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...

*The NHS wins elections.

No one is therefore allowed to criticise it.*

On the contrary, I can think of no other organisation (except possibly the government) that is subjected to such continuous, relentless scrutiny and criticism.

They are centralising and restructuring admin into ‘hubs’ at band 2 (downgrading) and putting secretaries into pools at band 3
This means all the experienced band 3’s and 4’s leave because their specialist skills are not recognised anymore. So you have big departments not well staffed with inexperienced administrators

On the contrary, I can think of no other organisation (except possibly the government) that is subjected to such continuous, relentless scrutiny and criticism.

Except possibly the education system

In other words, the two things we all pay for.

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?

The Sussex Orthopaedic Centre runs a really good appointment system for day surgery. They get you in 2 hours before your scheduled theatre time for pre-op prep and checks, then you sit in a cubicle in your theatre gown and wait till they're ready for you. They're so customer-focussed that the helpful booking team will even try and fit your time in around you - they gave me a slot that meant I wouldn't have to get one of the 4 buses a day hours earlier than needed.

We do Day theatre a lot with DD5 and there is a morning and afternoon list.

Morning list arrive at 7.45.

Afternoon most arrive at 12.

I get paid handsomely by the NHS to sit here and do nothing all day. I have about an hours work a day. But can I order equipment? No budget apparently. Does this place have a functioning telephone directory? No. Does staff attend their compulsory training? No. Do I sit and just move bits and bobs round spreadsheet, yes.

My line manager is an 8B (£55K plus London weighting of £6K) , her line manager is the Deputy Chief Nurse on a higher Band 9 so close to £100K, My office is full of Band 7’s (£40K) who haven’t been near a patient in decades. I like adding up their hourly rate and seeing whether the meeting in in is actually worth it. Invariably not.

Last week I was pulling a meeting together, a pointless meeting with no agenda, scrabbling for items to discuss. The meeting couldn’t be scrapped because it was timetabled. If I need a temp Band 7 in as cover, she gets paid £76 an hour on bank; I was looking at roughly 30 Band 7 nurses in a meeting with no particular agenda, wasting 2 hours. That meeting cost nearly 5 grand.

One Band 7 specialist I office share with complains she keeps getting 'caught' looking at the internet - let me tell you , all she does every single day is check her pension and retirement due date, then go to right move to fantasies about seaside cottages, look at clothes catalogues, phone her family, than at 2pm complain she has to do some phone clinic – not real clinic – I could do these clinics, in fact sometimes she’s too lazy and I do do her clinics. I sincerely have yet to see her actually do any thing that justifies her salary.

As an aside, a lot of staff condense hours so they work 3 x 12 hour days, then go a different Trust as bank staff.

The NHS is beyond wasteful.

www.nhsemployers.org/tchandbook/annex-1-to-3/annex-2-pay-bands-and-pay-points-on-the-second-pay-spine-in-england

One of the big problems with the NHS is that when they started cutting it too the bone they got rid of lots of the administration (because no one is willing to lose doctors, but lots of people stupidly think administration is unnecessary), which has naturally caused huge problems with disorganisation and lack of efficiency.

If we could go back to having more staff who actually organise things properly the all important frontline staff could actually do their jobs much more efficiently.

I absolutely agree that the NHS could save huge amounts of money if those that managed and worked in it exercised a bit more common sense.
I and other members of my family have much to be grateful to the NHS for but we’ve all seen at first hand how much waste there is - small things really in the general scheme of things, but when taken together it would amount to a fair amount of money.
I went through a stage of having lots of different appointments and tests and like other family members on more than 1 occasion received letters for an appointment one day, then the next day received another letter rescheduling it .
The most unbelievably wasteful thing though was when I was referred for scans of my wrists and I received 4 separate letters for a single appointment to scan the front and back of each wrist.
Unfortunately the time wasn’t convenient for me and when I rang to cancel and make another appointment I was told that the confirmation would be sent out in the post. When I suggested that it wasn’t necessary to send me separate letters I was told that the computer was programmed to do this - it was the way the system worked.
I’m sure there will be someone who will argue that this has something to do with budgets and costings but the cost of sending 4 separate letters to everyone having tests like this in terms of the paper, envelopes and postage is surely not insignificant, especially when the patient only needs to get one of them.

