To think sometimes we need to question NHS efficiency more?

[DayCareCase]

I support the NHS, I’m up for funding it properly even if this affects taxation. I get lots of contracts etc create issues and the NHS has a tough job.

But...

Sometimes it seems there’s a culture of ‘it’s not us, it’s the cut’ that behaviour can be inefficient, service is no just wrong, but simple things could be easily done to make things better. Either at no cost, or even reducing waste. For example our local hospital only sees children for blood tests in the busiest day when all the clinics run. They could change the time, sometimes you wait 2.5 hours with a 3 yr old, when at 3:30 you can be seen in ten min. Or they could run a kids queue, most no cost options.

Today I’m having surgery. The same. Everyone turns up at 7. Even if you’re due in at 4pm. The first load are allocated a cubicle but about half the people sit in the discharge lounge all morning. I cannot see how this is efficient or benefits anyone. Why not give appt times? (Knowing people may still have to wait) or even just the lot you’ve already got marked down as those without a bed until the first case are seen to come in later. No water 6am-4pm is hard!! Surely it makes later finding vines hard, more anxious patients to deal with and a generally more stressful environment?

I’m also sitting next to where the consultant sees male patients. I’m 6 foot from a guy having to discuss his testicles. Makes the whole male/ female division pointless. Moving the desk a bit, closing the door would be cost free.

Small examples, but every time I go there seems to be no real effort to improve. Some individuals work hard. The lower levels of staff are obviously working hard in a crap environment and ready for abuse. So I guess management? Consultants? There needs to be some focus.

Sometimes I think the culture of don’t question the NHS goes too far...

I didn't grow up in the UK and while I love the NHS I agree with you. The system is badly managed and needs a complete management overhaul. And no, I don't mean cuts to services. I mean things like sourcing your scrubs and uniforms from the same supplier NATIONWIDE (think of the discount you could get with that buying power). Learning to schedule appointments more effectively (perhaps with monetary punishment for those who do not attend without proper notice more than three times?) - for instance, if someone breaks their leg and will need physio when they are out of their cast in 6 weeks...schedule that physio NOW , not in 6 weeks when the cast is off making them wait another 4+ weeks to see someone.

Again, I love the NHS. I don't want it to go. Which is why we need to be able to say that there are certain things that are crap about it that need sorting out. You can't improve without criticism.

I received a letter about consultation results and then received the exact same letter again a few weeks later. That’s just a small example of inefficiency and waste in a juggernaut like the NHS.

YANBU. The NHS is the fifth largest employer in the world. The working population of the UK is 33.4 million. 1.7 of those work in the NHS. People really need to stop and think about that for a moment.

It is doing all sorts of things it was never designed for. There are two things it needs. First, a root and branch reorganisation. Second, if we want it to continue to do all the things "we" want it to, we need to increase taxes/NI across the board by at least another 5 p in the pound. It's probably more like 7 p to ensure mental health care and elderly care are properly dealt with too.

The problem is that it would be foolish in the extreme to do 2) without doing 1). But people keep shouting "throw more money at it", "it needs more staff" - it has more staff now than ever before! And unfortunately it's become such a sacred cow no Government will ever actually do the root and branch reorganisation.

OP, I believe the problem with appointment times is they know some people will not turn up or appointments are done quicker. By having everyone turn up together they can just get through them in sequence. Once they’ve finished them all, end of day.

I’ve had 3 appts in a week for this OP. I was referred already by a doctor saying the procedure needed. I saw another for 2 min to sign it off. I filled in a pre-op assessment there. I returned two days later to talk through a pre-op. Now I’m here. It’s minor, so everything could have been combined. There was huge repetition.

On the plus obviously a turnaround if under a week is amazing on my part, but I can’t help wondering about the room use/ staff costs etc that could be saved if they streamlined a tad.

Agree with the ‘it needs more staff’.

We have clinics with one consultant that run very slow with 6 other staff. Some people will just weigh 4 people in an hour and otherwise wait.

