# NHS and politicians



## RogerS (18 Jul 2013)

I found this timely piece on the web ...

_The tick box, target-driven culture of the NHS is neglecting the quality of patient care, a senior doctor has warned.

Craig Gannon, a consultant in palliative medicine, described the fragmented care of an elderly woman who was treated for cancer and eventually died from kidney failure, which he said could have been avoided._.......

......_.He said all the teams did what they were asked to do "but, sadly, they did no more than what was required".

"The patient's waits in the accident and emergency department were less than four hours; the three referrals were met under the two-week rule; and her operation was timely. But clearly such a potentially star-earning description would flatter the care actually delivered and underestimate the resources wasted."_

Written within the last few weeks, you might think. Actually no. This was written in 2005. Eight years ago.

So why can't the effing politicians of all parties realise this and get rid of this target-driven culture? Bring back Matron. Bring back Ward Sisters and FFS get rid of whole swathes of managers. It is really NOT rocket science.


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## Jacob (18 Jul 2013)

Agree! Ultimately Parliament is responsible but the whole extensive target and blame culture, the language of "failed" institutions, is governments way of passing the buck and dodging the issues. A failed hospital or school is the responsibility of the appropriate ministry and the politicians - they have the power, it's they who are failing to use it.


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## AES (18 Jul 2013)

@RogerS:

Agreed 110%!

And the silly "burgers" over here (Switzerland) are trying to bring in the same sort of rubbish. Over my dead body (and as I'm a citizen I DO have a vote here), so guess I'll be posting from the grave soon!

Krgds
AES


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## deema (18 Jul 2013)

A child dies due to an incompetent consultant not detected because their work was not monitored?
Waiting 12 hours an A and E due to no measures being in place or accountability?
Waiting months if not years for an operation as there were no measures on waiting times?
No clip boards and tables to filled in to reference when it all goes wrong and you need to claim compensation?
Poorly paid nurses?
Inadequately equipped hospitals with antiquated equipment?

Yep, I can see the benefits of letting the old systems to come back again. My wood working may need improving, but my memory is still intact.

There are a lot of issues that need to be addressed, but not as many as there were twenty years ago.


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## Phil Pascoe (18 Jul 2013)

I'm on ten prescription drugs ( with payment exemption) and I've had to go to hospital more than a hundred times in the last nine months, so it's probably wise for me not to be too critical of the NHS.


And I've just come home from hospital with a present - M.R.S.A.!


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## JakeS (19 Jul 2013)

deema":ue9e909d said:


> There are a lot of issues that need to be addressed, but not as many as there were twenty years ago.



To my mind there's nothing inherently wrong with targets - the problem is setting the _wrong_ targets.

If you grade/reward/punish people by targets, they will work to those targets and nothing else, because that's the entirety of what their work will be judged by... so you need to make absolutely sure that the targets encompass everything you want them to do. 

If you can't do this, of course, then it's far better to have no targets than poorly-thought-out targets - but I suspect that in 95% of cases it would be quite possible to do so, and probably in 95% of cases the problem is just that the wrong person with the wrong expertise was actually responsible for setting the problem targets up in the first place.


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## Reggie (19 Jul 2013)

I think it's wise for anyone to be critical of the NHS, no matter what your circumstances are, if they've done something wrong, they need to know otherwise how will they know what to fix? I also have an ongoing medical condition that means tablets and treatment for life. Defend the good but expose the bad, otherwise the NHS will never get better.

I had first hand experience of the nhs on friday, I won't describe my ordeal in detail, suffice to say that I was pushed from pillar to post and it actually took 5-6 phonecalls to get to speak to someone who knew what they were talking about and even they failed to give proper care and attention. There are so many pointless people in the NHS it's no wonder it struggles.


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## Kalimna (19 Jul 2013)

Consider those of us working within the NHS. The number of pointless people is staggering, and unlikely to diminish any time soon. Basic problem is one of promoting people beyond their capabilities. And a transference of reason for becoming a nurse, clinician, etc from one of caring to one of performing work. It is very wrong to tar everyone working within any profession with the same brush.

Reggie, Jake, I honk between you, you have hit the nail squarely on the head. Targets are, in principle, a good idea. But they make too many assumptions that just don't pass in the real world. If everyone behaved in a similar fashion (I mean with regard to their disease process, not with their interactions with other people!), then there really wouldn't be much of an issue, but people are different, and that can cause upsets in a conveyor-belt approach to treatment.

Oh, and phil.p - sorry to hear that your return from hospital came with an unexpected partner, but there is a good chance that you, along with most people entering hospital, took MRSA in with you. I wish you well in your recovery from whatever took you into a ward in the first place.

