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...

Personal experience in recent times.

My surgery is wonderful.
Of the two general hospitals within 6 miles of me, one is wonderful with wonderful staff; the other is a disgrace with a lot of appalling staff and I wouldn't send a dog there. Both run by the same trust.

I object to the fact that I have a condition that causes issues and when I am older could cost the NHS a lot of money. It would cost the NHS £6 per year to provide a monthly injection. They won't do it. I can have one every three months if I kick off enough. Yet I see all sorts of procedures being done that cost thousands of pounds which have little or no bearing on being able to carry on a normal life and which will not result in long term medical issues that will cost the NHS far more than the £6 a year I need.

I'm truly sorry for those who need IVF to have a child, but not being able to have a child does not cause permanent nerve damage and dementia, unlike my condition. While the NHS cannot or will not treat actual health conditions that affect your daily life and will leave to serious complications as you age, it should not be funding IVF or assorted other procedures.

Hence my statement earlier that if we all want these things, we have to be prepared to spend a great deal more to fund it.

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.

The NHS as a whole buys so much stuff that there can't be many suppliers who have the capacity to provide, say, all the scrubs or all the forceps. Then they would control such a massive section of the market for that item that smaller companies would never be able meet the NHS need. Sometimes it's better to put your eggs in lots of baskets.

marymarkle
The GP was to blame for the paperwork not being with the consultant, the system was to blame for the numerous copies of the leaflet, letters going in seperate envelopes and 1st class.
If you think a system couldn't prevent us turning up at two appointments, the first where paperwork wasn't there and the second which wasn't required because the paper hadn't been read, you are very much mistaken. You can't prevent the human error, bur it could have and should have been spotted much earlier.

To the person that said meals are ordered then people are discharged, surely those meals are given to people admitted that day who weren't there to order their meal in the morning

My mum is a medical receptionist and was complaining that they are phasing out faxes. Apparently they are "vital" to urgent information. I pointed out email would be a lot more efficient/cheaper/less wasteful.

Some trusts will not accept or send confidential info via email unless it's to a secure, encrypted email address. If you don't have such an address, then fax is the only way of getting documents transmitted quickly. When I've had to request stuff that's urgent, I've had to ring the sender and confirm that I am actually standing by the fax machine before they'll send it! We have the same with police info, but probation (who often send very sensitive stuff) don't seem to give a shit, unless it concerns a MAPPA offender, when they get very cautious.

So yeah, I get why they still use them.

PlainSpeakingStraightTalking That's shocking but doesn't surprise me.
I worked in a lowly admin role in the hospital after 30 years as a manager in the private sector.
I encountered steadfast resistance to any suggestion of change or efficiency. The biggest issue I could see was that the managers were all recruited internally and so the pool of "talent" was limited. Senior managers at high salaries who had previously worked as secretaries or nurses but were never actually trained as managers. I had 10 different line managers in 5 years. One who was in post 18 months I never actually met in person.

LakieLady
Then the should be give encrypted email, it is inefficient to be phoning someone to get them to stand by a fax machine while someone stands at the other end. If some trusts do it then all can do it.

45 tonnes of food per year left on trolleys at end of food service (not including meals left on plates by patients!).

www.thevisitor.co.uk/news/morecambe-bay-hospitals-introduce-emeals-to-halve-huge-food-waste-bill-1-9544404

But at least they've identified that huge wastage and are taking steps to reduce it!

Lakie that's bonkers. Law firms and courts which handle sensitive info day in day out manage fine without them.

Also when you book surgery in the private sector you are paying more for the surgeon to be available at that time

Not just the surgeon, either. Someone I know had a partial lobectomy done in the London Hospital in 2010. She got sent a copy of the bill that went to her insurers. The anaesthetist's fee was £11k, for a 4-hour operation. That's nearly £3k an HOUR! They also charged for every single consumable, down to the latex gloves and a roll of micropore.

Then the should be give encrypted email, it is inefficient to be phoning someone to get them to stand by a fax machine while someone stands at the other end. If some trusts do it then all can do it.

That was exactly my point.

There is resistance to removing faxes despite there being a perfectly feasible, already in use, secure email system that would be quicker, easier, cheaper, more auditable, more secure than a outdated, unsupported block of plastic where the "security" is reliant on someone typing in the right number.

What happens if their fax machine breaks now? Runs out of paper? Phone line goes down? The excuses to keep it are laughable.

CallMeSirShotsFired
The resistance would almost be laughable if it wasn't so stupid.

One of the big problems is that some NHS workers see it as a personal attack when inefficiencies are pointed out, when actually it's pointing out system faults. Anywhere I've worked people are grateful as it improves the service.

Except possibly the education system

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

Except that we don't really pay for it ourselves. Those 'consuming' the most healthcare will never pay enough in taxes to cover what it costs. A prolonged hospital stay with ITU, surgery and rehab will cost hundreds of thousands of pounds. Very few people pay enough in tax to cover that. We are incredibly lucky to have the vast majority of healthcare available free at the point of need. I get so sick of the "we pay your wages" mentality, when the reality is we don't pay anywhere near what we should be.

