked for the NHS for almost 30 years.
I can do my job, understand how the NHS works and I am not liked because I am a challenger to ideas that don't seem appropriate. I am sadly not a yes person, so will never achieve promotion. Others who have been in the job 2 minutes get the promotions, yet cant do the job, but say 'yes' frequently.
The top management struggle to make decisions and problem solve. Egos (and a lack of knowledge) from promotion are an awful tragedy to render these people a total waste of time.
If it was run like a private business (I don't mean the NHS should be private), then the dross would be cut loose and the staff who can do the job would be in post. Trying to remove a staff member due to poor performance is pretty much unachievable.

Yes, I can relate, it has been my experience as well for many years. More people should speak up the truth.