Cheers,
Adam (just finished a run of night shifts, not much fun trying to day sleep in this weather, a rather tiring and emotionally draining week. So, apologies if this comes across at all rant-y)


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## Random Orbital Bob (19 Jul 2013)

Don't forget that the NHS is the biggest employer in the country (one of the biggest in the world) with over a million staff. It's highly distributed with a scope of care requirement being absolutely monumental. So even with the best management systems in the universe, that sheer scale will create multiple problems and challenges.

But the real heart of the problem (which target culture are symptomatic of) is the short term nature of political thinking. The NHS needs solutions that take years, decades to implement and it needs solid and dependable management that understand the running requirements of each facility. But what happens every 5 years or less? Parliament shuffles the deck chairs on the titanic and some bright shiny new health minister has to "be seen" to reform the health service! What that really means is they re-organise (again)....shuffling people who are just developing some useful knowledge and skill in a facility...and break it up...attach this bit to that and change the goals and indeed the goal posts. That institution must have undergone more organisation designs than any other in the world.

I for one feel eternal sympathy for the staff. And, in the main, I have received excellent service on the few occasions I've needed to be there. Not perfect by any means, but dam glad they're there when I need them.

My acid test is this....if I were to fall sick, which country would I prefer to be in when the pain starts? For me it's here every time.

If the politicians just left them alone to create their own accountability structure and organisation design for say....20 years, I'm convinced the efficiencies would come through.


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## Hardwood66 (19 Jul 2013)

I have a mental health issue ifI want to see a gp I have to normally wait 4-6 weeks


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## RogerS (19 Jul 2013)

Adam...no rant at all. I think we are all grateful for the care that you and your colleagues provide.

Bob (Random Orbital)....you have hit the nail on the head.

However, what prompted the OP was recent experience by the Mother-in-law. Elderly....84..living by herself. Woke up in the early hours in a panic thinking that she was having a heart-attack. Her sister came round, as did the paramedics who thought that she was not having a heart attack (none of the 'normal' symptoms were there) and that it was most likely a muscular spasm. But to be on the safe side she went into A&E. Who ran a battery of tests and kept her in overnight. She was told to take in her medication with her (aspirin and something else...not sure)..which they promptly took off her.

Definitely not a heart attack but, oh me, oh my, she is now on the conveyor belt well and truly. In one of the scans they detected polyps on her liver....but they are benign...but they still started talking about her having an operation to remove them....why?...no-one would say..just 'that it was procedure'. She then goes home with a new bag full of extra pills...again, no explanation....no-one available to discuss/willing to discuss......(curious to know just where doctor/patient confidentiality boundaries are when you are dealing with an octogenarian....surely daughters should be given relevant information?)....

No-one tells her to stop taking her 'normal' GP prescribed medicine so a couple of days later she is in a panic as her legs have started going blue because she is over-dosing on aspirin!

Then the conveyor belt continues and she gets a letter from the hospital telling her to come for an x-ray of her stomach...which panics her as she has had breast cancer....the x-ray technician then told her that she had polyps on her liver. Ever heard an octogenarian swear before?

So the general impression is that once onto the conveyor belt no-one actually takes a step back and asks the question 'why are we doing this'. Do we need to do this ?


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## Random Orbital Bob (19 Jul 2013)

That's uncanny....I've just been on it myself. That's all down to poor patient records. They keep manual records for each patient and pretty much never read them...that's why when different shifts end/start or consultant/nurses etc come into the picture they re-ask the same questions time and time again. Their patient handover skills and information management are I would agree pretty poor.

Bless her....give her my best and tell her she is indeed on the treadmill and try not to worry......poor love.


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## Kalimna (19 Jul 2013)

Bob, whilst I sympathise with your patients' view, life on the other side of the bed isn't always straightforward. It simply isn't feasible for doctors (and nurses, but that's slightly different again) to always carry around in their head concise, accurate information on the 20-30 patients seen on a daily basis, all at different stages of investigation or treatment, and often changing both in number and location each day. Add to that the fact that many patients have a considerable number of letters etc in their case notes (imagine reading three or four magazines worth of typed or written info cover to cover, trying to find the three or for lines of pertinent info each time you see a patient). Also add to that the fact that patients frequently (thou not always) tell the doctor what they think we want to hear, not what we need to know. And on top of all that, the considerable time constraints placed upon clinicians. In other words, it is frequently more efficient to ask the patient first, and then follow up by reading the notes for confirmation or refutation. 
Remember the woodworking adage to measure twice and cut once, well it applies to medicine also.
We do read patient notes, you just don't see us doing so all the time.