"Today I’m having surgery. The same. Everyone turns up at 7. Even if you’re due in at 4pm. The first load are allocated a cubicle but about half the people sit in the discharge lounge all morning. I cannot see how this is efficient or benefits anyone. Why not give appt times?"

I know that seems illogical, but surgery isn't always that straight forward.

Operation 1 goes a lot quicker than they expected, because everything was more straightforward than the scans suggested.

Operation 2 is bumped because the patient suddenly declines surgery in the anaesthetic room.

That means surgery 3 is ready 3 hours earlier than expected. Operation 3 gets tricky, and they need a piece of equipment that was going to be used for Operation 4.

Operation 4 has to be moved back, so that the equipment can be sterilised and turned around, so Operation 6 is brought in instead.

Operation 5 proceeds as planned. However, the patient goes into septic shock on the table. The procedure has to change and it takes 5 hours to stabilise them.....

You just can't "book" surgery. All you can do is get the patients in and work through them, dealing with them as they present. Because they are real people, with real problems.

@DayCare You agree with it needs more staff? How many more do you think it needs? 1 out of every 20 working people in this country work for the NHS already!

Or does it actually need the same number of staff but the right type of staff?

I get that lougle. I taking about maybe something like an am/ pm list? Operations 6-10 realistically are not, fo routine surgery, going to happen in the first 2-3 hours

No, I was agreeing with the comment about staffing. There are lots of staff, but not focused on the right things

It's difficult because the length and success of each procedure will vary, each patient's body and recovery will be different in surgery, and those variables mean that a booking system for surgery doesn't always work. Having everyone there might not work best for patients but for surgical staff it means they have more room to juggle.

"The NHS needs another billion."

"The NHS has great buying power."

Therein lies the problem, perhaps? I think part of the problem is that the NHS has so much money (or easy access to it) that it's not spent efficiently and carefully.

As for more staff, yes, as long as they're actually staff e.g. nurses who do the front line work, as opposed to managers, pen-pushers, and yet more managers.

Oh god yes! I love the NHSitbis a wonderful organisation but it’s so badly managed, probably because it’s such a huge task, but I often think there must be a better way to deal with this. Especially with modern technology and communications. I also get sent out 4 letters for every appointment. I have no idea why they do this? I also get them text? I am happy to receive everything electronically and requested this but aparently is not possible?

Questioning things is always good.ut accept that your questions come from a lack of understanding a very complex system that few people not part of it couldn't possibly understand. The running of the nhs appears to be straight forward, it isn't. You would question why traffic controllers do things are they are, its not that dissimilar with the nhs. There are many complex matters at stake thst leads to decisions that might seem illogical to you but won't be in the context they're made.

The biggest threat to the nhs is workforce, ie. lack of. Money won't help except to encourage more and more staff to leave the NHS and go via agencies as they are then paid much more. When Trusts can afford it, they support it as their priority is safe level of staffing regardless of the cost.

Someone needs to examine communication from the top to bottom.Internal communication is animal and often missing.To external people,gp,patients,suppliers it is repetitive or not timely.
There may be more staff but we treat more patients for more complex conditions than before and this is an increading as people live like nger but not fitter lives.
The population to staff ratio makes it all look fine but what is the ratio of clinical staff to patients?Also it is not 1:1 care,for example for an appendectomy there will be about 7 clinical staff in theatre but you will also have care from recovery staff,ward nurses ,drs on the ward just for 1 day.
A lot of time is taken recording every little thing so that there is evidence of any short comings or not if care is questioned.

Whenever I've had surgery on the NHS (sadly quite frequent, mostly in the West Mids but also in Surrey), the afternoon operation people come at lunchtime. Although as a PP said, operation times can change hugely. I've had surgery six hours before I was expected to; and a good few days later than expected. It depends what else is happening.

It is inefficient, but ironically it will take money and proper consultancy to fix a company or that size, and it doesn't have either. Which is why the random siloed projects tend to fall apart when they don't work for the rest of the massive operation.

