The NHS; always seen ‘in crisis’, a national, or political problem?

[Isitmebut]

Apparently the ‘crisis’ has been called based on A&E figures for the last quarter ending December, seeing 20,000 more patients each week than this time last year, and not just the drunks, the obese, or worse still, the obese drunks.

• A&E England with a 4-hour waiting times target of 95%, was down to 92.6% (a “worst figures in a decade” crisis?), Wales with the same target (it never appears to meet) hit 83.3%, and Scotland’s figures hit 93.5% from a 98% target - with Labour currently running the NHS in Wales, promising 1,000 more nurse to Scotland, funded via the Mansion Tax on England, rather than the recent SNP doubling of the family Stamp Tax.

If I lived in Welsh Wales with an 83.3% rate without a prayer of hitting the 95% target, I’d be rather miffed with Labour if they were fawning all over Scotland with a 93.5%, for why, more 2015 Westminster seats?

• The main reasons are the UK populations GROWTH RATE, we are aging and have more complex medical cases, causing unprecedented demand.

• Over the past 5-years (2009) many serious illness have become survivable, increasing those needing ongoing care by 50% e.g 500,000 more cancer patients able to live with their illness.

• GP appointment requests up 900,000 a year since 2010, but despite better paid contracts, prior to 2010 working hours were cut e.g. out-of-hours. Surely we only needed Walk Ins, phone lines, and god knows what else, because we can’t get to see a GP?

• There are several thousand more doctors and nurses since 2010, funded in the main by getting rid of 20,000 hospital bureaucrats/managers added by the last government when Hospital Trusts were formed e.g the failed Mid Staffordshire Trust.

• We clearly need more doctors and nurses, and that will be ongoing, but if we remain in the EU, never mind as the strongest economy attracting ever more workers, HOW does the budget/hire for such a huge potential variable in DEMAND?

• The EXPERTS cite the need for better NHS services integration, from beginning care to discharging needed to clear the back log – apparently needing smarter government, rather than (ideological or economic growth slowing) taxes raised and thrown at the problem.

If the last government raising new taxes and spending the increased taxes from a financial bubble having doubling the NHS budget, STILL left less hospital beds and more Hospital Trust debt via Private Finance Initiatives (than when they came to power) within a mainly unreformed 2010 NHS organisation, then competence NOT MONEY has proven not to be the key determinate of a sustainable NHS.

But money is also key, and political parties may promise a few £££billion of NEW MONEY each year.

But if clueless how to run an economy and think business bashing will increase employment rather than get companies to CONTRACT both investment and employment – then they are taking their eye off MAINTAINING the approx £100 billion we CURRENTLY spend on the NHS, as countries like Portugal, Spain and Greece with weak/stagnant economies found - being forced to CUT their health spending, by up to 17%.

I read your summary of the problems although I'd add a couple more.

The first would be Conservative idealogy; as a party they are against the welfare state and the NHS, as part of this state. Perhaps privatisation fits in nicely with the kind of state that would suit them.

The second is that the media seem to further spin these figures to only show a failing NHS. The NHS may well have problems, but if the general public are made to believe that it's beyond recovery, there will be little or no opposition to Conservative idealogical privatisation, despite its obvious negative effects.

I think you’ll find anti NHS “Conservative ideology” is folklaw, as it appears they are the ones always trying to get the public finances under control, so are anti fat quango government, sucking in and raising tax payer’s money.

Furthermore, based on Labour’s 1997 to 2010 record, THE FACTS show that they used far more private money (privatisation) than the Conservatives have, ON TOP of a large increase in annual spending.
www.telegraph.co.uk/health/healthnews/8779598/Private-Finance-Initiative-where-did-all-go-wrong.html
www.telegraph.co.uk/health/healthnews/9356942/Blair-defends-PFI-as-NHS-trusts-face-bankruptcy.html

May 2007; “Blair's legacy: Health”
news.bbc.co.uk/1/hi/health/4555344.stm
“No government has ever invested more in the health service than Labour under Blair and yet the NHS is mired in deficits with patients taking to the streets to prevent the closure of their local hospitals.”

