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 NHS isn't on its knees, perhaps on its knees begging for money to fund it but PEOPLE, the general public, the users of the NHS are on their knees through health problems and through living longer, through a reduction of preventative healthcare in general and through poor education.

Fact is there is just MORE NEED now. Cut as much as you like, it won't make any more money for the service and you won't make people more healthy. National Health will only exist as a result of sensible integrated care with enough money to make things work and less of the buckpassing and blame that has become a feature of a system which is underfunded and where people are fighting for their jobs, their departments, their targets.

And don't forget the baby boom - all those babies being born have needed money chucked at them. It just costs a lot extra to care for the health of a child. We can go for 10 years with two appointments in our 20s, but under 16 and we're in and out of the GP's on a regular basis, in hospital with broken limbs, etc etc.

I wish those with huge tax receipts of speculations to play with, a balance 2000 budget, with a baby boomer generation reaching retirement, and issuing National Insurance numbers to 4 million new citizens (many of who have given birth since) would have spent all the new money wisely rather than spend time telling the country the NHS is only safe in their hands - and there is the pretence for you, disingenuously based on their own sorry record.

Throughout this thread it tells us how we got here, all the current demand pressures did not begin in 2010, but we have to cope, as the DEMAND ain't going to ease any time soon.

I think there are more demands but I don't know about more needs. And I think this post code lottery business must stop. It's an outrage that certain drugs are available in some areas but not others. Maybe a small charge to see the GP would be a good idea. This happens in lots of countries and works quite well.

"The postcode lottery business" ... are you referring to the one due to some English NHS Trusts more than others are struggling under the weight of Labour Private Finance Initiative debt on their annual budgets?

The situation in Welsh Wales.

Or the one where the £280 million Coalition Drugs Fund set up in 2010 to help against postcode lotteries, has now overspent by £100 million and now has to be more careful?

Labour in 2010 made several NHS promises but didn't want to ring fence the (then) NHS budget against cuts, never mind add more money and when they come in again in 2015 thanks to their electoral boundary advantage needing far less votes to get a majority - so within a year or so a patient will need to win the lottery to pay for their own drugs as the economy bed pans.

At last, a cross bench agreement on something, anything, on a NHS policy.

What happened within our public services, be it the NHS, Councils, Police, that refuses on its own initiative, to protect the tax paying 'client', especially those more vulnerable and relying on that help?

“NHS 'to get whistleblower guardians'”
www.bbc.co.uk/news/health-31362196

”NHS trusts will have to appoint a guardian to help whistleblowers in England, ministers have confirmed.”

”The measure was called for by Sir Robert Francis after he warned staff too often faced "bullying and being isolated" when they tried to speak out.”

”Sir Robert, who led the public inquiry into the Stafford Hospital scandal, also said a new national officer should be appointed to help the guardians.”

”The government immediately accepted all his recommendations.”

”Health Secretary Jeremy Hunt said: "If we don't get the culture right we will never deliver the ambitions we have for the NHS."

I don't think the NHS would be being privatised if whistle blowers had been protected many years ago. The top-down hierarchical structure was a perfect breeding ground for bullying and self-interested decision making, leading to wasted opportunity and stunted development.

Imagine how things might have been if all those consultants, medical and otherwise had been paid a lower salary and nurses and frontline staff a bit more.

I notice also that in London there is self-interested appointing going on - you find that a department can be made up entirely from one nationality speaking their language to each other, but in a different hospital the same department is made up of another nationality. I find that worrying, it shows how much power each department has to employ friends or compatriots rather than the best person for the job.

Many senior people within the NHS are fed up with their service being a political battle ground, and that was apparent early this week, on Newsnight if memory serves, where a retiring brain surgeon regularly having to personally involved to ‘free up’ beds for his patients, said so.

We also saw this man going to get his own patient trolley (whatever), he didn’t mind though, ‘its quicker’ he informed us, but was concerned that upon retirement when his senior welly (yes welly) is no longer there to make ‘executive decisions’, the log jam could get worse.

I mention all this as it appears some aspects of the day to day running of a highly pressured service COULD be improved with better internal management, but this should not be a POLITICAL issue, it is a PRACTICAL management issue, which will not change with a memo, and maybe government/NHS reforms to also lighten their day-to-day load.

Yet the party who HIRED the vast majority of the current managers are looking to score more NHS political points this side of the election, by rubbishing every manager to get to the Conservatives before May 7th.