Then the should be give encrypted email, it is inefficient to be phoning someone to get them to stand by a fax machine while someone stands at the other end. If some trusts do it then all can do it.

But that won't help when the organisation I work for (not NHS) doesn't have it! If I need to flag some worrying development with a client, or need urgent medical evidence for a benefit appeal or to support a homeless application, it has to go by fax. The only secure email system I can access is one used by MARAC, for DV cases.

To be honest at this point I’d settle for someone telling me it’s ok to have some water because I’m last on the list.

Ive been over 6 hours now without water, and this is a really hot lounge! I have a headache and I feel shit and fuzzy.

I’m sure someone will explain soon why that can’t happen. That all 10 people will vanish, the consultant will surprise them with an early start and I may have to run in as the only patient...

LakieLady
So how do those trusts without fax machines manage?

Front line NHS here (band 6):

I believe a major issue in the NHS is the (poor) quality of many of its middle managers. Many are recruited 'in house' so the managerial talent pool is often small.

My Trust, a merger of 2 big hospitals a convenient 25 miles apart, plus 2 smaller units, was formed 6 years ago. We are on our 4th Band 8C/Band 9 manager, each successive one chucking their 'blue sky thinking' at us, before pissing off and leaving us with the fallout.

The latest 'means business'. He has seven Band 8A managers clippy clopping their way between meetings all day. We all but never see them. We have seven Band 7 superintendents, the type that get their hands dirty. Our units, across 4 sites, provide diagnostic services for 570,000 people. We, as an example, need 24 MRI operators (band 6); we have 12.

So, the solution? Increase everyone's shift lengths, imposed a shift system that makes you work part of every second weekend (if there were 24 staff!), remove over-time to reduce pay, make the specialist MRI/CT radiographers do A&E general night shifts.

Result? 3 MRI staff resigning last month. As it is, of the staff who have left Diagnostic Imaging over the past year, more than half have left the profession altogether.

So, why? Because the inept, combative middle managers treated the hands-on staff's lives with contempt. Looks great on paper, no doubt.....

....but the Agency bill won't.

YANBU OP. The poor contracts alone, set up and managed by MPs and NHS Managers, haemorrhages money daily.

For example, the debacle of the 2002 NHS Database £9.8bn scandal that was shelved in 2011, is still costing the NHS in huge monthly payments, today.

The incompetency of NHS managers and MPs at the time, in constructing poor contracts that did not hold the American IT Companies into account for their poor delivery, is outrageous.

It was shelved because they used American companies that did not understand our Trust structure and that each Trust has/had their own systems. The company tried to just copy over what worked in America, without fully investigating if it would work over here. And because there was nothing in their contracts about signing off each stage first etc. and what would happen if they did not delver, that when the project was shelved, we still had to pay these American tech companies. In full. Still.

Mind boggles.

So when posters above talk about re-visiting contracts etc. they talk a lot of sense.

@really Did you read my post? I have paid into tax and NI for 27 years at the moment. In that time, I have been taken to A&E three times - a broken wrist, a suspected stroke and tonsillitis bordering on quinsy. They considered admitting me for the latter but I've never been admitted to a ward. I've only had to see my GP a handful of times in those years and the five most recent appointments have all been concerning my condition.

A condition they will not treat effectively AT A COST OF £6 PER YEAR. I've put in an awful lot in 27 years and I suspect I am probably well in credit. Without them spending this £6 per year, I am going to require more and more treatment as I age (and I'm only 45 now, well, almost) and it's already starting. It's nonsense that I should have to kick off to try and get them to spend just £2 per year on me when the extra £4 would make a big difference to my life AND do as much as possible to prevent me being a burden to the NHS.

I can't even day "here you are, I'll give you another bloody £6 per year on top of what I already contribute so I can be fit and well please!" Not that I should fucking have to.

@only

I don't know, because I only deal with the local one! Some of the GP surgeries are the same too, I've had to type and fax a letter to a GP because I can't email them on more than one occasion.

Surgery is completely unpredictable. When I had my gallbladder out it was expected to be a quick keyhole procedure with discharge the same day. I was first on the pm list and it took three times longer than expected and caused unexpected internal bleeding. The subsequent patients' surgery was inevitably delayed. If the surgeon had another like me, it's entirely possible patients at the end of the list would have got bumped completely on that day. Nobody's fault.

Yes people think about it as if you are making widgets.
I went with a relative to a psychiatrists appointment. The psychiatrist was concerned and spent 3 hours with us. Eventually I did take the relative home, but there was extensive support put in place from that day. The appointment time allotted was I think 15 minutes.

kitty Because they don't pay the going rate so get people who don't know enough. It is all about short term saving of money.