“Joyce Robins, of Patient Concern, said: "I feel sorry for Blair, but the money has been wasted."

“This seems to be the crux of the issue. The public was promised record amounts of money would flow into the NHS. And so it has.”

“But the problem is it has not necessarily gone where many would expect.”

“Once pay hikes - consultants and GPs have both received lucrative increases - covering for deficits and rising drug costs are taken into account, the 7% budget increases actually equate to about 2% for services, according to the King's Fund.”

”Surveys have repeatedly shown that when asked what they think of the NHS people reply it is in crisis.”

Not that you’d know any of this, as two days into the General Election, I’m sick and tired of hearing that the NHS is only safe in Labour hands.

Even hearing this from a UNISON about to go on strike; what a shame all the NHS money went on salaries for those at the top ‘few’, not ‘the many’ e.g. lower paid front line staff e.g. nurses.

Ah, come off it . Gidiot flies by the seat of his pants as far as controlling the economy goes. I don't agree with cutting taxes either because society loses infinitely more (police, libraries, care homes, meals on wheels, sure start etc) than it gains (a couple extra quid a week in the average person's pocket, if that).

As for lower paid front line staff e.g. nurses, it's the current coalition policy to freeze their wages, not the Labour opposition. I doubt (c)Hunt cares too much about their earnings.

Of course, the convenient media spin is that all public sector workers are scroungers, along with those dirty jobless, disabled or immigrant scum *not my opinion, just what it seems we're being told to think. So there won't be much of an outcry against their low pay.

"The main reasons are the UK populations GROWTH RATE, we are aging and have more complex medical cases, causing unprecedented demand."

There is a flip side of that, the obvious solution. Build more capacity in the system. Get away from the political philosophy that the system must be lean and mean and never have any waste. Build more facilities and hire more staff to meet demand at peak periods.

Politically untenable, I know. :( Just don't be surprised that if the system is taut when demand is average that the system can't cope at all when demand peaks.

It's the consequence of an ideology of paring public services back to the quick.

that's why we had the MRSA problem, because hospital beds were being occupied constantly and in those conditions MRSA was more likely.

Any public servant will tell you that for decades the Govt has been preoccupied with Just In Time ideology. The number of lectures I've had to sit through where Tesco's supply chain and management structure was held up to us as a thing to aspire to. It avoided so re capacity and the cost if redundant inventory and under utilised human resources.

The problem is that you cannot resurrect an entire ward full of hospital beds Just in Time to meet the unforeseen blue demands that arise It takes time to hire and train nurses etc.

The Givt should stop looking at Spare Capacity as some sort if inefficiency and start realising that spare capacity is essential to meet the peaks of demand

God help us when Ebola hits us.

Ebola won't hit us (and yes I really should know).
(Shocked at how much of WetAugust's post I agree with otherwise)

Any system that has peaks and troughs should be geared to meet the peaks (or maybe 95% of the probable peak level). It would then normally be working at maybe 60% capacity, with easy room for maintenance, training, staff development, incremental development etc.

If you run a system so that it always at nearly 100% capacity, then as soon as the demand goes above normal then it will not be able to cope and a backlog will build up, and only decay once the demand drops back to normal levels.

I spoke to someone recently who has been told she is on a waiting list for gall stone which will be 3-4 months (has already been waiting for at least a month). She is suffering from nausea akin to 24 hour a day morning sickness.
It is her type of routine operation that get postponed when the system is overloaded. And in addition to the unnecessary suffering, what is that doing to her long term health ? Surely she (and sadly many others) are having their long term health compromised by a totally mismanaged (and underfunded) system.

To my mind that is a political choice. A society we have underfunded our health service for years link.

We spend far more on the NHS than pensions and than education. In fact combine both together and you're probably getting closer.

So I don't think the problem is underfunding. We're spending literally billions upon billions on the NHS.

The issue as I see it is how that money is being spent. Until that is sorted out, throwing more money at the NHS is simply throwing more money after bad.

