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...

FIL was told he needed to attend a consultant clinic for tests. He is in a care home with poor mobility and gets very anxious so the hospital arranged for an ambulance to come and take him to the appointment. I took the morning off work so that I could be at the hospital with him. We arrived at the hospital to find the appointment had been cancelled due to the consultant attending a conference and no one bothered to inform us or the ambulance staff. So that’s two ambulance staff tied up for ans entire morning, elderly FIL stressed and anxious, and I wasted a half days holidays. Things like this happen a lot are just so wasteful and frustrating.

@swingofthings oh the irony.

People cant cancel or even get appointments at my Virgin Care surgery via phone because the phone system only works when it feels like it.

And if you are that worried about productivity why are you cheering on a cut that will affect mixed age pensioner couples which includes a younger partner who in a lot of cases is their carer. What do you think that is going to do to the NHS which is under enough pressure as it is.

because family carers are a group who cant win no matter what they do.

They get moaned at by the hard of thinking for not working but then get moaned at by SOME healthcare/NHS professionals for not being available when needed.

Onlyjoinedforthisthread - yes, you did, didn't you?

Whenever I see a job advertised the wage is at least equal to private sector and the benefits much better especially up to at least middle management and even into higher management. Things like generous pension contributions, excellent sick pay, good holiday entitlement, enhanced maternity pay, often flexi time

Do some research. The T&C of NHS jobs, the ones that count, patient-facing/coal face, now are no better than any private job.

You need to bear in mind that something like 20% of NHS front-line staff are within 10 years of retirement. When many started, like I did, 37 years ago, the pay was eye-wateringly bad. I worked 38 hours a week, plus an on-call a week, which was 'on duty', so a 27.5 hour overnight shift, of which 8 hours was my '9-5' ordinary shift.

However, we got free parking, laundered uniforms, a generous pension, good sick leave. And some respect.

All that stuff has gone, as the Red Tops made an excellent job of blaming nurses' and teachers' pensions for the 2008 financial crisis.

My T&C are no better than anyone's, anymore. I have to pay to park if I'm called in at 3am to scan an emergency. Oh yes, the traffic wardens are still active, or a £60 fine (been hit, so know).

Flexi-time... hahahahahah. Sure. Try every other weekend, plus a nightshift per week, plus at least one 13.5 hour 'day' shift per week. Try finding child care for THEM. And I'm part-time!

So please stop peddling that rhetoric.

Bejam- (I remember Bejam!)

I agree entirely (except maybe for the conflating Mid-Staffs with a 'fuck you' attitude from staff- I don't think that's what you meant, but it was a bit difficult to separate out!).

HJWT- was that a criticism or praise??!

Kazzthoward- time and motion has its place. But in my diagnostic imaging unit, they are drawn from our own, more junior but doing-an-MSc-in-NHS-management cohort... who really need to demonstrate why we are 'inefficient'.

Let me save you a job. Because, I, as a Band 6, have to trudge up and down from a waiting room 36 times a day to collect and change patients because management can't see the 'need' for a Band 2 HCA to do that. Which is what we've been telling you for at least 9 years.

The use made of the NHS and peripheral services needs looking at, for example why are ambulances being used to sweep up the drunks from the streets and why are they then cluttering up hospitals? They need to be taken to sober up somewhere very uncomfortable. The range of the NHS now far exceeds the ideals under which it was formed, to make sick people well, not to pander to a lot of self-inflicted life-style problems.

Miljah
As I the post I was replying to was about management then that is what I am talking about not nurses but guess what I also work shifts, pay to park and wash my own clothes.

But we don't get enhanced sick pay, maternity pay, paternity pay, we do get the legal minimum contribution to our contributions based pension. Maybe it's you who should look at your terms and conditions and compare them and try living off statutory sick or maternity pay, and I've never seen nurse's and teacher's pensions being blamed for the financial crisis just the bankers. This thread is about inefficiencies not pensions or wages or the benefits of nurses which most people don't have a problem with. Surely you can see that there are many inefficiencies.

There's too many cheifs and not enough Indians.
I work for the NHS I'm my dept there are 8 band 4 staff which are managed by 4 band 5s then a deputy manager and a dept manager (band 6&7) then a Matron so for 8 nurses we have 7 managers !!!! Obviously the work gets done by the 8 band 4s but when you complain your just a problem employee , we only need 1 manager .

What we call "privatisation" in the UK is actually just cost-cutting and cherry-picking.

Some privatised bits are actually really good. Such as specsavers for NHS hearing aids. None of the old NHS method of several different appointments in different places seeing different people spread over several weeks with loads of unnecessary admin with appointment letters etc. With Specsavers, it's just phone for an appointment (usually within a few days), straight in, hearing test, fitting, and straight out in one easy to get appointment. The NHS can learn from the private providers in those kind of peripheral areas.