Oh, the inefficiency! I had an appointment 2 days ago for a condition I've had for a few years, medication seems to be working after some teething troubles, all good.
The appointment was for 10.30, so couldn't go to work first - that's the morning gone. Sat there for half an hour to be called in to see the consultant.
"How are things?"
"good, all still fine".
"you need to lose weight"
"Yes I know, I've been trying for 2 years"
"Hmm, try eating more 'veggies'. Ok, I'll see you in 12 months, take this letter to reception".

That was it, finally got into work at 11.30.
Why couldn't it have been done in a phone call and say if I'm not feeling good or they want a blood test then call me in for that? But no, every 12 months we all go through this procession of "checking".

plainspeaking The majority of staff in the NHS are low paid. These staff are usually running about like blue arsed flies trying to do too much with too little time to do it in.
Stories like yours makes me angry because most staff are incredibly busy, and undervalued.

StormTreader You do realise that medical staff have an obligation to physically see the patients they are prescribing medication for periodically don’t you? You can’t imagine what might happen if they didn’t?

If you don’t require him or her to keep prescribing for you, then of course you are under no obligation to attend that appointment. It isn’t a summons.

A 30 minute wait for a busy Consultant is also very good!

as opposed to managers, pen-pushers, and yet more managers.

God this is so nonsensical. As has been pointed out, the NHS is the fifth biggest employer in the world. It's a mammoth organisation, it needs management. It almost certainly needs more not less.

Of course it needs high quality managers (and it may not currently be employing those) but the knee jerk 'bin the managers' is stupid beyond belief.

millymae It is crap computer systems. That is because contrary to what many on here think, the focus in the NHS is saving money. Not doing it the most efficient way which actually costs money. So old computer systems, or ones built as cheaply as possible.
My DP had to use an ancient computer system which constantly crashed.
All those pushing for the NHS to save money only makes things worse. Most of the things people are complaining about are precisely because things are done as cheaply as possible.

Our daughter needed an appointment go see a consultant, it was a cancelled 3 times, fair enough no problem except each time it was cancelled we received a leaflet telling us what would happen at the appointment, each time it was rebooked we received the leaflet again, so we have 7 copies of said leaflet, we also got the cancellation letter and new appointment on the same day sent from the same person separately and sent first class when the appointment was weeks away. This is just pure waste, if I did that where I worked there'd be hell to pay.

When we got to the appointment the consultant asked me for the test results, I had never seen the results that was why we were there but our GP had told her I had them, not sure why I would ever have them. We then had to have another appointment when they found the results, another 3 letters, and they looked at the results in the appointment she said you'll need to come back for another test as the result says xxx, so we wasted the consultant's time twice because no one checked before the appointments that they had the correct paperwork. So yes there is inefficiency in this case and I doubt it is alone, if this was reduced it would free clinical staff to do their job, almost like employing extra staff as their time wouldn't be wasted.

Then there are the people who don't turn up for appointments and don't cancel, they hardly help efficiency

And agree that the idea that you don't need managers is stupid. Of course you need managers. Just as money is needed to be spent on evaluating outcomes and what actually works.
The general public IMO have not got a clue about what it needs to run a large organisation well. And the NHS suffers because of that.
Also we spend far less on healthcare than nearly every other developed country.

onlyjoined Your GP was at fault then. No system can prevent human errors like that.

Racecar, your experience of the NHS is very different from mine. I've encountered the occasional rude or uncaring person, but in the main, they have been polite, friendly and helpful.

In AAU once, I listened as a consultant, who was treating a homeless man for a urinary problem, explained to the man that his feet were in a very poor way and that he would get someone to sort them out. Within the hour, someone came and spent over an hour working on this man's feet. The man was treated with tremendous dignity and respect, and it made me feel really proud of the NHS. I broke my wrist in very icy weather, and the staff at my local minor injuries unit had come in early, knowing that they would be busy with people like me who'd fallen in the ice and snow. Despite it being incredibly busy, they were polite and cheerful. When I had to go to A&E to have the fracture reduced, they were still efficient and in good humour, despite having treated over 300 injuries that.

I've been present during phone calls when a client with MH issues has been haranguing their psychiatrist with a diatribe of foul-mouthed ranting, and still be spoken to calmly and respectfully. I've had clients have CPNs that go above and beyond in their efforts to help resolve issues that are entirely social.

My local health centre even has nice receptionists who do their best to accommodate with regard to appointments etc.

Maybe my part of Sussex is exceptionally good.

One of the big problems with the NHS is that when they started cutting it too the bone they got rid of lots of the administration (because no one is willing to lose doctors, but lots of people stupidly think administration is unnecessary), which has naturally caused huge problems with disorganisation and lack of efficiency.