Politician's have to stop with the notion that the NHS can be saved by chucking a couple of billion at it. Sometimes the answer isn't more money. But then turning the NHS around takes years of hard work and political capital. Promising to chuck a few billion more is easy and plays well in the news.

I agree with the PP that a lot of the problem is not funding but organisation of resources. It has been known for a long time that the NHS procurement system is far too fragmented and inefficient, for example. Given that the NHS generates no revenue but is simply a spending operation, this is very serious.

A simple example of the waste this results in is the purchase of disposable gloves - and imagine how many millions of those are used across the network every year. Rather than a central body negotiating a really cheap deal with one glove supplier for a selection of sizes and types of glove, it's being done piecemeal with hundreds of different sources, hundreds of different stock items and vastly different costs.

AllThePrettySeahorses ….. re your ”Gidiot flies by the seat of his pants as far as controlling the economy”, I suspect that you have little idea what constitutes a ‘sustainable’ economy i.e. a low tax for all, business friendly environment = private sector job growth job, as it was nothing like the one the Conservative led coalition inherited in 2010.

Especially as Labour (having already flagged their intent by raising National Insurance, prior to 2010, to come in AFTER the 2010 General Election) were keeping most their tax rises quiet until afterwards.

France in 2010 with a similar economic model to the one Labour left, STILL has record unemployment levels, and near flat growth to pay down their budget deficit, admittedly much, much lower that the one passed on to the Conservatives.

Socialist governments try to CREATE jobs by using taxpayers money and it was clear by 2010, years after the crash started, and many tax PAYERS supporting the growth in government lost their jobs – either Labour did not understand their government job fest was unsustainable, or needing their election funding, they were unable to upset the Public Sector Trade Unions. Whichever, with higher taxes to follow, it meant we would not have seen the economic recovery we have seen, and be as Lost In France as the French population is.

Re lower paid front line staff e.g. nurses and your non constructive ideological rant; in my opinion there are two ways of looking at this, and one I have already alluded to.

Firstly, forget we still have a £90 billion plus annual government overspend, as far as public sector pay rises are concerned, up until now, have all the taxpaying masses all had big pay rises noting that flat wage growth is a factor immediately after any major recession, never mind the worse one for 80-years that started in 2008?

Secondly, when in 2000/1 the UK had a BALANCED ANNUAL BUDGET, it is clear from my links further above MOST of the new money going into the NHS went on wages, BUT NOT TO THE LOWER PAID FRONT LINE.

Furthermore, from 2000/1 the last government CHOSE to spend many, many, £££tens of billions on NEW government quangos and ‘non jobs’, INCREASING annual government borrowing to do so – and if you want EXTERNAL NHS examples I’ll be pleased to provide them – but here in an internal one, The Institute of Health Care Managers listed 1,700 separate job categories in 1995. By 2002 this had grown to 5,529.

So while history shows many voters falsely blame the Conservative ideology for sorting out what the UNSUSTAINABLE socialist mess they inherit, not the party that caused the problems - it should not be hard to work out that if Labour/Balls had any better DETAILED ideas in 2010 (or 2015) how to rebalance the economy after their 2007/8 crash, we would have heard them, rather than blame and non detailed ideological mantras.

WetAugust …. You mention a few points; hospital acquired infections and NHS capacity.

I am very aware of the MRSA and C.Diff strain as my late mother with various illnesses caught them on three different occasions over as many years, the last time the hospital requested a ‘do not resuscitate’ authorisation – and while she did recover and leave the hospital, lets just say the drain of catching those illnesses WHEN ILL, did not prolong her life.

Re hospital bed capacity, the figures I saw showed that from 1997 to 2010, the number of general and acute beds in hospital FELL by 13,000.

But again, all this was going on in A TIME OF ££££PLENTY, when the NHS budget was nearly doubled from the proceeds of a national spending/debt bubble, so while I agree with niceguy2 that it is not ALL about money – it would have been nice to find out that if money HAD BEEN SPENT WISELY, what COULD have been achieved.

