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...

Theatre lists are a tough on as the original list and times can change. Patient didn't follow the nil by mouth, bloods aren't back, infected case etc. So I can see why they tend to get everyone in at the same time. Annoying though if you're last.

I have worked for the NHS for many, many years and yes it's severely badly managed. Right now I really believe it's being run on the goodwill of the lower band staff members. Management appear to not have a clue and just want more and more from us.
In all my years I've not seen staff morale so low. More clinical staff need to be running the hospitals in my opinion.
People who have experienced the 'shop floor'

The public sector as a whole needs turning upside down in my experience; poor management, inefficient use of resource. I've yet to see a public department well ran (no I've not come across every one!)

I agree. I worked in a branch of the NHS for over 20 years almost half of them as a senior manager. It is so easy to get sucked in to the culture of permanent meetings which most of the time don’t resolve anything. The last few years has seen an upsurge of managers with meaningless titles and high salaries. As an example when I left the NHS ten years ago the branch I was in had 1500 wte the majority of which were frontline staff. It now has 4500 wte and the balance towards non-frontline staff has increased markedly.

alltheusernames I have seen well run ones. But they had the money cut to the bone, anyone decent left, and it became badly run.
Running a service well takes money. Attracting and keeping good staff takes money.

Attracting and keeping good staff takes money.

GPs earn more than ever but more than ever are taking early retirement and working part time and leaving to work abroad or private. So, no, it's not always about the money. Pay too much and they can afford to work fewer hours (which means less patient treatment!) - pay them too much and they can afford to retire early. It's got to be a balance of money, working conditions, opportunities, etc.

The private sector is more efficient because it cherry picks the easy and cost effective procedures. If those go wrong they boot people over to the NHS. Or refer on their own patients because of complexity.

kazzy I was thinking about other issues actually. My DP worked in the NHS until last year. He now works elsewhere for the same pay and actually worse terms and conditions. BUT he is no longer working from home in the computer until late at night catching up on paperwork, and ultra stressed as there is not enough time to do the job. It takes money to employ enough staff so that people can actually do the job properly. And he was not a GP and not highly paid. But saw patients every day.

I think it works like this:

NHS is underfunded and frontline staff overworked
Politicians bring in managers to improve performance without putting in sufficient money to really sort it out
Frontline staff get pissed off at having too many managers who make stupid rules, stop bothering to use their initiative because managers breathe down their necks
More managers are brought in...

I think people work really hard but it needs cultural change and more trust of people on the frontline to make a difference - as well as lots more money.

Attracting and retaining good staff requires effective HR knowledge.

People usually want intrinsic rewards of the job itself , respect, flexible jobs, training. Pay is not first, or they wouldn't join the Nhs in the first place. This is about job design, decent management practices, values and training.

I agree with pp who has said that they examples you have given would make the patient experience more pleasant but they would not make things more efficient in the way the NHS means efficient ie. it saves it money. Giving people different arrival times for example would create more administration and risk there being gaps in the day if the person before you hadn’t turned up.

But all that takes money. And the main complaint from many front line staff is far too much work. That takes money to solve. My DP said every year the managers just asked them to do more and more work. My DP did it and got good outcomes - they were measured. But it really affected him. As soon as he left the NHS he started sleeping better.
He still feels sad about leaving the NHS as he believes in it. But it was affecting the whole family.

I think the NHS is wonderful, but I have to agree that sometimes I find the staff attitude and their general efficiency of operational procedures low.

I truly believe the issue is they are still operating like it 1950 when we had a far less population size and the demand was less.

It needs a overhaul from middle management up, but that will never happen. And frontline staff will continue to take the hit for the fact the manager wants 4 identical pieces of paper filed in 4 different filing locations and so on.

A lot of the waste is in the management, not even visible to most people... I've worked at an organisation that works closely with the NHS and we attend a lot of meetings and consultations etc. There's a lot of staff turnover and staff moving roles and what tends to happen is Manager A starts a piece of work, works on it for 18 months, attends a lot of meetings with 5-20 other managers. Then Manager A gets a new job in a different part of the service and Manager B takes over their old job and completely changes the work that was done or at least needs another 6 months to be up to date with it.

Small changes require a lot of consultation and staff input (keep in mind these are people on Band 6/7/8 so a two hour meeting costs a lot in salary terms). Recently they've been upgrading some of the rooms in one of the hospitals where we work and they've had nearly a year of staff and service user consultation, highly paid external consultants and architects working on it, endless meetings and presentations... and now the main person has gone off on maternity leave and all work seems to have stopped!

