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...

Following with interest

One of the many problems with trying to make the NHS more efficient is that such decisions are made by the managers, not the clinical staff.
Managers will never choose to axe their own jobs. They prefer to cut clinical staff or close wards. They also like to empire build by expanding their own departments.
We already have more than one manager for every hospital bed in the NHS. Staff are buckling under the weight of paperwork, bureaucratic interference and the sheer duplication of checklists.
Before I retired in despair two years ago, my own hospital required a safety checklist to be completed for every patient going to theatre.
Excellent idea, all in favour. Except...
First, the list is filled in by the ward nurse.
Then it’s completely checked through again by the theatre person collecting the patient.
Then ditto by theatre reception.
Then ditto by the anaesthetic nurse.
Then ditto by the anaesthetist.

It’s then discovered to have been filled in wrongly and nobody has spotted it because it’s such a repetitive chore nobody has the time, patience or sole responsibility to do it properly.
Delay while it’s sorted out.
Then it’s checked again by the theatre team.
I used to anaesthetise 20 patients a day in the 1980’s. This had fallen to 5 by the time I left, due to the sheer inefficiency of the system.
The final straw for me was when consultant dermatologists were lined up to have their skin inspected by a SECRETARY- because she was the management’s “designated skin care person”, and she’d been given one hour’s training to spot industrial dermatitis! And she then had to complete a “skin health” form on every member of staff in the hospital.
I could go on, but I’m sure you can imagine the sheer waste of man hours and money in a system that has been micromanaged to death.

I know higher education is different from the NHS but huge contracts with no flexibility are pretty standard in both.

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

Less people present = less staff, less chairs, beds etc. Doing a pre-op twice uses a tong staff.

Also many staff clearly have a shit Woking environment,it can’t be good for staff retention working with stress as well as shifts. I’d quit and work agency just for a break...

No, no, no please. The NHS (and education) are victims of constant reorganisation, the 'root and branch' reform is neverending for them. Just leave them alone, let medics and educators run them, keep know nothing politicians noses out and fund them properly. The UN has described the NHS as one of the most efficient and best value health care systems in the world.

I know systems aren't perfect but the constant reorganisation is really, really, not helpful.

More staff is needed. We are so understaffed at the front line.

Totally agree - the system is massive, unwieldy and there's no joined up thinking between GPs, hospitals and other professionals.

I had a hysterectomy two years ago and they removed my cervix. I'm getting increasingly cross letters from the NHS reminding me about my smear. For my non-existent cervix. Phone the number on the letter, explain, apologies, we're sorry we'll make sure it doesn't happen again. Six weeks later, another cross letter ticking me off and lots of papers about how awful cervical cancer is.

Yes it's a small thing but seriously. What a waste of paper, postage and time.

You need to make sure you are efficient though. Never reorganising things does not work. Contracts are renewed every 3 or so years so things will be bound to change as New providers, legislation, policy etc comes in.
You can’t leave everything as it is

One of the best things acute and community trusts have done is revamp A&E pathways with GP, minor injuries, clinical navigators and ambulatory services

@KennDodd I'm sorry, but there has NEVER been a root and branch reform. There has been continual tinkering around in areas. And can you please provide a link for your statement about the UN as I just tried to find it by Google search and couldn't. I find a survey by the Commonwealth Fund that claims it's the most efficient and best value out of just 11 countries they looked at. I find a report in The Lancet stating we are 30th, not first.

I always have to get to the hospital at 7:30, along with everyone else, when I'm having surgery because we need to see the surgeon and anaesthetist before we go to theatre. If we had staggered admissions when would they be able to do that? They can't just pop out mid operation. I've got a procedure next Friday, on the afternoon list, and have to be there for 1:30 which is much better, I agree.

If the procurement of supplies was properly looked at, and treated like a private business, the NHS would suddenly have millions more to pay with.

Simple supplies that are £20 on amazon are being bought for £100. It’s a disgrace.

In my trust you buy crutches from an outsourced company for £14 or refurbished ones ‘in house’ for £9.
The £9 is to pay for the refurb and transport
But they never have enough in stock to send to you so you end up buying brand new £14 ones

My hospital has an AM/PM list. I had surgery last week. Was on the afternoon list so told I could have a light breakfast up to 7.30, then water until 11.30 I was told to get to the ward for 12.30 (most people on the ward sleeping off their anaesthesia from having been on the morning list) and then went to theatre at 4pm. It was all very efficient so it can be done.

@TheFairyCaravan I’ve been here since 7, my surgeon hasn’t started yet. Everyone comes at 7 because some start earlier. My list hasn’t started running. Heard them mention who starts work when. It’s a 7-11 unit, the staff aren’t all working 7-11. Theatres are running on other specialists

Procurement needs to be centralised, each trust buying equipment etc doesn’t take advantage of economies of scale- and the admin burden is so much higher.

Maybe there needs to be a clinical/ management role? Is that the issue? Not clinicians making decisions?