Miljah

As I the post I was replying to was about management then that is what I am talking about not nurses but guess what I also work shifts, pay to park and wash my own clothes. But we don't get enhanced sick pay, maternity pay, paternity pay, we do get the legal minimum contribution to our contributions based pension. Maybe it's you who should look at your terms and conditions and compare them and try living off statutory sick or maternity pay, and I've never seen nurse's and teacher's pensions being blamed for the financial crisis just the bankers. This thread is about inefficiencies not pensions or wages or the benefits of nurses which most people don't have a problem with. Surely you can see that there are many inefficiencies

I was supporting you!

Public workers' pensions absolutely were being blamed for the financial crisis! It was all over MN! 'Fat Cat Pensions' etc.

I already detailed that the massive burgeoning of ill-qualified Band 8A management in my Trust is a serious issue, both in terms of their over-payment for what they do, and their instigation of work-loads that cause actual coal-face MRI staff to walk. That's pretty inefficient.

Did you read what I posted earlier??

Do you think I should pay to park 6 times in a 24 hour period in order to race in and scan very ill patients?? At 3am? Is that OK with you?

Do you not understand that the laughably poor pay of NHS workers when I started was compensated for by T&C that included laundered uniforms? And a reasonable pension? Which, it may surprise you to know, is pretty much gone. As I contribute 9.5% of my pay to my pension fund.

Do you realise I didn't get a payrise for 7 years? And the one I got (after striking...) still hasn't caught me up with inflation?

The one thing you didn't address was clearing up that the investigators of Mid-Staffs recognised that the coal-face staff weren't to blame.

Miljah
You do realise that most of the population haven't had a pay rise in that time not just the public sector, yes you contribute 9.5 percent but what does your employer contribute? That's the bit that is the benefit, ours is 2 percent, before this year it was 1 percent and 5 years ago it was zero, you obviously don't realise but your pension is still a bloody good deal as are the or be benefits you are avoiding mentioning.
What had mid staffs got to do with any comment I have made?

My comments have been based on inefficiencies in basic admin that puts extra pressure on the service provided and those who provide it and the money available to provide those services

I agree with a PP who said there's a lot of poor planning due to cutting a lot of budgets to the bone creating firefighting and constant flux.

I'm a senior clinician. Clinicians are busy, very busy. We ourselves are not inefficient.

But my Trust like most trusts has no big budget for accommodation. It generally rents. My team is housed in a privately rented building. More teams are set to join us. But, as other businesses moved out (on their own timetables, we had no control over that) they took their support staff with them - receptionists, cleaners, maintenance etc. Meaning the trust had to provide their own services at short notice to cover a building we suddenly found ourselves in alone.

So suddenly we have no receptionists to let patients in. No people fixing broken things like doors. No cleaners. A skeleton staff is hurried in.

Meanwhile, turns out the toilet roll dispensers don't fit our toilet rolls. We have to procure them from company A. The previous businesses only procured from company B. So we run out, then have loose ones rolling about everywhere. We have to wait to get trust people in to buy (expensive of course) new toilet roll holders then people to come put and fix them to the walls (still waiting).

The soap dispensers run out but the skeleton cleaning staff don't notice because they don't clean our toilets, they focus on patient areas only.

A door falls off a cubicle so we can't use that toilet. Another one has flooded.

Now we learn that we may have to move out of that building as it's too expensive to run and a budget has been cut somewhere by DoH. So there's a halt on recruiting staff like cleaners, receptionists...

Meanwhile, busy front line staff have come down with D&V. Meaning sick leave. Meaning inefficiency. Meaning low morale.

And partly because this building originally came as a special cheap deal.

Every NHS Trust is subject to an annual Use of Resources review by NHSI.
Most commissioning is CQUIN dependent and trusts are paid fined if they don’t meet targets.
Part of the bureaucracy has developed as litigation has increased payments to the NHSLA are huge because of the risk of compensation claims.
There has been chronic underfunding but increased demand and expectations. People want a Proton Beam centre in UK but have no idea of the cost versus impact on both quality and quantity of life. There will be two centres by 2020 but people will start moaning that they have to travel too far....
The real profiteering happens in medicines with huge profits being created for the pharmaceutical companies from NahS funds.

Some efficiency isn’t as efficient as one might imagine. Patients are often all bought in for day surgery at 7am to allow the list to start on time with all patients having been reviewed by the surgeon and anaesthetist. Very inefficient and hugely expensive to have the surgeon keep popping out of theatre to see patients. Theatres need to run at 92% capacity to be financially efficient.

