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%.

The moral of that story being, don't hit your child over the head with a pan in the first place. lol

Four-hours is the target wait, now I don't know if we can find the AVERAGE A&E waiting time in England, but if we can, I'd also suggest the NHS number crunchers have TOO MUCH time on their hands.

As this government pushes ahead with privatisation of the NHS (now NHS England, business brand being sold for profit, greed and vested interests) many frontline staff are speaking out about the savage govt cuts which will mean medical care is increasingly based on ability to pay rather than point of need. In 2011 the NHS was considered to be among the West's most efficient healthcare systems. The last government cannot be blamed for the mess this government has made as eg, thousands of elderly people die unexpectedly because of savage cuts to health and social care services. www.independent.co.uk/news/uk/home-news/thousands-of-unexplained-and-unexpected-deaths-among-elderly-revealed-in-leaked-government-analysis-8731985.html

£20 billion per annum is needed by the NHS to meet patients demand but each year the NHS is forced to hand over £10 billion to private companies whose only concern is making a profit.

Last year 50,000 + NHS staff protested against NHS cuts in Manchester, not about an ageing population. www.bbc.co.uk/news/uk-england-manchester-24286582 and many frontline staff are speaking out about the damage government cuts are causing www.communitycare.co.uk/2013/11/07/we-are-no-longer-prepared-to-remain-silent-frontline-staff-blow-whistle-on-impact-of-mental-health-cuts/

10,000 jobs have been lost within NHS England and under Tory LibDem Coalition the private sector now accounts for 1/3 of NHS services. Large corporations are moving further into NHS services and more decisions are being made in boardrooms. Profit before care.

£50 million cuts to child and adolescent mental health services at a time when there has been a 40% increase in youngsters self harming because of poverty since Cameron came to power. These cuts are deepest in more deprived parts of the country. The Tory heartlands predictably are not affected and are receiving adequate funding.

Oh and this government have also legislated so they no longer have a duty to provide healthcare or social care. I think people are beginning to understand the rather limited scope of Conservatism and IDS wasted at least £25 billion on bungled welfare 'reforms'.

JaneAHersey…you lost me in your first line pushing the Labour propaganda, SHOW US THE SO CALLED CONSERVATIVE PRIVATISATION PLANS, as all figure shows, on this thread, as Andrew Neil keeps handing Labour spokespeople’s bottoms to them on a platter, if ‘privatisation’ means using private contractors – *of the 6% currently, 5% was under Labour with Private Finance Initiative’s DRAINING the NHS for decades to come, with these figures (and many others throughout this thread) showing complete Labour incompetence.

“The total value of the NHS buildings built by Labour under the scheme is £11.4bn. But the bill, which will also include fees for maintenance, cleaning and portering, will come to more than £70bn on current projections and will not be paid off until 2049”

“Some trusts are spending up to a fifth of their budget servicing the mortgages”.

“Across the public sector, taxpayers are committed to paying £229bn for hospitals, schools, roads and other projects with a capital value of £56bn.”

In fact despite huge tax receipts from the financial excesses before the crash, and huge spending, when we needed nuclear power stations (2004 promise) , a Trident replacement, a few million more homes (a 2004 Barker Report, other infrastructure - WHERE did all the money go????
www.taxpayersalliance.com/economics/2009/09/new-book-reveals-the-total-cost-of-gordon-browns-mishandling-of-the-economy-as-3-trillion-or-3000000.html

Of course there are pressures, Mental Health is one, but how on earth can you state, with all that ££££ money, 4 million new citizens arriving from between 1997 and 2010, the ‘baby boomers’ 13-years closer to retirement, that it is the Coalitions fault – when Labour left both 13,000 less hospital beds, and a £157 billion annual budget deficit to fix it – WHERE was Labour’s planning and extra facilities?

In fact in which decade, never mind year, was the last time a Labour government left the country in a better state than when passed over to them, yet the Conservatives always get blamed when the money is all gone but still have to clear it up.

If Labour can't plan and build enough NHS facilities when more than doubling the NHS budget, what good is a poxy £3 billion gonna do, as the 'starter for ten' other taxes no doubt, and more national Debt.