”Tories accused of hiding 'totally shocking' report into NHS management”
www.independent.co.uk/life-style/health-and-families/health-news/tories-accused-of-hiding-totally-shocking-report-into-nhs-management-10052011.html

”A “totally shocking” report by one of the country’s most respected businessmen into how the NHS is being run must be published before the general election, MPs have said.”

”A withering assessment of NHS management, by the Conservative peer Lord Stuart Rose, who is credited with turning around the fortunes of Marks & Spencer, was submitted to the Department of Health in December but has still not been published by the government.”

”It is understood to paint a damaging picture of a culture in which mediocre managers can move around within the NHS without being held to account, while those who are successful go unrewarded.”

Clearly having now identified this meritocracy problem seen in other areas e.g. teaching, and gone some way to address it, this is an issue for the next 2015 government, if not afraid to address it and the trade union lets them.

IsItMeBut...seriously? You re-read my quote repeatedly, and still couldn't see your hundred-fold magnitude error??

I can't believe I'm having to spell this out for you, but as you can't manage it for yourself...

What I said: "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."

How you managed to interpret this: "You tell me that the NHS Chief Executives (alone) are (only) taking around one tenth of the NHS budgets"

Why this is wrong:
One tenth is one hundred times as much as one tenth of a percent.

I hope this helps. If your maths was so spectacularly awful here, and you failed to spot it despite looking repeatedly, it might just be possible that your maths was spectacularly awful in all sorts of other areas of your political thought, and this might mean that the fact-base from which you were arguing was wrong. As one quite famous economist said: "When my information changes, I alter my conclusions. What do you do?"

HomeHelpMeGaw’d ….. hello there, are you seriously being rude to me about my apology (about misreading one of your ‘small picture’ smokescreen points) on the 6th February, on the 23rd of February?

Based on your t-t-t-t-timing, hardly the art of repartee, so maybe if you had used the time better to answer/debate the points I made, we could take the debate forward.

May I remind you on my last point before you went M.I.A., and let me repeat an earlier link and King’s Fund bit of math, pointing out I’m not the only one wondering where all the money went.
“so feel free to FULLY explain why you think such a low percentage of the new NHS money got through to the front line.”

“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 (under Labour) that when asked what they think of the NHS people reply it is in crisis.”

The problem is it really does not appear that Labour have learned a thing from their 13-years of high spending on bureaucracy/administrators, where only around 30% of budget increases gets to ‘front line’ services – so the DANGER is in tight deficit budget times, a 2015 Labour government will divert current front line money to reforming their army of NON front line personnel and god knows what else.

'Disastrous' £11.4bn NHS IT programme to be abandoned

”A multi-billion pound IT project started by Labour to link all parts of the NHS is to be abandoned.”
www.telegraph.co.uk/news/health/news/8780566/Disastrous-11.4bn-NHS-IT-programme-to-be-abandoned.html

Yes, IsItMeBut, "please excuse me" isn't really an apology, and you're not exactly in a position to judge what is significant or not if you can't tell the difference between 10% and 0.1% of the NHS budget.

I see no reason to be polite to you when you are so fixated on tendentious arguments yet can't do basic maths.

How VERY convenient for you, having looked to deflect from the big picture, now blaming me for all those unaccountable ££££ billions of Labour's NHS (and other) waste. Maybe this new book will point me in the right direction.

”New Labour ‘blew £230bn on errors, fraud and inefficiency’
www.thetimes.co.uk/tto/news/politics/article4368120.ece

”The hundreds of billions of pounds of public money wasted through errors, inefficiency and fraud under Tony Blair’s New Labour government have been revealed in a book.”

”A retired businessman who spent three years examining where taxpayers’ money had gone found that by 2005 the government had wasted more than £230 billion, much of which was lavished on projects started under New Labour.”

By 2005 there had been around 80 new Labour/Brown taxes; our UK tax pounds at work.

Miliband talks today of "a rattled Prime Minister" last night, but HE was the one who could not give any details on how he his anti business rhetoric is going to keep UK economic growth going - so how can he financially protect the NHS or any other spending, when HE is balancing the UK books, with government spending cuts YET UNSPECIFIED?

As for the new 'capping of private sector profits':surely the answer is don't let a party without a business grey brain cell between them, SIGN numb-nut Private Finance Initiative (PFI) contracts in the FIRST PLACE.

