Andrew Lansley - vote of no confidence from Nurses

[wideawakenurse]

here

Watching this with much interest.

Really hope the nursing unions get this right this time, and don't just roll over and take this.

And hospital car parks! Why do they let private companies profit from them? Why doesn't the NHS run them?

Mellow - maybe on your income you pay less towards your share of the health bill, than you receive - but that can't be the same for everybody. Some are 'net contributors' and they may have their limits. The young and the childless tend to be net contibuters and we can't rely on them to pay for our health care when we are old. Others might prefer to see their tax revenue spent on education and social housing, for example.

The US health insurance model has many faults - I agree. But it is not the only alternative.

And who should best maintain hospital car parks - porters or nurses perhaps?

I don't think so - I hardly ever see the doctor. But whatever I pay, it's worth it for the peace of mind it gives me that should any of my family ever fall ill, the care will be there for us.

And as I said, I'd rather my taxes went to the NHS and Education budgets than anywhere else.

I agree, Mellowfruitfulness - what we pay to NHS is worth it. It's a very dodgy route to go down when you talk of net contributors and beneficiaries when health itself is such a lottery. I have encountered a couple of GPs who have misdiagnosed simple childhood illnesses or given the wrong advice about breastfeeding or weaning, etc. But I'm pleased to say that most are competent in their clinical judgement yet managing budgets is a whole new ball game

As the 'gatekeepers' to services some GPs will be making rationing decisions about care just to save money in their budgets when previously they would have referred a patient. And that could lead to delays or much worse. Or they may decide to test out different new 'providers', companies that might come and go, when a person has a long-term health problem or one with a particular complication that needs to be under the regular supervision of a hospital consultant. There's no continuity of care and that person is just a guinea pig.

Meanwhile, staff in PCTs have lots of management expertise and administrative resources to link up all of these myriad and complex services - so why reinvent the wheel in a way that cuts the specialists out of decision-making, isn't accountable, and will lead to enormous imbalances in provision and less patient choice?

The ONLY winners are private companies. Nurses, consultants, managers, patients and even overworked GPs all lose out.

"It's a very dodgy route to go down when you talk of net contributors and beneficiaries...."

In the context of suggesting other people should be willing to pay more in - it's valid. And it's not just about relative wealth. Younger people tend to 'pay more in' than they get out and intergenerational debt is a big enough problem already.

Much improved efficiency would secure the future of the health service. Continued gross inefficiency will eventually cause it's collapse.

"PCTs have lots of management expertise and administrative resources to link up all of these myriad and complex services - so why reinvent the wheel?"

I'm guessing because it isn't working as well as it should? If it is then why go through the headache of change? It's not as if the present government hasn't got anything else to do.

No Jackstarb, that goes against the principles of the NHS - health is a complete lottery and no one should be privileged based on ability to pay, whether you are a child with cerebral palsy, diabetes, PKU, hip dislocation, etc., or an elderly person with heart disease, Parkinsons, brittle bone disease, or the mother of a large family with complicated pregnancies. Or childless and perfectly healthy and a net contributor until you hit 50 and go through years of cancer treatment. It's a lottery and more often than not, completely unpredictable.

I would agree wholeheartedly that if you are a smoker, or overweight, or an alcoholic, you should be given the best preventative health advice and high risk groups should be targeted. IVF for the over 40s, liver transplants for chronic alcoholics? Tough call. But consultants and ethics committees are used to taking those decisions. Meanwhile, Cameron's election campaign focused on expensive cancer drugs for all, even if they do not give proven value, as if politicians and tabloid newspapers know better than NICE. Yet he didn't mention these reforms. Ringfencing not rationing. What an utter liar.

Rant over, think I will stop hyperventilating.

"health is a complete lottery and no one should be privileged based on ability to pay".

Of course they are - 10% of people have private health insurance and plenty more dip into their savings to beat the waiting lists when they need to.

And according to my nurse sister - even the quality of healthcare you get from the NHS depends on your ability to understand and navigate the system - which is a function of your education and often social class.

As Peter Hain has just said on TV, I couldn't disagree with you more.

I have never had private insurance, and several of the people I know who have it either don't use it or find that private hospitals have been inadequate in dealing with A&E or cancer, and one person contracted MRSA in a private hospital. MOT/heath checks in private clinics? Nice. But not the same as insurance, and half the tests are unnecessary or unreliable.

On the other hand, waiting times in NHS hospitals for cancer have been so drastically improved in the last 10 years that the several people I know who have been diagnosed with breast cancer saw a consultant within DAYS. And their lives have, quite literally, been saved.