Procurement in the public services is a joke! I went to the Bursar to say that I was going to buy 50 basic calculators locally, they were on offer at 75p each, and I would submit receipts for repayment to me. No, I had to go through the official suppliers and pay £3.25 for the exact same thing!
I bought a printer for £15, in the sale, it was ex display, no box but a full guarantee, I couldn't reclaim the money, I should have gone through official suppliers and paid £65. And so it went on.

It really does come down to management. As the NHS is just so massive, I do think it should be run like a major global organisation - sure, there are senior managers setting strategy etc but individual offices/ departments/ services are run separately with centralised services having a global (or in this case, across-NHS) approach - eg facilities management etc.

Our Gp surgery is incredible. Efficient, responsive etc. Both my sister and SIL, who live near to me but with different surgeries, experience completely the opposite. I couldn't say what it is that my surgery is doing to be so efficient, but it works. For example, if there's been some need to see someone or have tests, it is not unusual to receive a call in the morning from the reception/office staff who will pass along a message from the doctor eg "tests result show low iron levels so a prescription has been set to the pharmacy for you to start immediately and we can discuss in more detail in your already-booked appointment". Similarly, I had to see a doctor at another surgery for DD once so he couldn't take swabs as needed. He told me to do it and drop off at my regular surgery the following day. But I still got a call the following morning to check that I'd got the message and was coming in. I have no idea how they do this, or what processes they have in place to make sure it happens, but it does. Every single time.

What it means is that it CAN be done. Someone just has to figure out how to apply this across the board.

Actually, on that note, I think senior management from the private sector could change things. A large restaurant or hotel chain, for example, would have senior mangers with an understanding of some of the issues. Ditto, major global organisations like banks/retailers.

@marymarkle I completely agree money is needed and the government is deliberately strangling the NHS (amongst many others) but what I would say is the public sector in many areas have been too slow to change, it's not innovative enough to utilise the resource it does have. Funding, bureaucracy, and lack of skills and experience all play into this.

I've had several routine surgeries at my local private hospital that has a contract with the NHS to keep waiting lists down. Found that they were more efficient than going to an NHS hospital, I saw the consultant who gave me a date for my op, then saw a nurse on the same day who did my bloods & MRSA swabs, on op day I had to turn up 2 hours before my theatre slot, got changed, saw my consultant & the anaesthetist & was taken up to theatre. When I came round after the op I was taken back to my room, my obs were done over the space of a couple of hours, once they were satisfied that I was ok I was able to go home, my drugs had been arranged before I went to theatre & were waiting for me. The consultant told me that if I had my op in the NHS hospital I would have been kept in overnight, how much would that have cost? No doubt the next day I would have been expected to wait ages as my take home drugs would only be prescribed that day & I would have had to wait until all the paperwork was done. Every time as soon as I returned from theatre there was a pack waiting for me with everything I needed, drugs, information sheets, a letter for my GP, sick note, dressings & any follow up appointments for physio & the consultant. My experience was so much more efficient, when I have attended NHS hospitals for treatment it has involved several separate appointments, letters sent out for each one, separate appointments for all the diagnostic tests, lots of waiting around & rushed consultations with a different doctor every time. My son attends the hospital for learning disabilities & every time I have had to ring up to chase our next appointment, the appointment has then been cancelled & rebooked, if he has needed blood tests they don't have a paediatric phlebotomist ( in a specialist children's hospital) so we have had to travel to a separate hospital, the consultant asks you to see them again in 6 months, in reality that means more like a year, if physio or occupational therapy is needed you get put on a waiting list for that, if you need an emergency appointment you have to attend A & E to get referred to get an appointment. How much must all this be costing? Surely their must be a cheaper, more efficient way of doing things.

Nat6999 I’m glad you had a positive experience and yes, the private sector is being commissioned to reduce waiting lists for elective surgery.
Are you aware how much that costs compared to cost if using NHS provision?
Do you know that private hospitals cherry picking the procedures they do stops NHS being paid for their work. No money in emergency care of frail elderly but good payments for elective hips.
Do you know most private hospitals don’t have emergency provision and if there are problems you are transferred to NHS?
Do you know the exclusion criteria the independent sector have to ensure care costs are minimised?
Do you know how much time paid by NHS is used by consultants working in their private practice?

It’s not a case of comparing like with like.