Much of the Coalitions government 'savings' since 2010, is by cutting the cost of Labour's fat government by £££tens of billions a year, which INCLUDED re-negotiating such contracts where possible.

The total value of the NHS buildings built by Labour under the (PFI) scheme was £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”

Yet another General Election where the political parties promise the £££££ earth needing to out-do each other, especially on the NHS.

But as far as real money is concerned, only one of the two parties will form the next administration and FUND those promises;

The Conservatives still growing the economy at a G7 world beating 2.8% a year (despite various components slowing recently down as worried about the coalition result of the election) when the OBS is projecting around 2.5% for the next 5-years, when they are calculating the ‘lowering the deficit effects of government spending – so extra growth gives more revenue/spending flexibility.

or

The Labour Party who for 13-years previously grew the UK economy on the proceeds of a financial bubble and government debt to fail at the first recession (as it did), currently alienating small, medium and large businesses who will further slow down investment/jobs – and despite generating MORE government debt than the Conservatives, will have little chance of SUSTAINABLE growth at 2.5%, never mind higher – leaving even less revenue/spending flexibility.

At this point it is worth repeating an old market adage;

“Governments run out of money before the markets do”

Especially if governments end up held to ransom by the markets in the meantime, paying penal rates of interest until they have stop borrowing, due to the cost of servicing that debt AND begin the spending cuts & tax rises then needing to be much larger than if tackled earlier.

With Labour It is neither fair or prudent to current and future generations when paying for the UK’s bills, PROMISING to do it with ever more government debt, even for the NHS. IMO.

Probably get shot down in flames for this but I think the main problem with the NHS is inefficiency. I think it would benefit from some private companies running hospitals. I'm not talking about a private, paid for system but private companies helping in the running of NHS services. Look up Hinchongbrooke for a good example of how this can work.

I do think the story of Hinchingbrooke is not fully known yet, and is the kind of movie I'd pay big money to see [bureaucracy nerd] I also wonder if the kind of CQC inspection Hinchingbrooke got, with its damning comments about care and infection control, was in fact more detailed than the inspections some other hospital Trusts get? God knows there are enough horror stories about NHS services out there.

However, Circle arrived to a big deficit and pulled out leaving a big deficit. They also ran the contract so that a lot of the costs were pushed towards the end of the original ten year term. They also blamed problems on other elements of the health system - but that's the thing; health care is always part of a system. You can't run a hospital on its own - hospitals seize up very quickly if social care and community services are not in place and working well. That kind of coordination takes time to build up. The inefficiencies built in to a system requiring frequent organisational change are heart-attack inducing. And that's just as true of contract tendering as it is of NHS reorganisations.

The three main Labour scare stories on the NHS over the past week are ‘the Conservatives have a secret (no doubt cunning) plan to cut 2,000 nurses from May, that their commitment to put in the extra £8 billion requested by the NHS top knobs is ‘unfunded’, AND NHS Trusts are paying themselves too much under THIS government - which are all kinda linked.

First Labour brought in NHS Trusts, which was possibly one of their most useful quangos, so for Labour to blame the Conservatives for taking their eye off the ball on any quango costs/salaries, is worth a belly larf.

Next Labour’s extra NHS money will be funded (and shared with Scotland) via the uncertain revenues of the Mansion Tax, especially as Labour chasing away ‘Non Doms’, wealth in general and multinational companies etc from the UK, will CONTINUE to put downward pressure on ‘top end’ property prices – and many citizens will look to get a home revaluation as often as possible, to limit their exposure to the tax.

As mentioned further above, the Conservatives trusted to run the economy and therefore allow businesses to plan ahead, had seen their spending/tax/cuts plan calculated via the Office Budget Responsibility (OBR) assuming a 2.5% GDP growth rate - but as the IMF and others are seeing much stronger growth for the UK for years ahead under the CURRENT plans closer to the current 2.8% and above - that will allow more money to allocate/spend on our priorities, such as the NHS.

So whether £2.5 billion or £8 billion extra, the Conservatives will be in a much stronger position to do what they did over the past 5-years, to find more money for the NHS when required via economic growth, rather than hope high end home prices keep rising, when their own policies are taking away a lot of the demand for those properties – so why on earth would Conservatives need to cut back nurses?