Disagree, NIceguy. The more people there are, especially older people, the more money is needed for the NHS. The amount of money needed will continue to increase year on year as the population grows

Two responses. Firstly where does the money come from? Do we endlessly increase taxes? After all, that's how the NHS is funded. How much is enough? Right now I don't see an end. If they said "Hey, if we raise income tax by 2p then we'll have enough cash" then I for one would be pressuring my MP for a tax rise.

But like many I suspect that a 2p rise would be met the year after with "We need more money". At what point do we say we've given you enough money. You must make do with what you have.

Secondly we've been living beyond our means for such a long time. Cuts are being forced upon us to balance the nation's budgets. In short we've funded an NHS we couldn't afford in the first place. Yes Labour found a way to invest heavily in the NHS. They borrowed it. Would you be happy if your parents took a loan out and gave it to you to pay your council tax bill? Would you be happy if they took that loan out in your child's name?

I used to work for a company who supplied the NHS with a lot of IT equipment. The busiest period was always around the end of the financial year where every dept was trying to blow their budgets so that the next year they could get more.

So don't tell me there's nowhere to save money. The NHS management structure is a complete quagmire. For me it's a miracle the doctor's & nurses get any work done and its often in spite of management rather than with the support of.

Totally agree with muminlondon- Labour improved Cancer services spectacularily- anyone with symptoms suggesting cancer were seen within 2 weeks by a Specialist. This has quietly been scrapped by the Conservatives.

Not sure which area Niceguy2 was supplying -I think you will find that towards the end of the financial year most Trusts clamp down on spending-no bank/agency staff /no stationary(yes really!)and most computers not replaced until they have completely had it.

I think 'used to' is the operative word there. 'used to work in IT'

I used to be able to afford a reasonable standard of living on my AFC contract, too.

No more.

Sarah - it depends if they have spent all their money or not.

In 'cost plus' based budgeting the trick is to exactly spend your budget. If you spend less, you get less next year (as you obviously were given too much this year).

This is one of the reasons it's difficult to control public sector spending.

In the private sector you are normally judged on your profit (p&l) which is a cleaner and sharper way of measuring performance.

I see some crazy examples of "budgeting" in the NHS.

We have an ancient printer on our ward that breaks down frequently. When it breaks down we can't discharge people as we can't print the discharge papers. We could go to another ward I suppose but in reality we don't as we're so short staffed we couldn't safely leave the ward to find another ward, log on to their computer, etc. So we just tell people they can't be discharged until the printer is fixed which would be the next day if not the day afterwards. This is on a ward where there is reguley a bed crisis. So we end up having to shut the ward to new arrivals and as we're the only ward in our hospital to take maternity cases we have to shut the maternity unit. Hospital gets a big fine for this. Do they replace the bloody printer though, no!

We're only allowed to use one treasury tag in each set of handheld notes. Notes get thicker and thicker and its very difficult to file stuff in them as the treasury tag is so tight. So people give up and stick stuff in loosly or the tag is so tight that the holes get ripped trhough and stuff falls out. We can't get the CNST level we want (which would save us hundreds of thosands of £ in insurance) as when we get inspected if they pick up any notes and there is something loose in it we don't pass the inspection.

We used to have special sheets to stick blood reports on. The sheets had a peel strip that was sticky underneath. So you stuck the report on the sticky strip. It was decided that this was too expensive and we were to use ordinary sheets and sellotape. But then some bright spark in accounts banned our manager from being allowed to order sellotape. We're not allowed paperclips either.

@Rennies

I still work in IT and honestly I try to avoid public sector contracts whenever possible as it depresses me to see the sheer inefficiency & wastage which goes on within them.

we got some snazzy new office chairs the other day. After spending two years sat on dining chairs swiped from the patients dining area. Thanks.

VLB at your examples!

Niceguy, I agree - terrible wastage. But surely what's needed is joined-up thinking when it comes to budgeting, not cuts. What you describe is exactly where the efficiency savings should be made, not by reducing numbers of nurses.

Also accept your point that the amount of money needed for the NHS will rise every year, and it is a bottomless pit. But the number of tax payers also rises every year. What doesn't rise as much as it should, imo, is tax on higher earners and the amount recovered from tax cheats.

(For some reason the SNP have promised to freeze Council Tax in Scotland for 5 years if they are re-elected. Why? Blatantly trying to be popular, if you ask me ...)