I've been working in the NHS for 20+ years and it's always been 'in crisis'.

Treatments are getting more complex and complicated, more and more conditions are treatable and demands are getting higher and higher.

The conflict between 'best care for every individual' and 'best possible care for as many people as possible with a finite pot of money' is never going to be resolved unless politicians were prepared to talk about this honestly. Which they are not because they all want to be elected, so they make promises that none of them can deliver . Small example: 3000 (or maybe 5000?) more GPs - there are not enough drs being trained to go in to Primary Care to possibly be able to fulfil this pie in the sky 'promise'. And even if there were it would take at least 6 years to train them.

It's not all about money, but a lot of it is. And other resources: staff, training, facilities, education (and that includes education of the public on how to use healthcare provisions appropriately).

IMO politics ought to be taken out of healthcare planning altogether and short-termism needs to be replaced by long-term strategic planning that does not involve anybody cronies . Never going to happen.

PacificDogwood ..... an interesting, inside, constructive view.

Re your last paragraph on the need for "long term strategic planning", isn't one plan offered by the NHS big knob Simon Stevens that the current government has intimated they'll accept, a big step in the right direction - as if he don't know what the NHS needs from top to bottom, who does????

It seems to me, that during the 2000's, it was no social secret that in the UK demographically WE ARE AGING fast, and if we were going to encourage immigration to SUPPORT US in our old age, whether 2-3 million turn up or not - THE STRAIN ON OUR SERVICES needed to be planned for BEFORE the 'crisis' became a 'CRISIS'.

And while we DID increase the clinical staff by an average 3% a year (according to the link below), this was NEVER going to get in front of the problem, and just like Housing, its a bit rich that the party (then) in government, NOW wants to make political capital of the increased DEMAND - after they left a note saying 'the money has all gone', and then (a £157bil) some.

March 2010; ”Rise in NHS managers outstrips doctors and nurses”

“The number of managers in the NHS has risen at double the rate of doctors and nurses under Labour, official figures have disclosed.”
www.telegraph.co.uk/health/healthnews/7520408/Rise-in-NHS-managers-outstrips-doctors-and-nurses.html

Way to kill a discussion...

Shall I revive it?

I am not sure that Simon Stevens is my kinda guy:

"The £189,900-a-year NHS England chief executive (he volunteered for a 10% pay cut this year in solidarity with wider pay restraint), took up one of the toughest jobs in public life in April after having settled with his American wife and children in Minnesota where he was president of the global health division of UnitedHealth Group, a giant US private healthcare company."
from here

One week as a porter and doing some paperwork in the mortuary is not enough to give insight in to what goes on at the coal face IMO.
And IMO private companies (who are there to make a profit after all) are really NOT likely to be making a 'valuable contribution' to the problem.

PacificDogwood …. So although you post you want apolitical long term NHS decision making, you don’t think the long term plan by the top NHS executive, an English ex Labour Councillor, with extensive UK Healthcare Manager experience, NHS Policy Advisor to Labour Ministers from at least 1997 to 2004, IS UP TO THE JOB, WITHOUT DISCUSSING HIS PLAN?
en.wikipedia.org/wiki/Simon_Stevens_(civil_servant)

Interesting, that you appear to worry more about his private sector healthcare management experience and his salary, than his early role in Labour policymaking, but surely the combination of Mr Stevens early Labour ideology/work, his work within the UK healthcare system, and the ability to work with (and have the confidence) of the Conservatives - IS THE BEST CHANCE for NON POLITICAL NHS LONG TERM PLANNING?