So space cadet Miliband can promise to 'beam down' 1,000 new nurses from Planet Zog (from “Day 1” in office), or offer 2-weeks in Tenerife after every operation - the funding of the WHOLE NHS can not be trusted to an anti business/tax receipts Labour Party heavily influenced by trade unions - trying in their 2015 manifesto to limit ANY business representation/knowledge in parliament.

P.S. The Labour Mansion Tax promises to fund the NHS was pulled to pieces by the Daily Politics today, as although a Labour spokesman said the tax would raise £1.2 billion and was ‘verified by an independent expert’, he did not know all the rates of tax e.g. £2 million to £3 million properties – so one has to wonder how any expert COULD verify £££ anything.

And there ‘lies’ the problem of ideologically choosing to base funding our services on extra taxes (and debt), rather than have to confidence and policies to pay our bills (and pay our debts off) with SUSTAINABLE private sector driven economic growth.

Good god, Labour/Miliband today is now warning of a ‘two-tier’ NHS with longer queues due to a ‘stealth’ privatisation under the Conservatives.

From the Labour Party;

• With longer queues managing the NHS in Wales NOW than England, having CUT NHS spending in Wales.

• That brought in private sector competition with the NHS via the 2000 NHS Act, so when they left office there were 13,000 fewer general and acute NHS beds than in 1999.

• That when they did spend more cash, less than 30% of that cash got to the ‘front line’ services.

• Who through incompetent NHS financial deals via PFI ripped the taxpayer off, and saddled Hospital Trust and other services budgets with crippling repayments for up to 35 years - Labour will no doubt blame the NEXT five successive parliaments for, if a non Labour administration.

www.independent.co.uk/money/loans-credit/crippling-pfi-deals-leave-britain-222bn-in-debt-10170214.html

So for yet another General Election, Labour is despicably accusing the Conservatives of planning to do with the Private Sector, what the facts show THEY DID in 13- years of power.

With that level of own-record hypocrisy for votes, can anyone trust a word this man says????

I wonder who Labour will blame when the NHS money really runs out; runs out of the UK, as they ideologically chase the tax receipts from international companies and Non Doms off these shores, and can’t borrow any more.

In 2010 Labour passing over a £157 bil annual overspend, said the Conservatives were irresponsible ‘ring fencing’ the then NHS Budget – and the Conservatives not only did that, they increased spending by £7 billion a year.

And based on their proven ability to keep the Business/Investment grow going, far stronger than the rest of Europe, the Conservatives have said they’ll add a further £8 billion a year, as requested by the current NHS boss Simon Stevens, to also help implement HIS overall care reforms.

The alternative being MORE political reforms as ‘Burnham knows best’, as the last Labour Health Minister passing an unprecedented ‘demand’ poison challis - and a party who allowed 90% of GP's to opt out of 'out of hours' treatment, at the same time NHS Dentists became as rare as hen's teeth.

Yet next Fridays Prime Minister, nay World Statesman, is still spreading Conservative/NHS lies like cheap peanut butter.

Ed Miliband: “£2billion NHS black hole means nurses face axe at 66% of hospitals under Tories”
www.mirror.co.uk/news/uk-news/ed-miliband-2billion-nhs-black-5637119

Apparently despite Labour/Burnham passing over in 2010 a huge influx of demand from the previous 5-years to a Conservative administration without the capacity to treat them, there are few excuses to that inheritance , even when a new government hog-tied by unprecedented debt, still fails to meet our NHS waiting time commitments.

But what possible excuse can a soon to be Labour government have to spread those lies, when they screwed up when MONEY WAS NO OBJECT?

“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.”

www.telegraph.co.uk/health/healthnews/9356942/Blair-defends-PFI-as-NHS-trusts-face-bankruptcy.html

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.”

'Disastrous' £11.4bn NHS IT programme to be abandoned
www.telegraph.co.uk/news/health/news/8780566/Disastrous-11.4bn-NHS-IT-programme-to-be-abandoned.html
”A multi-billion pound IT project started by Labour to link all parts of the NHS is to be abandoned.”

Labour had 13-years, clearly in times of £££ plenty to get the NHS to that state, so ‘we can do better’, as can’t do worse - so why don’t we see what another party can achieve after 10-years?

As on Labour’s NHS and Economic record, combined with a current inability to work with nation wide small, medium and large businesses currently paying our public services and welfare bills – it can easily get a lot worse under Miliband, as the money/borrowing REALLY runs out.