Roger - thank you. I will also add that your last few lines represent one of my greatest frustrations - the "why are we doing ths?" Issue. I do hope your mother in law recovers well, and in good time.

Adam


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## Cheshirechappie (19 Jul 2013)

The politicians damn well SHOULD get hold of the NHS and give a really good shake at fairly frequent intervals. If they don't, then the running of the NHS is entirely in the hands of unelected and seemingly unaccountable bureaucrats. Those of us forced to use the NHS (because we can't afford private healthcare) and forced to pay for the NHS (£120bn this year, or about £2000 for every man, woman and child in the country), would have no way of influencing the very grand NHS senior managers except through our elected representatives, however feeble their interventions tend to be. Senior managers spend a great deal of time and money making absolutely sure they don't listen to ordinary people like patients. They are adept at burying and brushing off any complaint that any ordinary patient might have the temerity to make. Result - a rubbish service.

There are still quite a few people trying to do their best in the NHS, but they seem to be outnumbered by time-serving apparatchiks and people who daren't do anything off their own bat in case they get reprimanded.

The NHS needs to concentrate on doing the basics really well. Over my lifetime, this has really slipped. Twenty years ago, if you rang your GP's surgery for an appointment, you got one either the same day or the next day. Now, you may have to wait a fortnight. Also, you can't get any (sensible) GP service outside normal business hours. Twenty years ago, out-of-hours cover was normal.

Perhaps the NHS needs some competition to focus it's mind and sharpen up it's act. It needs to remember that it's us that pay their wages. We are the customer. At the moment, they can get away with shoddy and (as we've recently seen) sometimes downright criminal levels of service, because we've got no choice but to put up with it. For what the taxpayer pays, the taxpayer has a right to expect far better, and every right to have their voice heard when things are not as they should be.

Politicians - kick NHS senior management ass. That's what you're elected to do.


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## Phil Pascoe (19 Jul 2013)

Someone in the press a while back made an interesting observation - it's the people who maintain that the N.H.S. is perfect that are the very people that prevent it's improvement. And another one - if the N.H.S. is so perfect, why has no other country in the world copied it?


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## Eric The Viking (19 Jul 2013)

I'm married to a time-served GP, who also spent years in hospital medicine, in unfashionable specialities like geriatrics and psycho-geriatrics. Frankly, her workload is going to break her if something doesn't change soon. 

She has the 'wrong' sort of patients - inner city, heavily immigrant area. They have a translation service on speed-dial for consultations. She can't meet QoF* targets because they don't turn up for screening etc. Working hours have become daily 0800-1900h (sometimes until 2030h).

Four weeks ago, they had several days with over a hundred calls into the practice each day, on top of the usual GP sessions. Every caller wanted an urgent appointment or a visit; every caller had to be called back and screened by a GP in case it was serious. 

One example encapsulated the problem (she narrated this over dinner that evening): "Can you take a look at my son? He's been off colour for a few days and I'm worried about him. I'm wondering if you could just drop by later this afternoon to check him over." My wife: "We're very busy at the moment, and it's now practice policy that we don't do home visits unless the patient's condition is serious enough to merit it. Can you tell me a bit more about what you think is wrong? Can you bring him into the surgery?" Mother: "Oh, I can't do that, he's in school today."

The GPs take shifts handling the phone calls. It doesn't save them much time. She eats lunch at her desk in between patients (sometimes during consultations. After surgery she has to check all the reports that come in from patients that have been referred for hospital & blood tests, in case something serious has been found. If she misses anything, she's liable.

When she gets home she has 3-5 hours reading every week of medical journals, practice management meetings (often on scheduled days off), and presently every third Saturday morning in surgery too. 

The practice is borderline viable (commercially). Until this year she's had three consecutive years with quite chunky drops in income. We've never met a GP earning the fabled £200,000. We don't expect to. The only difference this year is that she's been forced to do more hours, because they're three GPs down (two salaried+one partner) and although they've recruited two, they won't start until September/October. It took the practice a year and over £20,000 in advertisement and recruitment agency fees to find these two. Everyone's hoping they'll stay. Others haven't.
. . .

One of our friends was a radiologist, who became the chief executive of one of our bigger local teaching hospitals. This was about 20 years ago. Soon after starting, he removed FIVE tiers of middle management, and all their performance and efficiency measures improved.

I worked for a Fortune 100 global company with 200,000+ employees worldwide. It only had five layers of management in total, between any individual employee and the CEO.

Go figure, as the Yanks say.

E.