Over the past year wealthy people in the UK have seen their wealth increase £40 billion while the Red Cross have had to launch food aid in the UK because of welfare cuts, slave labour, zero hour contracts, minimum wage or below. The UK is not skint it's a playground for the rich and privileged www.opendemocracy.net/ourkingdom/gerry-hassan/uk-isnt-skint-it-is-playground-for-rich-and-privileged

Whenever we have a Tory government this is what happens. We are a rich nation and Tory governments ALWAYS enhance the wealth of the wealthy by cutting public spending, then voters expect Labour to redress the balance.

Of course, we don't have a Tory government currently, it is a Coalition government because people believed Right Wing press propaganda that Labour had no economic credentials and voters had not regained faith in Conservatism because of the mess Margaret Thatcher made of the economy, destroying manufacturing, deregulating the banks etc. I think people are now learning from experience the difference between a civilised government based on the needs of the majority rather than an uncivilised government based on greed for the top 1%.

Now we have a shortage of GPs and nurses. How on earth can we have a shortage of nurses, did no one at the top of the nurse's union or in any major hospital not ever think, oh, we're having to bring in more foreign nurses, perhaps we should run an advertising campaign.

It's pathetic. And we don't have GPs - despite the wealth they are supposedly rolling in, no one wants to do it! That's illogical.

Recently I've heard two people with long term illness moaning that their complaint is largely due to some strong/ new medication that the doctor gave them. Huh, so the doctor made you ill, not the fags, lack of exercise or lifetime of uninspired food. Funny they aren't suing them for the millions they deserve.

I think we are struggling partly because many patients are a pita, they hand over all responsibility for their health to the NHS with no help or expectation that they too can contribute.

Many elderly ARE very ill, but that's bound to be the case, they are living much longer (despite being ill) there is no magic wand. Perhaps putting more responsibility on their families to support them when they leave hospital would make a difference. But God forbid any tax paying member of the public should be put out - it's the NHS's job to sort all this.

RAnt over (for the time being)

If you're keen on the private sector, isitmebut, why do you proudly trumpet the removal of 20,000 managers? The NHS has far fewer managers and leaders as a % of its workforce than private sector companies, despite being much more complex as a business system. Those managers also earn much less than their private sector counterparts earn, and much less than their clinician peers do. And Lansley's idiotically broken reforms (technically broken, not a question of ideology) have led to an exodus of the best talent. In London, Ruth carnall was respected as the very best of the NHS's leadership, and she drove tremendously important and positive change, most significantly the stroke and major trauma reconfigurations that saves hundreds of lives a year, as well as being less expensive to run. She's gone now, along with most of her top team, and her replacement is not in the same league and doesn't have the power to make change happen anyway, because it's been stripped away.

The Tories have stuffed up on health in an unimaginably stupid way. It has not been their finest hour, to put it mildly.

Yes, many elderly people living in poverty spend all their money on fags, beer, poor food, generally living it up after working a lifetime on poor wages with high living costs in the UK (aka Treasure Island for large supermarkets and businesses. 1 in 5 people retiring into poverty, below the breadline) and malnutrition cases have risen sharply. Only Mexico has a worse State pension than the British.

Also tens of thousands of elderly people have died unexpectedly because of cuts in health and social care. We were told by Cameron that health and social care would be protected. Many of us knew that was a lie.

Over £1 billion per annum is claimed by corrupt doctors for dead and phantom patients. Dentists and other medical professionals have similar 'perks' This has been reported in the media. The public never question this or stigmatise these corrupt people or their children.

I think people forget now Conservative health policies of the mid-80s on waiting times and booking procedures (in the Bottomley days) and how these just fell into abeyance under New Labour.

Also that the party which introduced privatisation was Labour.

but yes I agree with the thread title - for as long as Labour sticks to its decision to "weaponise" the health service, it will suit their (destructive) aims to keep the inaccurate rhetoric going and promulgate the idea of a crisis.

Why is everything worse here - our new.y qualified doctors are flooding to Australia because the job is easier, better shifts, fewer patients!! What are we doing so wrong here?

Im sure our nurses move abroad too, then others from third world countries take their places.

Things are bad regardless of who is in power.

So it's corrupt dentists and phantom patients, hmm, seems unlikely.

I think they pay to see their GP and possibly for prescriptions in Australia, likewise most other countries.

Thatcher introduced the market in health and social care.