I think the inefficiencies extend beyond the NHS itself - if I miss a half-day at work every time I attend hospital or gp appointment then it really matters if the NHS systems has me attending on 3 separate occasions instead of dealing with everything on one day. If I'm not at work I'm not earning for my employer who still pays me, my employer lose my production, their profit is reduced by this amount and their tax bill is less. So every hour of my time the NHS waste reduces their income. The sums aren't vast but multiplied up they must be pretty significant.

Is a healthy working population who have minimal down time (I.e. wasted sitting in waiting rooms) not a very positive thing for the economy? Would there not be greater tax-take (working people are those who will be contributing greatest proportion) overall so more to spend on NHS?

This is a simplification, I know, but it's an aspect that never seems to be considered.

Out of hours appointments is something our trust tries very hard to provide but the costs easily mount up.

Take my example above - we rent a building or part of a building. It's shut at weekends. To allow front line clinicians to see patients out of hours would mean other staff needed - people to lock up, security, reception, car park attendant, cleaners, the lighting and heating to be running an extra 2 days per week plus evenings.

As I suggested in my example above, building plus support staff costs are areas where we struggle the most. A 7 day a week plus evenings service is expensive, it's why private healthcare passes those costs to the patient to pay.

Incidentally, I have done the same job in NHS, private and charity sectors. The bottom line is all were inefficient due to sparse funding meaning cutting corners in similar ways. Clinicians keep trudging on but sometimes things really feel they're crumbling around us.

pootles I'm not saying appointments need to be out of hours, but that if gp says ' We need to do a blood test ' it shouldn't be necessary to return to the surgery 3 days later for an appointment with nurse. Even if the option was 'blood test in 3 days or pop along to the hospital now and join a queue' that would still be better than having to fit in an appointment on a separate day. There's no consideration that I have a busy work life, appointments with external people (who may have travel tickets booked), and can't just return in a weeks time, or pop back three days later.

I'm sure it's not a local problem, lord knows that my gp knows all about busy diaries, but the overarching system doesn't seems to recognise the benefit in keeping the working population at work.

I recently lost my mum to cancer. She was in hospital for almost two weeks, and died less than three weeks after coming out. Getting her into hospital took three referrals to A&E by her GP. Each time, the GP could not get any answer from the team that could have admitted her directly.

Each A&E visit involved at least four staff members asking exactly the same questions, recording the answers in some form - even though it was all in the referral letter. The same bloods and even the same scans done every time.

On the ward, there did not appear to be huge wastage, but meals kept coming and nobody noticed she was eating nothing at all.

It was at home that the most obscene wastage occurred. We'd asked for nutritional drinks…a crateful arrived that would have lasted months. Blood thinning injections in preloaded syringes… there were about 30 left when she died and the pharmacy would not take anything with needles back. Ditto morphine.

Stupid funding decisions that seem to save money, but actually cost money. A hospital bed for her at home was initially refused, despite being ordered by the district nurse. The delay resulted in a prolapsed disc for me, and an ambulance call out to get Mum off the loo.

Above all, the lack of clarity as to who is responsible for what. Everything was a complete muddle and only the hospice seemed to be able to cut through and get things done.

I'm sad to say it, but within the NHS, there were very few staff who actually seemed to care - two nurses and one practice manager stood out. Hospice staff were all brilliant. Agency carers went above and beyond. The local authority put a care package in place in 36 hours. I was left thinking the NHS is broken.

That's odd goat because in my area you can have a blood test done at your surgery, or hospital blood clinic or a walk in centre.

In a GP surgery all appointments are fully booked in advance so an ad-hoc blood test would be hard to accommodate, they have a 5 minute turnaround at ours. I guess that's why you can opt to do it elsewhere.

I work for the NHS and it us hugely more complicated than you could ever imagine. Each patient is unique and as medical care gets better, people are living longer with more complicated medical histories. I have a relative who had a major operation last year who has a history of stroke, heart failure, diabeties and cancer. That is hugely risky and you have to balance all these conditions/medications etc before even planning surgery.

The original NHS was not designed to provide this depth and breadth of care. Yes if it was built from scratch today with proper finding and technology you might find or more efficient (or maybe find that those old systems worked for a reason!)

The examples you give in your OP are efficient for the system, but not for you.

Of course they have blood tests on the busiest clinic days. Staff and rooms will be busy all day long , therefore greater staff efficiency.

Like pps have said surgery is complex and unpredictable. They are balancing medical need, emergencies, infection control the whole time. If you are last on the list you are likely the most stable and fittest patient. The surgeons I work with tend to arrive at 8am, do a ward round then they are in theatre by 8.30am. Anesthetists are there earlier than 8am ensuring the patient is fit for theatre.

Private care cherry picks patients ( like elective surgery knee replacements etc)and will work around you as you are paying for that convienience. If you get hit by a car and need intensive care and numerous speciailites you will not get that privately.