I know it must cost the NHS to use private hospitals & that some don't have any emergency provision at night. For someone like me who has a morbid phobia of hospitals it is the only answer when you need treatment because I can have someone with me all the time I'm there. I was able to have my parents with me for my first two ops, my partner was able to stay overnight for one of my ops & it means that I'm there for the shortest time possible. If the NHS makes use of spare theatre slots in private hospitals, it means that there is more availability when you need treatment, as a single parent it meant that I was able to plan care for my son & not mess anyone around when ops get cancelled. There is less chance of getting an infection as you are in a single ensuite room, you get better care, I'm not knocking the NHS but from what I have recently seen when my dad was in hospital & passed away, the nurses are rushed off their feet, as their numbers have been cut due to budget cuts, it's hard to get to speak to a doctor, most doctors only visit a ward once or twice a week, the quality that used to be the symbol of NHS care simply isn't there any more. Contracting out care to private hospitals is only a tiny fraction of the NHS budget, it's time they cut the management & non hands on staff & passed the savings down to employ more doctors, nurses & HCA. When you ask a patient of their experience of being in hospital, it's the hands on staff that are remembered, not the management. Nurses are now spending a good portion of their working hours doing paperwork & not actually caring for patients, it's time it was streamlined, it systems should be refined to make them more efficient.

Current average funding to NHS Trust for hip replacement £5, 232
Current average cost of NHS funded hip replacement in private sector £11, 478
That’s before you cost in pre admission care done by NHS and emergency care, where necessary.

Much nicer, of course, to have a single room (although Surgical Site Infection rate and Never Event rate may be lower in NHS). Better care is a very subjective view. If you had a major bleed, you’d undoubtedly get better care in the NHS.

Much nicer to be able to plan your life and have nicer hotel services but that’s not about NHS efficiency - it’s about individual preferences.

Most trusts would love to employ more nurses and doctors. Most trusts have funding to employ more. The issue is finding them. Recruitment is a real problem with high agency use and many unfilled posts. Sadly, expansion of the private sector for easy, high priced surgery has increased difficulty in recruiting nurses to NHS.

My mum had a major bleed 2 days after leaving hospital to recover from her surgery paid for by BUPA, our GP contacted the hospital & the surgeon returned at 11.00pm to take her back to theatre & stop the bleeding.

Private care is all very nice and everything is efficient in terms of paperwork and people having time for you. However, if something goes wrong, what about then? That would be the deciding factor for me. For example, if I had a cardiac arrest, the person I'd want on the scene first would be an anaesthetist. A teaching hospital might have 5 anaesthetists on site overnight. A private hospital will almost certainly have none. There's a huge amount wrong with the NHS but private care isn't quite what people realise.

The old 'get rid of the pen pushers' (that's really offensive to the absolutely vital non-clinical staff btw) and 'get more nurses' comments show no insight into the reality of the NHS. Everything now is about performance and targets. That has to be managed and reported on, and in many NHS organisations, services are commissioned and then performance reported on a weekly/monthly/quarterly/annual basis. That has caused an increase in non-clinical staff. As has the complex management of a finite resource with almost infinite demand. Bed management is an industry in itself now.

For me, the best way to start saving the NHS is to pump more into Public Health. Use this resource to get children moving, reduce obesity and make sure they dont start smoking. Support and educate the public more on what a healthy lifestyle is. We've normalised obesity, that's madness. It causes long term health conditions and kills people. Prevention through education, along with good free support to lose weight are really important. All of this will help reduce the long term burden on the NHS.

Social care is of course the other issue - causing so many problems for the NHS. We need to contribute more to this, whether we want to or not, probably through increased taxation, if we want a better society, never mind NHS. Bed blocking is the cause of so many cancelled operations.

As for the NHS itself, it needs to be innovative and flexible. Get the right people doing the right thing. I remember years ago we tried to introduce a new grade of staff who would cannulate, take blood and do ECGs to take the burden away from junior doctors. The junior doctors at the time were really reluctant as they saw these functions as their remit. The roles were introduced anyway and continue to this day, across the country. Continuing innovation eg Advanced Nurse Practitioners will make an enormous difference. As will the use of technology. One service I work with has put much of what it offers online, improving patient experience whilst reducing costs. Not every service can do that, but every service can make better use of technology (dont start me on sending out letters) to offer an improved service which may be cheaper.

We also need to stop automatically cutting admin staff. They're an easy target, away from the public eye. The work they do has to be picked up by someone, usually someone clinical whose hourly rate is probably double that of the band 2 who used to do the job. It's short sighted and adds to stress levels.

We within the NHS need to become more flexible and start thinking differently. Often change is blocked because everyone wants to protect their own interests. Acute hospitals are the most political places I've ever worked - you just have to read about what went on at St Georges for evidence of that. It's time for all us NHS staff to actually all work together to make it a better organisation, that's still possible.