What salary do YOU think we should offer any ‘NHS visionary’ of your choice for you to examine their ideas, £100k, or less? As other government executives are paid over £100k, frankly I would rather pay a NHS visionary a £190k salary than say the Chief of The Potato Marketing Board, even though looking at our obesity rates, that Chief Executive has done a ‘fantastic’ job.
www.dailymail.co.uk/news/article-1214001/The-cost-quango-Britain-hits-170bn--seven-fold-rise-Labour-came-power.html

And re your ”And IMO private companies (who are there to make a profit after all) are really NOT likely to be making a 'valuable contribution' to the problem.” -

Are you seriously suggesting that any Public Sector Department, never mind the NHS, can be run for 13-years by the same government, with few reforms and loads of money chucked at it, AND THAT is better for the efficiency, sustainability and taxpayer value, than having some Private Sector type financial/management discipline imposed upon it FROM WITHIN?

*If the NHS was run with similar financial, efficiency planning and management parameters as the PRIVATE SECTOR, not only would those cacking themselves at the thought of the NHS competing with the private sector be far more relaxed AND see a better NHS service – BUT WASTE LIKE THIS, WOULD NOT HAPPEN, especially as it appears we needed all the doctors we could get.

March 2007: “Doctors' training system 'a shambles'”
www.telegraph.co.uk/news/uknews/1544307/Doctors-training-system-a-shambles.html
“As much as £2 billion has been spent on the training of up to 8,000 doctors who find themselves without a new job under a Government initiative.”

“Such is the fury at the scheme, called Modernising Medical Careers (MMC), that doctors have renamed it "Massive Medical Cull".

“It costs £250,000 to train a doctor and the "shambles" is said to be blighting the careers of dedicated young men and women who may now leave the NHS. Many are also saddled with debts of more than £40,000 after funding their training.”

Back in the bad old days of the Cold War with Russia, there was a nuclear arms race between the super-powers, and based on the level of explosive ordinance per person, if a nuclear war had started the result was thought to result in Mutually Assured Destruction or MAD for short.

I mention this as Ed Miliband discussing their NHS strategy with the BBC, used a military term usually associated with nuclear war heads e.g. in the potential use of nuclear power station uranium, to be converted into a nuclear bomb.

And while my main concern is ’why would the Labour Party Leader be holding general election policy meetings with a room full of the usually ‘leftie’ BBC senior executives and Mr Miliband speaking so freely on their 2015 election strategy’ – one has to wonder that with Labours past NHS record, why, other than in policy desperation, the Labour Party IN TELLING VOTERS THE NHS IS ONLY SAFE IN THEIR HANDS, is in a self inflicted danger of a Mutually Assured Destruction?

Ed Miliband said he wanted to 'weaponise' NHS in secret meeting with BBC executives
www.telegraph.co.uk/news/politics/ed-miliband/11338695/Ed-Miliband-said-he-wanted-to-weaponise-NHS-in-secret-meeting-with-BBC-executives.html

”Ed Miliband has come under pressure to admit that he plotted to "weaponise" the NHS as an election issue after it emerged he secretly briefed up to 15 executives at the BBC over his plans, The Telegraph can disclose.”

MAD or politically disingenuous, repeatedly warning the Conservatives would PRIVATISE the NHS when currently around 6% of the NHS is managed by private companies, with around 5% instigated by the last Labour government e.g. via PFI contracts mentioned within this thread.

MAD or politically misleading, lecturing the Conservatives on comparisons with Labour A&E waiting times record with lower demand and those patient surveys, when PATIENTS WERE DYING from ministerial and enlarged managerial ‘targeting’ incompetence, ignoring warnings on non targeted hospital care, - not just in the now infamous Mid Staffordshire Trust, but other trusts as well.
www.dailymail.co.uk/news/article-2363808/Labours-NHS-denial-machine-Experts-verdict-ministers-covered-problems-failing-hospitals-thousands-died.html

MAD or managerially inept, to keep on about the cost of a “Top Down” change in the running of the NHS, when it had after 13-years become ‘top heavy’ and inefficient, and please correct me if I’m wrong, but the money saved annually and resources changed from the back offices to the front line, more than makes up for that early cost.

I could go on but my point is, while it is clear that continually smearing other parties on the NHS with soundbites while your own record sucks clearly works in the NHS Polls - wouldn’t it be more comforting for the next 5- years if we found out what other parties would do so differently to alleviate CURRENT pressures, with demand as unclear in 2015-2020, as it must have been in 2005-2010?