QoF* "Quality Outcomes Framework" is a way of "incentivising" GPs for behaviour the DoH wants from them: points = prizes, for things like smear tests, diabetes management, Well Woman clinics, surveying patient lifestyles, etc. If your GP hands you a survey, it's because some bureaucrat wants them to be doing that (usually).


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## Cheshirechappie (19 Jul 2013)

I think this article puts it far better than I could; especially the last two paragraphs.

http://www.telegraph.co.uk/health/healt ... ouble.html


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## Phil Pascoe (20 Jul 2013)

Last time I was in hospital, I was in a ward with a bay that only had four beds. I'm sixty, and the others were quite a bit older than me, I used to press the button when any of them got into a situation that they couldn't manage, and struggle out of bed to close their curtains when they were having problems with a bed pan or bottle. No one else was there to do it, and one of the nurses said one day that they they tried to come as quickly as possible when I rung the bell because they knew it wasn't a false alarm. When I went home, one guy called me back and all three of them thanked me. That is just WRONG WRONG WRONG!
I am in no way condemning the the nurses.


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## Phil Pascoe (20 Jul 2013)

Eric - a relative of mine who's a G.P. asked to see my repeat prescription one day. oh, beauty! he said. Your G.P.'s making a fortune out of you!


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## Eric The Viking (20 Jul 2013)

GP surgeries are remunerated according to the money they SAVE on prescriptions. They have a system on their computers (instigated by the DoH, I think), that tells them the cost of each drug, and about any generic alternatives, etc. They are at liberty to prescribe a brand name or a generic (if a generic is available). Meeting drug budget targets result in funding to the practice, BUT contractually that money can only be spent on equipment and facilities, NOT staffing and NOT GP personal income either. 

The prescription payment is part of the pharmacist's remuneration, not the GP's, who sees none of it.

Whatever your relative meant, it can't have been what you are suggesting.


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## John51 (20 Jul 2013)

No enterprise needs more than 5 layers of management.

I agree with the idea of having a matron for each hospital. She should be a battleaxe that even the doctors are frightened of.

20 years ago a nurse told me that managers were being brought in to cut costs and they did it by sacking cleaners.


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## JakeS (20 Jul 2013)

Hardwood66":2vuo2xlw said:


> I have a mental health issue ifI want to see a gp I have to normally wait 4-6 weeks





Cheshirechappie":2vuo2xlw said:


> Twenty years ago, if you rang your GP's surgery for an appointment, you got one either the same day or the next day. Now, you may have to wait a fortnight. Also, you can't get any (sensible) GP service outside normal business hours. Twenty years ago, out-of-hours cover was normal.



This is entirely down to the individual practice, in my experience. I've known of four over the last ten years:

- One in the village my parents live in, which I could call up most times of day and get an appointment that day or the next, but who gave me a week's notice to find a new doctor the moment I moved out of the village
- One in the suburb I moved to after I moved out from my parents' house, where I could get a same-day appointment so long as I phoned early enough in the morning to secure one, but only booked appointments in advance for stuff like tests or follow-ups; the reception opened at 8:30 and generally all the appointments were gone by 8:45, but they were also happy to book you appointments at the main practice in town that they were a branch of, which could generally be got same-day up until around 10AM.
- One my girlfriend used to go to in Lincoln, who also didn't book in advance and you had to get an appointment same-day first thing in the morning... but who bizarrely prioritised people who turned up to the surgery and queued at the reception over people who called in on the phone!
- The one I'm currently with in a different town, who will cheerfully book appointments up to two weeks' in advance, usually within a couple of days, and keep a few emergency appointments that you can usually book same-day; if they're out, they'll give you an appointment with a nurse instead, who can perfectly adequately deal with most of the things I've ever gone to the doctor for.

On top of this, if I want to get myself to Peterborough or Lincoln I can go to a drop-in centre where I can be seen by a nurse within an hour or so, more or less any reasonable time of day.



Not to say that there aren't problems with the NHS - there are lots of problems with the NHS, and a lot of them start with the letters 'MP'! - but that it's not reasonable to expect that your local doctor's practices are universal. Every time in the last ten years that I've felt like I need an urgent appointment to see someone, I've managed to see a professional within a day or so and they've always been patient, helpful and surprisingly cheery. If you don't like the way your current doctor or your current practice does things, you are often at liberty to look around your area for alternatives, even within the NHS. While it's not always the case, everywhere I've personally lived there's been more than one option.






Eric The Viking":2vuo2xlw said:


> I worked for a Fortune 100 global company with 200,000+ employees worldwide. It only had five layers of management in total, between any individual employee and the CEO.