Different trusts/hospitals operate differently of course. I was unfortunate enough to have to regularly attend our local oncology unit. Two different reception desks in the same waiting room, one for consultant appointments, one for day treatment. One has 2 receptionists, the other has a whopping 4 receptionists. I've sat for a couple of hours several times in that waiting room. Barely a trickle of patients coming to check in, maybe one every 10-15 minutes. Maybe one incoming phone call every 5 minutes or so. Receptionists not actually doing much (if anything) other than gossiping, making brews etc. The usual nursing staff/assistants doing the calling through so the receptionists not even receiving calls to send patients through. Not doing filing etc as there are no filing cabinets in the reception areas - another couple of "office attired" people seem to keep coming and going with armfuls of files so presumably they're the "admin" staff from a back office somewhere. Thing is that once you're through to the consultant or day treatment room, the proper medical staff are absolutely rushed off their feet, and often being let down by the reception/admin staff due to missing test results, medication not having been ordered, etc.

Certainly no need for 2 reception desks, and certainly no need for 6 staff between them. Probably 1 person could do it, but say 2 to allow for the "busy" time when you have a patient to check in at the same time as a phone call. I think they bolster up staff numbers by employing too many "cheap" staff to hide the chronic shortage of medical staff.

Also, talking of admin, my dad got a letter through the post for a follow up appointment last week . All well and good but he died in said hospital 16 months ago

The lack of joined up thinking and efficiency is certainly an issue.

At point of care I love the nhs but at the same time it isn’t half frustrating.

Ds is under multitple trusts (even in the same building) which automatically creates issues.

Two weeks ago I got a letter saying to call to make a follow up appointment (due in feb) called as soon as I got the letter to be told the consultant had no appointments left so they would put him on the list and send one in the post when one comes free. I know from experience I will have to keep chasing to actually get him seen!

Well said Moaning - I couldn’t agree with you more.
I still can’t get my head around why people that go into the caring professions to do just that end up being responsible for huge budgets and managing huge numbers of staff. Many of them are like fish out of water.
Just because you are an excellent nurse, doctor, physiotherapist or whatever doesn’t mean you have the knowledge or administrative and management expertise necessary to run a hospital efficiently.
Back in the day there was a professional qualification for NHS administrators with national, regional and local training schemes, nowadays administration appears to be a dirty word and it’s no wonder there is so much waste and inefficiency.

I also think it has other inefficiencies. I know 2 people who work frontline for the NHS. When I had my DC1 one of these people brought me half a suitcase full of tablets, gauze, creams, plasters, sterilising stuff that they had just taken out the stock. That stuff would have cost a fortune in Boots. The other person I know also helps themselves. According to them it is one of the perks of the job.

The NHS needs money spent on getting it shipshape and to stop haemorrhaging money. There is no reason why a public sector company can't be run like a private one. The thing stopping it is politics and bureaucracy.

@mary - not in this Trust. And it is like it in every Trust I have experienced. I linked the pay scales as they are uniform across the country. Admin are largely lowly paid, nurses are not. They are very well paid, starting on 30K in London (incl LW) plus al lthe other little extra allowances, and bank of course. The consultants do AM in the NHS then shoot to their private practice PM.

I threw away hundreds of pounds of drugs at the weekend, all prescribed to DH. They issue 28 days worth with every hospital stay, repeatedly, I end up awash with them. Profligate waste. I suppose I could stock pile for Brexit.

www.nhsemployers.org/tchandbook/annex-1-to-3/annex-2-pay-bands-and-pay-points-on-the-second-pay-spine-in-england

I’ve only got as far as @homemadegin comment on the first page but this is just ridiculous! Are the meals thrown away? That just seems like pure stupidity and a problem so simple to fix! 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.

Ironically, the King'sfund organisation has just shared a publication that shows that the NHS has been more productive last year that the average economy in this country last year.

Can't be bothered to retrieve it, not what people want to read anyway, it makes people feel good to slag the nhs and believe they know what they are talking about.

Oh, just to comment on the poster who was comme ting about the waste of plastic cups. You might want to educate yourself about the risk of injection attached to re-using a cup. You'll find that cruises for instance have the exact same rules. As for the costs of such policy, it will be a pittance compared to the over 200 millions lost each year by the nhs because people can't be bothered to cancel their gp appointments and that's only GPs.

Before people criticise what thry know little about they might want to consider their own behaviours and impact on the nhs productivity.