JaneAHersey ..... "bloody Thatcher" still, after an uninterupted 13-year of Labour, with a minimum 66 seat majority to do WHATEVER they want, like the 2000 NHS Act?

newleftreview.org/II/62/tony-wood-good-riddance-to-new-labour

“The 2000 NHS Act, meanwhile, called for a ‘mixed economy’ in healthcare, introducing ‘Independent Sector Treatment Centres’ to compete with the public sector in low-risk elective surgery, and expanding the role of private companies in primary care and community health. The same year a Concordat was signed making the use of public funds for operations in private hospitals a normal, rather than exceptional, practice.”

“What has been the impact of these changes? Though NHS funding rose significantly after 2000—on average, 7 per cent a year in real terms—the costs of creating and operating the internal market now consume 10 per cent of the total NHS budget; sizeable sums have gone on the expansion of new managerial layers.” [26]

“The need for public healthcare providers to focus on the bottom line has brought a damaging combination of staff cuts, dilution of the skill mix, and faster through-put of patients; drives to reduce waiting times have meant a rise in the number of readmissions, while cost-cutting in subcontracted services has brought declining standards of hygiene. “

“While PFI has resulted in new facilities being built, their construction has been guided by the rationalities of investment rather than medical assessment of the population’s needs; in some cases they are too small to serve the area for which they were supposedly built. Most damagingly, payments to PFI investors are locked in for a generation or more a long-term drain on resources out of all proportion to the short-term gains. ”
www.telegraph.co.uk/health/healthnews/9356942/Blair-defends-PFI-as-NHS-trusts-face-bankruptcy.html

“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.”

Moniker1 ..... you are correct, what did happen here, people should ask WHY we have so many foreign doctors and disregared our own - a part of the 2000 Labour 'multicultural' plan?

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.”

HomeHelpMeGawd ..... you can talk about individual managers, and we could look into the full facts, but clearly to many, the concept of taxpayer money going to 'front line' services is alien.

Too often, the top gets bloated and when the cuts come, as they invariably will with Labour's flawed economic model, who gets toasted first, the managers or 'little people'?

The quangos or the libraries?

And that is the Labour 1997-2010 story, THERE WAS THE MONEY, but did it go to the nurses and other low paid workers, no, it went to 'the many' at the top?

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

"The NHS workforce in England has now reached a record high of 1.43 million, up by 30 per cent on 1999."

"The majority are qualified clinical staff but the fastest increase has been among managers which has outstripped any other group, data from the NHS Information Centre has found."

"In the last decade the number of managers has increased by 84 per cent to reach 44,660."

"This is an average increase of 6.3 per cent per year."

In comparison the number of clinical staff has risen by a third in a decade with an average annual rise of just 3 per cent.

Talking in generalities such as "too often, the top gets bloated" is pointless.

Specificity is much more useful. Specifically, the NHS is undermanaged and under-led, by comparison with other health services around the world, and especially by comparison with private sector organisations (in and outside health).

As the link you yourself provided showed, 1.3 million NHS workers were being led by 44,660 managers. So 96.5% of the workforce were not managers and the majority of those non-managers were clinical staff.

The vast majority of those managers are not "at the top" but are instead doing work that has to happen but which a clinician should not be doing, like managing sites, accounting for the money, ordering supplies, etc. They are typically earning on a par with senior nurses or non-consultant doctors.

It is therefore patently obvious that the 3.5% of the workforce that are managers are not a significant cost driver for the system, by comparison with other pay costs, or non-pay costs such as MSSE, facilities, etc etc.

For example, there are about 450 big NHS organisations eg hospital trusts but not GP practices. Assuming that the all-in cost for a Chief Executive for one of these is 250k, which is spectacularly over-generous compared to what they earn on average, but never mind, the entire pay for all of the CEs at all of these organisations would amount to 117m per year, which is quite a lot less than the average annual running costs for any one of these organisations, and amounts to about a tenth of a percent of the NHS budget as a whole.

Incidentally, clinical pay did pretty well in the Labour years. Agenda for Change etc really helped. A senior nurse could earn 50 or 60 quite readily.

Finally, you have made the frankly bizarre assumption that the only right thing to do with extra money is to employ more clinical staff. That might often be the right thing, but it is definitely not always the right thing. Amazingly enough, it can help to buy equipment, real estate, employ secretaries (or even - shockingly - decent managers), or invest in such trivial intangibles as clinical decision support systems or reconfigurations to improve care etc etc.

It is really helpful to look at the world as it is, not the world as your ideology tells you it should be. You should try it sometime.

