How would you fix the NHS?

[PinkFruitbat]

The Government is asking for ideas on how to fix the NHS.

https://change.nhs.uk/en-GB/

What would you do to fix it?

Oh look, here’s a different graph (source is given). The dip after 2020 is obviously the drop in covid spend.

The whole approach is crazy imo

@Rummly do I need to explain how inflation works ?

@Rummly oh and a lot of that extra 'funding' disappeared into the pockets of fake PPE providers. And private medicinal companies. Not into the NHS.

The graph is in real terms. It’s adjusted for inflation.

(Snark-free response.)

The DoH estimates 1-4% of PPE contracts being compromised by fraud.

That's the problem. There is no National Health Service.

It's split between the various regional governments of the UK and, in England, among various "Trusts".

Stage 1. Nationalise it. One overall health service for the whole of the UK run by a UK wide Dept. of Health.

Never happen, of course, too many vested interests working against it.

Make hospitals pay a charge if they cancel someone's operation. I am sure they could help people if they kept to original appointments. My DP has had 10 cancellations.

@Rummly using which basis for inflation ? Because estimates vary defending on which you use. Depending on your original bias and agenda.

amp.theguardian.com/politics/article/2024/sep/09/tory-covid-contracts-worth-15bn-had-corruption-red-flags-study-finds

I think they should focus on continuous process improvement and encourage staff to be feeding back inefficiencies, bottlenecks, wastage on a continual basis.

The resources wasted for absolutely no reason other than disorganisation and apathy are phenomenal.

I’m sure Nuffield or the BMJ (the secondary publisher) could give a full explanation.

I’m not blind to the concerns, of course. But the better places to look for even tentative assessments of wrongdoing and unlawfulness are the court judgments in the many JR cases brought. Except in one very minor respect all the challenges to the contracts examined - which were selected as being the best cases to go for by GLP and EveryDoctor - failed comprehensively.

I won’t go through it all here: it’s too far off-topic.

Why has no other country adopted this? Why do you think this would work?

Many years ago, we had a staff suggestion scheme.
I suggested a scheme whereby staff could put forward their suggestion, with estimated costings. In return, if it was implemented, the staff member would get a % of the savings from the first year as a reward. This would motivate staff to find ways to save money, to streamline processes, and to actively look for ways to improve.
They loved the idea but immediately threw it out as they didn't see why they should reward staff financially. The fact that they would make those savings year in year was of no concern.
Instead, they get badges printed with some trite saying like "I'm an NHS saver" on it. Like we are all 5 and love a badge.

Absolute idiots! FS 🤦🏻

The incentive drives the cost savings 🤦🏻

This is driving me mad just thinking about it. Even a £10 incentive would be something. Fools, dickheads, twats. And it would surely reflect well on those implementing and signing off the scheme too. 🤦🏻

This sort of thing is standard in companies that follow six sigma and continuous improvement models, and it saves them millions of pounds a year – and results in a better experience for customers/suppliers/service users too, as well as employees and internal stakeholders.

This must have been such a frustrating, exasperating experience. Aaaghhhghhh!

Well, it's clear that fragmenting it into so many different trusts over the past 20-30 years hasn't worked, has it?

No other country has any form of "NHS" like hours! Fragmented via Trusts or not!

In our local newspaper many years ago (maybe 15 years??) there was an article about one particular ward at our local hospital where the staff procured their own non clinical supplies, i.e. sick bowls, loo rolls, soaps, paper towels, pens and paper, etc - so basically just consumables. It was some kind of trial.

The article said they'd saved tens of thousands of pounds in a single year.

For a start, it's unfathomable that they spent so much in a single ward on consumables to "save" tens of thousands, but that aside, it just showed the immense waste in procurement whereby the "official" procurement was grossly overpaying for such things when they should, by virtue of being huge buyers, have been able to command massive discounts far below what a random groups of ward staff could buy the things for!