Mr Miliband keeps talking about the Mansion Tax (and other taxes) £3 billion going into the NHS, of an approximate £100 billion NHS Budget, which is roughly a 3% increase - but backing the good old Labour spending days, they were increasing the annual budget by 7%, but somehow left far fewer beds – yet still talks of the NHS is in crisis OUT of their hands.
newleftreview.org/II/62/tony-wood-good-riddance-to-new-labour

“The characteristic paradox of New Labour’s record in healthcare is that, by 2008, there were 13,000 fewer general and acute beds than in 1999, while a ‘burgeoning market of alternative providers’ has developed, ready to draw personnel and resources away from the NHS.”

You might want to read John Seddon on the NHS (or publuc services generally). He promotes systems thinking, or the revolutionary idea that we need to re-design services against the need. I don't find it helpful to just blame the users all the time (which is what you're doing complainng that it's all an ageing population's fault)

He points out that actually increasing amounts are being spent on the nhs, to no great improvement - reform isn't working. Clearly the money is being spent in the wrong place, eg on the admin of targets, which themselves are hopelessly counter-productive. They result ipeople being passed from pillar to post to attempt to meet targets: every passing on generates more cost and waste while severely impacting any attempt to solve their problems, which gives them more health problems, etc etc etc.

On the A& E crisis he reminds us that the reason a&e visits are on the increase are because they are the last accessible point of healthcare, and the one to which we can all turn. GPs are understaffed - we all know how hard it is to get to appts. Walk in clinics have been shutting down. A & e is the last place to go. In fact "Everyone... parrots the assertion that demand is rising. It isn't. In every case we have studied so far, we have learned that demand is stable; demand for adult care support is stable, acute demand into hospitals is stable." He has figures to prove it. (p. 84, The Whitehall effect). The problem is managing demand. So yes, its a political problem. Interesting, no?

His best books incidentally are 'freedom from command and control' and 'systems thinking in the public sector'. Usually on public services he tells us only what every front-line staff member could, if only anyone was prepared to listen.

I am not blaming users, but other seem to be blaming 'top down' reorganization', which tends to indicate they when 'in Whitehall' had it right.

When did we need to "redesign healthcare", before we were accumulating 4 million new citizens and people born in the 1950's (no warning there) getting old, during, when?

Did (trying to keep a straight face) all those people and wrinklies really not raise demand at all?

Did allowing new GP contracts to 'opt out' of out of hours treatment help in the numbers game?

I reiterate an earlier point, I understand the current geezer in charge of the NHS is reorganizing it, the government has given him money to integrate services, a start, no?

You are getting back to 'thinkers' again, when we need 'doers', shall we form a new government quango and ask them to report, in say 2-years time? lol

Re 'listening to the front line staff', I read they did in the Hinchingbrooke Hospital in Cambridgeshire, and it was going great guns, they paid off the £40 million of debt the new management inherited, had great patient reviews, and then got nobbled for ideological reasons.

Apparently better to have no hospital, than a successful one run by the private sector.

Is everyone open to new NHS ideas, it don't look like it to me.

Wait until that nice Mr Farage gets on the case. lol

What gets me is that a four hour wait is considered acceptable - what the hell, absolutely no, no, no.

A four hour wait is appalling.

A two hour wait in difficult cases is acceptable.

The NHS is not working imv.

Moniker. Personally I think it depends what it is.

Every A&E I've ever visited operate a triage system. If you go in and you NEED to see someone straight away you get seen. If you can wait then you wait.

A friend of mine used to be an A&E nurse and often yes people had to wait a long time. But that sometimes was because they were overrun with drunken idiots, attention seekers who know exactly the right words to say to get the paramedics to take them to A&E. Sometimes it was a critical patient like someone who'd been in a serious car accident.

In that sort of context if you have to wait more than four hours because your child has got a pan stuck to your head then so be it.

*his head lol, not yours thought I guess both could work for my point.