HomeHelpMeGawd …. The “world as I saw it”, or the UK at least, had a government in 1997-2010 that massively grew the size of quangos, Hospital Trusts included, and while the population grew by 4 million (not including the increased birth rate), society got 13-years closer to ‘baby boomer’ age related problems – was spending a shed load of money, and the only thing I can see where it mainly went, when my mother was in wards catching hospital caught MRSA and C.Diff diseases, was a whole new layer of paper pushers – when the number of 'front line' potential users, rocketed.

And paper pushers, possibly with Final Salary pension funds my grandchildren will be paying for, NEED to justify themselves, by ‘managing’; not stopping one of the many Nursing Assistants walking through a ward with an open grown ups nappy with exposed C.Diff shit, they need to be more ‘creative’ than that, maybe re arranging the deck chairs on the Titanic if lucky.

I take your point about how well paid a senior nurse can earn, and I don’t think that can earn enough, but was this nurse’s assistant categorized as a “Care Manager”?

I ask this as within my post to JaneAHersey above, dated 1 Feb and time 21:45, at the end of the 2nd paragraph it mentions ‘new managerial layers’, with a (26) sub note by it – well here is the note.

[26] ‘The Institute of Health Care Managers listed 1,700 separate job categories in 1995. By 2002 this had grown to 5,529 : Jenkins, Thatcher and Sons, p. 289. Figure for internal market from Leys, ‘Reducing Social Democracy’s Last Redoubt’.

As it beats me how even Labour quangos can ‘create’ almost 4,000 new job categories in ‘care managers’ over 7-years??

IsItMeBut, if "the only thing [you] can see where it [the new money] went" between 1997 and 2010 was "a whole new layer of paper pushers", then you need your eyes tested.

That doesn't surprise me, as you appear to have read right past the inconvenient parts of my previous post where I used the evidence you yourself had cited in order to show you that pay to managers was not, in fact, soaking up all the extra cash pumped into the NHS.

There is no such thing as a nurse's assistant in the NHS, and there never has been. There are health care assistants, who are frontline clinical workers, who are paid much less than nurses, and who are not managers, and whose job is to be paid less than nurses to do jobs that nurses used to do but which don't require nursing skills. They should do them with care and compassion, and under the direction of clinicians, and they have really nothing at all whatsoever to do with the category of actual NHS managers.

HomeHelpMeGaw’d … I’m sorry if I did not explain myself properly, my main point being, if we are going to have a New Army of NHS Managers, what a shame they were not ‘managing’ at the front line to reorganise better and in particular, get rid of hospital caught diseases far quicker than the years under Labour that it took.

But lets look at what your quote below accuses me of, that I “read right past” for my convenience;
“That doesn't surprise me, as you appear to have read right past the inconvenient parts of my previous post where I used the evidence you yourself had cited in order to show you that pay to managers was not, in fact, soaking up all the extra cash pumped into the NHS.”

You tell me that the NHS Chief Executives (alone) are (only) taking around one tenth of the NHS budgets, but according to my link further above, in a decade NHS Managers had increased 84% to reach 44,660 - so WHO is using convenient statistics?

What £££ figures do you have for the total increase in new NHS Managerial positions under 13-years of Labour, hopefully not just in annual salaries, but (as Labour tends to forget when bloating the State payroll) the unfunded Final Salary Pension liabilities our grandchildren will have to pay out of annual budgets in years to come?

As please correct me if I am wrong, on top of the current £1.5 trillion (and rising) of UK National Debt, we have a separate Public Sector Final Salary Pension liability of around £1.2 trillion, with £1.0 trillion UNFUNDED, but paid to the retiree, when drawn on demand.

As you may have worked out, I firmly believe the costs to the taxpayers of government/services, should only be as big as it NEEDS to be, when under a Labour Party even now looking for new layers of government after 2015, funded by public sector trade unions - the public sector is used to ‘create’ jobs – that as night follows day, ideologically always means taxes rise under Labour, yet only a relatively small percentage of that £££, gets to the front line services.

Ideology that believes taxing ‘the not so few at the 10% top’ of the private sector, and giving it to ‘the not so few at the top’ of new public sector quangos, usually party apparatchiks, so THEY can have private healthcare and send their children to private schools - are the policies of a Marxist banana republic, not a balanced wealth creating economy.

But even now, all I hear from Labour is ‘there was no need for the cost saving over years NHS TOP DOWN re-organisations.