All of our problems boil down in the end to overpopulation. But the most effective measures to combat it are counter productive and/or inhumane and/or uncivilised and/or illegal! We're left with only the long-term solution: education. But that's being cut too ...

"All of our problems boil down in the end to overpopulation."

No they don't.

The benefits system and the NHS are being hit by two primary problems and neither are related to over population.

The first is that people are living longer into retirement. In the 1950s the average lifespan for a man was about 65. So on average most men would be lucky to make it to retirement at 65 and then wouldn't be retired for very long. Now days the expectancy has gone up to about 77. So suddenly, on average, men are claiming out of the system for 12 years when they would have hardly made any claim at all when the system was put in place. So that's 12 years of claiming and healthcare compared to, on average, none when it was all worked out.

So we've got an increasing population who retire and claim benefits and require healthcare. And who pays for them? The younger working population, and here lies problem number 2. There's less young people.

It used to be the case that each generation was supported by a more numerous younger population. Your typical age population pyramid. Not any more. We're just on the cusp of hitting the point when things turn around, the generation about to retire will be supported by a less numerous younger population. And both these problems link together, this smaller younger generation will not only be supporting a more numerous "just retired" generation but also the older generations who are still around due to improvements in life span.

And that's the problem.

We need more young working people to pay for the current system, so we actually need population growth.

Or we need to have a sit down with ourselves and have a very serious chat about how we're going to pay for all of this because the current system is broken and is going to get much much worse as the population becomes increasingly aged and are no longer economically productive.

You are so right - badger

As I've tried to say - it beholden on us to ensure all our public services are run as efficiently and effectively as possible. Just handing over the problems to the next generation is nolonger an option.

Agree, BP, but it was the ageing population I was thinking of when I wrote overpopulation.

In Scotland in particular, people say we need population growth - ie more young people to look after the old. But I don't think I agree, because that will bring with it its own problems.

What I think is vital is that we don't reduce the chances of the younger generation of becoming tax payers. So we need to educate them. That's surely one thing that my generation (baby boomers) can and should be doing for them, out of our taxes, before we retire. (So I'm in favour of retiring later. Not raising tuition fees, fgs).

"In Scotland in particular, people say we need population growth - ie more young people to look after the old. But I don't think I agree, because that will bring with it its own problems."

If you do not have population growth then the current system, which is already crippled by lifespans far beyond what was imagined and by people having less children, will break completely. Just about every presumption that it was built upon (short retirements, short lifespan and a more numerous younger generation) has been shattered.

So we either have massive population growth, give less in benefits and healthcare or all pay a lot more tax. Politicians have spent too long dodging that question and that has landed us where we are. We either answer it now, or really drop our children and grandchildren in it later.

This demographic 'timebomb' is wide spread across most developed countries. And even China has a particular problem because of their 'one child' policy. Young people will be in great demand. I doubt the brightest and most ambitious will accept a high tax burden.

...But the number of tax payers also rises every year. What doesn't rise as much as it should, imo, is tax on higher earners and the amount recovered from tax cheats.

Actually no it doesn't. Yes people grow up and become tax payers but remember each year people retire too. Immigration of course could change that by allowing people to come into the country, work and pay tax. Alas the Tories seem to think its more popular to reduce immigration.

Tax on high earners is already far too high. We have one of the highest tax burdens in the EU, indeed the western world. Tax cheats are being clamped down on but it may not be at a speed most of us would like to see.

Simply put, our current economic woes cannot be fixed with taxing high earners more or a few "efficiency savings". We're way beyond that now. If we are serious in balancing our budget, We NEED to make large cuts. And that will hurt.

Anyone who thinks otherwise is simply (as I just read elsewhere) an economic flat-earther.

I think there have been some valid points made about rising/ageing population and the demands on the NHS. It's hard to defend wastage and inefficiency. But you cannot apply the profit motive to the NHS as an outcome or objective. It's not even a motivating factor for most of the staff (which is why the GPs contracts were badly handled - and as an opposing argument on the wastage, think about all the unpaid overtime by low paid staff and consultants alike - I know examples of emergency patients seen in a doctor's lunch break, in hospitals at least).

You need continuity of care, you need joined up services, accountability, decisions on care taken by specialists for the long-term, a cohesive whole, not fragmentation. The patient must be at the centre, not profit.

Led by GPs, these reforms just won't address the points you have made, Jackstarb - consultation has been so poor, and the legislation so rushed and flawed. You've expressed your own doubts.

muminlondon I so heartily agree. You have eloquently made some good points. Have you ever thought of going into politics?