#homemadegin I was also in hospital for a week after the birth of my dd and my experience was very different from yours. I was given a China cup to use with my water jug. I only had my bed sheets changed if I asked, same with towels. I took the pads I didn't use home with me and all the parts I used for the electric breast pump were reusable once sterilized they only replaced them per patient (and if you used a medula swing pump at home you could take them with you) Everyone was given access to the nursing kitchen which had sterilisers available for this. I couldn't have praised the service enough and considering I work for the NHS that's high praise indeed considering we are generally more critical than most. I was dreading it and the whole experience was wonderful.
I do agree though there are far too many managers and lots of people that appear to get paid to "project manage" but I'm not sure what. It will also never cease to amaze me how many people don't show up for appointments or use A&E as a walk in gp surgery or pharmacy and there is absolutely no way to crack down on this abuse of the system at the moment.

There is a way for you to have the perfect service you want for your surgery OP and that is to pay to go privately. Then you will probably be the only patient having surgery on that day with your surgeon not the 14th. the reason you were brought in together at the beginning of the day was for exactly the reasons given above. You never know you may end up going down at lunchtime.

For me, it's the pitiful lack of options that logjams the system. GP or A&E are pretty much the only choices for most people, given the drop in centres all seem to have closed.

GP should be for consultations and prescriptions. Drop in centres for minor injuries (stitches etc). A&E for major incidents.

Oh, and stop the malingerers clogging up the system with their non-illnesses.

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!

Yes, but private hospitals don’t also have to deal with emergency surgery as well and they often don’t deal with complaicated problems. My Dad is having a simple knee operation soon but because he has has a pacemaker and another heart op he is higher risk so needs a hospital with ICU spaces in case he need them. This all makes it more complicated.

YANBU OP
my poor dad twice had surgery cancelled, both times arrived at 7am and sat on a hard chair with no food or water for hours in a crowded waiting area before being told it was cancelled. He was in his 70's and had cancer. I wanted to cry as it all seemed so cruel.
I don't know what the answer is but it seems a very common problem
I love the NHS (I work for them) and there are amazing things going on every day but things like this never seem to change.

DayCareCase- just go private.
You'll get what you want, and we won't have to hear you moan about getting care that would cost thousands in the US but is not up to your standards.

It does need reform. But not much of what you mention is relevant.

The clinic time for the bloods probably depends on a chunk of time toxicology has assigned for their tests.

The queing for the OPs - it all depends on what happens in surgery. If all the ops are straightforward, they might have everyone done and out by lunchtime and the staff getting on with other things. Ditto with people not turning up or not having starved so needing to be cancelled or pushed later. But if a surgery is more complicated than expected you may wait longer. People are moved around backwards and forwards on the list during the day dependent on resources etc. That’s actually an example of efficiency and making sure scrubbed up staff aren’t standing around doing nothing or wastefully having to scrub twice.

The door thing you can complain about. You should ask him to shut it. Other patients shouldn’t be able to hear.

The problem with reforming it is that it’s very difficult to make it happen because it’s used as a political football. If the Tories ever try and reform it Labour always (and usually falsely) characterise it as privatising or selling off the NHS. There was a fantastic report called the Naylor Report which suggested selling off old and useless buildings and unused land to raise money for modern, well equipped hospitals. It was a brilliant idea, but Labour campaigned against it tooth and nail and characterised it as selling off the NHS and it seems to have stalled. So the NHS has been left with a load of useless, leaky, tumbledown unsuitable buildings that they can’t use instead of having a large modern, suitable, well equipped hospital at no expense to the taxpayer just because Labour wanted to play games and win votes. Their PFI plans were far worse.

Labour put more money into it, because that’s their vote winner, but they don’t spend it wisely. They add layers of unnecessary management and sub trusts and admin teams - on high than average wages (so they vote Labour) they just want bums on seats because an NHS employee is a Labour voter (I was once paid £32k per year to sit at a desk doing nothing under Brown). They like to just say ‘look how much we spend, aren’t we great?’ Rather than actually being concerned about making more people not die and shit.

Until politicians stop using it to score political points, it will never be meaningfully reformed. It needs cross party cooperation.

But why can’t we at least question efficiency? Why blindly accept and keep it as it always was? Unlike every other.

I’m sitting here ok, but it just doesn’t look efficient on their system.

Staff seem to be sending people for scans, another staff member will then appear looking for them, then someone else will appear for something else for them. Even a culture of writing something on a white board by the desk would make their lives easier. It’s not I want private care, I just don’t understand some of the obstinate level of ‘this is how it is and it’s the best’. I work as a teacher, we simply couldn’t act this way. Not just the big things, some of the little fixes. Like not making a 6month old or a profoundly disabled person be seen as a priority in a blood test queue.

Yes, it's called socialised health care I'm afraid.

Now those like @mobyduck duck are out.

This is the attitude. Private or never improve. Pay tax, don’t question.

It’s like a sacred cow, to be worshipped. I’m not anti-NHS. You don’t have to listen to me moan (press the little x in the top right or back space). I have right now time on my hands though so though it’d discuss it!