As I say it's not perfect, but I am privileged to witness lives being saved on a daily basis there. Luckily most people never have to experience the complexity of care the staff deal with on a daily basis.

Our trust just paid 300k to have a building renovated for us to move into. Well that was paid for over 3 years ago now. We have been paying rent on an empty building for 3 years that isn't fit for purpose. Whilst our colleagues in another building pay £1million a year rent and have half their rooms empty that we could happily be using. Despite being severely understaffed we are still working separately paying millions in rent when the obvious answer is to move us into one building. Tried to tell one of the 6 band 7's managing a team of 30. Also the three band 8's above them. But No, they just had lots of meetings about all the things they should be doing but haven't all this time while we just struggled through understaffed and unsupported by this whole bunch of management and did our best without them. Six managers and three people managing my six managers and I can't even get a maternity risk assessment done. It's beyond ridiculous. If we are lucky enough to be given a large budget, we will spend it on staff we don't need and fancy toasters because our managers can't bear for the chunk we don't use to go to a department who desperately need it. I could go on for hours. Basically I agree with you except for the part about going in at 7 for day operations. Half of the paperwork stuff we have to do is put in place by non clinical management who have no idea what is going on on the frontline but need to fill their meetings with some sort of tasks to look like they are earning their ££££ somehow.

Well, after going in at 7am and having no water and being seen later I developed severe tachycardia, had a rough recovery with nausea and gas. Delayed waking and ending up I’m not probably staying.

Ok, maybe in part a reaction, but someone noticing I wasn’t going to be seen soon at the end of morning surgery and saying I could have water- instead of 11 hours dehydration sweating in a hot room- could saved a whole heap of resources potentially. I’m shivering my arse off feeling crap, and having had jaw surgery not able to shove a meal in....

Doesn’t feel efficient, however lovely individual staff are

partystress, sorry about your Mum .

I read somewhere recently that an NHS trust had reduced fatalities after a certain type of operation just by introducing people who sat with patients to help them feed. Small things like that are not costly and can make a big difference. But frequently policy making is so detached from frontline staff who could make these sort of sensible, practical, low cost suggestions that don’t happen. Too many decisions are made in boardrooms with not enough input from frontline staff, particularly lower level ones like healthcare assistants who would be picking up on them. Instead, management level decisions are frequently for high cost, large scale projects or policy which don’t translate well when they’re practically applied, so are wasteful and can do more harm than good sometimes.

Actually, one of the best trusts I ever worked with had a former nurse, former midwife and former GP in board level roles rather than people who’d come up through graduate trainee programmes who only ever worked in offices making policy decisions. They really had a practical understanding of how what they were planning would impact the frontline and the best way to apply it in practice. I’m a huge cheerleader of clinical staff being in NHS management roles.

Thank you Bejam. On one of our prolonged A&E visits, I ended up dishing out cups of water to several people who were waiting, terrified to move in case they missed their name being called, but who were desperately thirsty. The only food available was chocolate or crisps from a vending machine. None of that can help someone who is ill and, as you say, that kind of thing possibly results in longer illnesses and more cost for the NHS.

I'm sure it's not a local problem, lord knows that my gp knows all about busy diaries, but the overarching system doesn't seems to recognise the benefit in keeping the working population at work.

I can identify with that. A few years ago when I needed hearing aids, it took 2 GP appointments to even get referred. Then a visit to hospital A to see a ENT consultant, who ordered a hearing test which was done a few weeks later in hospital B, then a few weeks later, back to consultant in hospital A who authorised the issue of the hearing aid, then a few weeks wait for an appointment for them to be fitted in hospital C, then a return visit to fine tune them in hospital C a few weeks later - due to delays, cancelled appointments, etc., it took about 5 months start to finish! Last year, it was time to renew them, I went to Specsavers, in and out with new hearing aids in a single appointment that I could book a few days beforehand. The NHS places no value at all on the patients' time which as you say, means that less work is being done and therefore ultimately the NHS attitude is costing the UK in terms of lost GDP (plus increased traffic to travel to multiple unnecessary appointments). It's time the attitude of "it's free so you're lucky and don't whinge" was abolished!

I’m a huge cheerleader of clinical staff being in NHS management roles.

Yes, people who've worked up from the "shop floor" are essential in any board room, as long as there's a proper balance with them and "professional" managers. It's where there are too many of one or the other that you have problems - get the balance right and you're good to go. BUT, at the same time, you need the "right" type of shop floor worker too - it's not just their experience at the sharp end, they still need other abilities such as confidence to speak up, intelligence/education to eloquently argue their case, prepare reports, understand matters outside their scope, etc. You can't just put a random nurse or doctor on the Board and expect good results.