AND the dire need for ‘Infrastructure Commissions’, grand English devolution ‘Constitutional Commissions’, all unelected, sucking in taxpayers money, usually buck passing rather than make a decision, and always taking a yonk to come up with findings, which are then open to a double yonk of consultation. Arrrrrrrgh.

I got as far as reading "You tell me that the NHS Chief Executives (alone) are (only) taking around one tenth of the NHS budgets" and I gave up.

It's not worth the candle debating with someone who makes a one-hundred fold error of magnitude in quoting me, on a debate which is all about numbers. Particularly when they're trying to convince me that they've read what I've written.

I hope you're better at your dayjob than you are at this (or that your dayjob is not very taxing).

"Many elderly ARE very ill, but that's bound to be the case, they are living much longer (despite being ill) there is no magic wand. Perhaps putting more responsibility on their families to support them when they leave "

How do you put responsibility on families when families are geographically often hundreds of miles from said elderly person or miles from each other.

And when they have been told to move to find work. Or are in precarious zero hours contract min wage jobs Employees rights are being eroded so they will be very reluctant to ring up their employer and say "sorry cant come in today Ive got to look after Granny."

The “army of 5,000 new Homecare workers spending longer on their visits” from Labour sounds promising, but State quantity if compromises quality, is not always the solution.

The pay for Home Care workers has to be reviewed, but is it set by central government, or are local government setting it – and are all local authorities across the country ALREADY paying all their full time staff the Minimum, or Living Wage?

And what rates are we paying our other small government armies, is there an unfair disparity?

In policing we had an ‘army’ of what was derogatorily known as ‘plastic policeman’, that no doubt the putting boots on the street (when it was said only 10% of our police force was out at any once), WAS useful, but they were often restrained in what they could do, as they never had all the powers of the real thing.

In teaching, we had an ‘army’ of new teacher assistants (“unqualified” Tristam Hunt?), that after years was assessed as providing little overall increases in education standards, often as many of the children receiving individual attention, by having work done for them meant what they were being taught on the day, didn’t actually sink in.

In summary; we have seen via videos etc quite vicious assaults by some care workers who should not be trusted with animals, never mind the elderly, so throwing better paid ‘numbers’ at the out-of-hospital-care problem can only work IF ‘quality’ of care is maintained. IMO.

HomeHelpMeGaw'd ..... re your "It's not worth the candle debating with someone who makes a one-hundred fold error of magnitude in quoting me.."

Please excuse me, you know I read back your earlier quote (that I was referring to) several times and STILL didn't see your problem with my post, thinking it more a candle in (or with) the wind, so to speak.

But as per several of your personal accusations, I'm clearly not that bright, but up to speed now - so feel free to FULLY explain why you think such a low percentage of the new NHS money got through to the front line.

HelenaDove, anothersplace... . So many social problems with the modern model of employment have been ignored for so long.

Due to reforms to help small, medium and large businesses the UK is certainly in a better place to concentrate on pay rates for the lower paid NOW, than back in 2010, and should be addressed from 2015.

Lower/tighter unemployment rates puts upward pressure on pay rates anyway and our rate is 5.6%, and no doubt while some ‘people’ who’d kick the prosperity pooch from 2015 would say the 2.7 million more Private Sector jobs from 2010 were only for “the very rich” or “zero hours” jobs – we should realise that we have been doing something right.

Just look at our neighbours expected unemployment rates and public sector investment forecasts for 2015 & 2016, with growth based on the expectations of a weak currency and oil unlikely to remain at current price lows.

“EU Raises Eurozone Growth Forecasts”
www.wsj.com/articles/eu-raises-eurozone-growth-forecasts-1423131184
“Improved Growth Outlook Doesn’t Take Into Account Recent Tensions Between Greece and Its Creditors”

“The (EU) unemployment rate is also expected to remain over 11% this year and at 10.6% next year, still near record highs for the currency area. And the forecast sees investment by companies and the public sector remaining weak.”

Who's policies and unemployment "social problems" would you rather have, the UK's or the Eurozones?

I wish we could have a 'normal' health service. That is people not lying in trolleys and not having to wait a month for a GP's appointment. If that means having to pay for certain services then fine. Of course that should be means tested. But I'm sick of all this wonderful NHS a national institution. It's a great dinosaur that's on its knees. I wish the pretence would stop.