Never heard of again of course. Can't have a single ward showing up the NHS like that can they?

@MoonPieHazySky it did drive me mad. It was the early nineties when I suggested it so over 30 years ago and it still annoys me to this day.

I was in the NHS for 40 years. When I started the hospital received a budget as a whole. We had a finance manager who had to sign off on large purchases, in-house maintenance staff, and all equipment was pooled. and apart from medical secretaries, ward clerks, and record clerks, there were very few admin staff.

Fast forward to the introduction of the internal market in hospitals. Each ward now has a budget. If I needed medicine from another ward I could no longer just go get it. I had to generate loan forms, log the fact I had lent it, send the form to pharmacy where they would take it out of our ward budget and give it to the other ward . All of these extra layers required extra finance staff and auditors to monitor spending and budgets. Then they introduced targets and this required more staff to monitor targets. There was an explosion of office staff. Meanwhile in 40 years on the coalface, apart from advances in medicine, nothing much really changed. It worked more efficiently under Labour as in waiting lists improved, but there was a lot of manipulation to reach targets.
The 4-hour wait in A&E was manipulated by sticking labels on trolleys with the words 'temporary bed', or turning areas into an 'observation area'. The actual treatment of the patient didn't change, they still waited in A&E for test results to come back and be interpreted, they were just classed as being in a bed now.

I'd bring GP surgeries properly inside the NHS. Most issues stem from them and their inability to have compatible systems with the rest of the NHS. They are profit making companies who only work for the NHS. Its an insane waste of money that does not deliver good care

Yes these were businesses/providers that were never part of the NHS in the first place.

I'm talking about Community MH, OT, Physio that were always part of the NHS but then moved across into a private company, totally different.

Its quite incredible the mental gymnastics Tory supporters will engage in, just so they can say that no part of the NHS has been privatised.....

GPs are mainly paid for reaching health promotion targets called CQUINS. They have to reach a certain percentage of a target, for example, cervical screening, blood pressure checks, weight advice, flu shots, and vaccination.
They are all important, but it incentivises them to push these. I can't visit my GP without getting a BP cuff on my arm. I get consent vaccination and cervical screening reminders. I get 'invited' for an annual health check with the nurse.
But if I'm ill it's virtually impossible to see them and they are extremely reluctant to refer on unless it's pushed for.

So you want medical staff spending work hours buying "consumables? or do you expect them to go shopping in their own free time, provide storage space for these products & bring them into the work place all free of charge....

Of course getting people to do things for free is going to be cheaper than having a commercial supply chain....

I also doubt very much it even happened, i do not imagine staff are going to buying large amounts of paper towels, loo roll, stationary for a busy ward

How have people living in their own home "benefited from" house price inflation? They live in the home - so no cash available from it. (Equity release is known to be a rip-off in many circumstances).

And thanks to house price inflation, many are isolated (at a vulnerable age - when especially needing family support). Because their children and grandchildren have been socially cleansed out of the area, and/or can't afford their own home - which is a source of distress for their parents, most of whom can't afford to help their DC buy a home.

And no they can't all just downsize. Even if well enough for the massive upheaval of moving, downsizing has been devastating for childless/child free people and only-child families. Might be area dependent but in many parts of the UK, not only is there a lack of 1-2 bedroom homes full-stop, there's far too few suitable for elderly people (or younger disabled people).

And if you mean even more tax on landlords (who are all generations - more than a few in their 20s and 30s), what a disaster for lower income, or even medium income renters, who'll be without any home - because the landlords will just sell up and no that won't mean people on the lowest incomes will be able to get a mortgage to buy. Btw homelessness including substandard temporary accommodation costs the NHS loads - because bad or insecure housing harms health.

I do, however, agree with slightly increased income tax - with the caveat it's not misspent.

Also more council housing across the UK asap, including 1 and 2 bedroom homes, and homes suitable for elderly (and younger disabled). More council homes (that are well-maintained) would save the NHS loads.