The NHS is appalling. I’m actually embarrassed on behalf of all the people here who think it’s the envy of the world (it’s not guys). By far the biggest problem I’ve encountered is the attitude of the staff. 50% of them are absolutely horrible. Unfortunately the other 50% who are very nice can’t make up for that. Another low cost fix.

You just can't "book" surgery

But people do if they go private.
That’s what people pay for really ( because the surgeon probably works for the NHS as well ). People pay for a specific day & time, knowing it will actually happen!

I agree re efficiency OP.

I recently stayed for a week when I had DD. Side room and bar one midwife very positive experience. Slightly different to the points you raised but the waste was unbelievable.

Examples-
-Water cups. Hard plastic water jug. Every single time I had a drink I was given a new cup. I wanted to use the same cup all day, nope. So maybe ten cups a day, that's just me.

-Hard plastic tea cup holders. New one every time.
-I had to express. I was not allowed to use the same pump attachment twice, despite the fact that I would if I had my own pump. Like you buy one, and wash it.

-laundry. I assumed I would ask if I needed fresh towels, nope I was given the, twice a day, whether I had used them or not.
-anything that was opened was binned. So maternity pads, packs of disposable knickers, nappies, wipes. So if you used one lad out a pack of twenty the binned the rest. Single wrapped pads would have cut this right down.

-everyone orders evening meal at nine in morning. They do discharge rounds at eleven. So on average in the ward I was on over half those meals were not needed.

There was so many things like this, even DH who is the least observant person noticed. That's just my use, for one week. Seemed crazy.

I know infection and cross contamination is a huge issue but some better ordering and thought into types of products would have saved a fortune on me alone.

The thing is a lot of the issues you have listed would use patient's time more efficiently but not NHS time.

As Lougle has said, surgeries get moved around a lot for a variety of reasons. Having all of the day's patients available means there is never an operating theatre going empty for want of a patient, even if that is inconvenient for the patients.

The same is true of appointments. The NHS isn't really about customer service.

lougle your post about operations was incredibly helpful and the sort of thing that the NHS should tell us. That made so much sense!!

The issue is trying to be addressed by NHS improvement but the onus is on Chief Execs to eliminate their waste - and pass this way of working down to managers

What you will find is that many directors are over involved with developing new pathways and policies, trying to balance the books for the next quarter and not actually focusing on the smaller cumulative inefficiencies they already have

I am NHS and my employer has just done exactly this exercise to eliminate waste and improve services. Badly run trusts seem to just make the same continuous mistakes over and over....

Also adding to the surgery one (I’m a theatre nurse). We sometimes stagger our admission times. We always have an AM and PM separate admission times but sometimes stagger them too.

Sometimes we need to process blood results or we change the order of the original list. It takes time for the surgeons and anaesthetist to see patients too so for them to have to leave the department (have to get changed usually) and see the patients then return can impact on theatre time too. Theatres are very expensive to run so to have the patients in and ready to go is key.

I agree. Negligence nearly killed my DD and she may potentially have long term effects, because staff couldn't be bothered to listen to me. Cuts don't help but some people are just awful at their jobs.

I now have a lifelong chronic health condition, it is managed under consultant care now. My consultant writes to my GP with an update of my condition. My GP has sent me a letter saying I need a 30 minute review with her about my condition. She is a wonderful GP but honestly I don’t see the point. She probably has to do this and has a box to tick somewhere that needs doing.

I did have the most efficient appointment last year. I had a growth on my eye, not the eyeball but the corner of my eye. Was sent to consultant as it was interfering with my vision a little. He said it needed freezing but he would do it there and then. I thought about how efficient it was after and that usually I would have had to see the receptionist, wait for a letter and take up another appointment slot another time.

I would imagine that having to always buy equipment from a designated supplier loses millions. I worked in higher education for over twenty years. We would have to buy x from y supplier and that was the only supplier we were allowed to request things from. But that item was available from z far more cheaply. Case in point was when we all received a new printer each, far more expensive. The procurement dept where I worked was spectacularly dreadful though.