(And for what it's worth, until recently I worked for a Fortune 500 global company with a similar workforce, and we had five layers of management in our office alone; I think the manager of our office reported to people who went to meetings with people who reported to people who reported to the CEO, or something along those lines. Needless to say, it was a total shambles a lot of the time! ;-)


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## RogerS (20 Jul 2013)

John51":1okhzlxd said:


> No enterprise needs more than 5 layers of management.
> 
> ....



The Army? Navy?


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## Jacob (20 Jul 2013)

These threads are the depressing result of a campaign of denigration and demoralisation against all public services, health, education, welfare etc which has been on going since the 70s. They've got everybody moaning and complaining whilst they slowly pull the carpet from under us. 
Slowly but surely they are fragmented and sold off, the result being inefficiency and chaos, but high profits, especially short term windfalls, for the usual suspects. The problem is down to stupid and venal politicians, feeble opposition and weakened unions. It's not the fault of teachers and nurses, not really the fault of management either - the buck stops at the top with the politicos, and ultimately with us, as voters.

PS I should add - once in my case, twice with my wife, we have had absolutely top rate service from NHS in difficult circumstances where things could easily have been a lot worse, and the nurses were brilliant. The only complaint was the food - absolute rubbish provided by a privatised service. Not a life threatener but unnecessary and a sign of things to come.


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## Jacob (20 Jul 2013)

Eric The Viking":2iaf8tll said:


> ....
> Go figure, as the Yanks say.......


One thing the yanks have completely failed to figure is universal health care, though there is plenty of profit to be made. The actual cost per capita of their inadequate state system is much higher than the NHS equivalent, but theirs is a second rate service only for the poor and needy. Their private insured system works well for the minority who can pay (or have paid for them) the astronomically high premiums, but is fraught with traps and small print which can leave you out in the cold when you or your family most need to be cared for. That's the way it's going here .


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## Reggie (21 Jul 2013)

I'll kick off my reply by stating that I am extremely grateful for all the great work that the NHS has done for me and my family.

I think it's far too easy to say that these threads are the result of a campaign of denigration and demoralisation against all public services. I've based my opinions on my own personal experiences as I suspect everyone else has too, we can't all be part of a campaign to destroy the NHS can we? I think all any of us want is an NHS that provides what it's supposed to and isn't more of a burden to everyone involved than it needs to be.

Jacob, anyone old enough to remember the 70s and how the public services have changed will have different opinions on unions, my own is the crushing power the unions had over the whole country, some fights they were justified, others were entirely self serving, it can still be seen today in the shape of the RMT, their last effort was holding the olympics to ransom, next time a strike is called by any union, take a look at the actual turnout for the vote, as low as 15% in some cases. It is entirely down to management, teachers, nurses and anyone else involved, including us, we've all let this happen and now it's in this state.

I think though that we can all agree that the public services today are a lot better than they used to be, the NHS is just infuriating because it could be a lot better.

The major problem with the NHS is there are far too many opinions because there are far too many vested interests. By that I mean that anytime a politician farts in the general direction of the NHS there are 50 different groups all lobbying for their say in how the fart should be managed. If these groups actually worked together towards what we all want instead of complaining about what they don't want, they might actually sort things out a lot better, there is so much negativity surrounding

I am absolutely shocked at the state of how some of the services are run, it also really does beggar belief that they haven't got a coherent IT strategy across the whole country NOW, especially considering the amount of money they've thrown at computer systems in the last 10 years.


I heard that one of the big issues with trying to implement these things countrywide is each gp practice, hospital, health authority records information differently so will require slightly different software, which makes it a nightmare for whoever has to write the stuff. This leads me back to my far too many opinions comment, take the choice away from the the gp practice, hospital, HA and tell them how this software should work, clearly there should be a sensible consultation to agree best practices but once decided, it's stuck to and everyone works from the same song sheet.

We are incredibly good at IT in this country, we have some of the sharpest minds in the world, we should not have this level of incompetence in IT provision for the NHS, we should be looking at 'big data' to enhance the NHS instead of my dietician asking me to bring a paper copy of my blood test results from my visit to my specialist because she's in a different health authority and not allowed access to my information at the hospital.

As for not getting information from the relevant people that are treating you or your loved ones, you have to assert yourself and demand that they explain themselves, keep calm while you're doing it but be firm, it's the same with treatment, if you feel you're not getting proper attention then you have to make sure someone knows about it. If something doesn't seem right, if information is contrary between 2 parties, stand your ground and make sure that you leave with the right treatment.


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## RogerS (21 Jul 2013)

Reggie

IT is not the answer. Blair tried it. OK..he was arrogant enough to think that he knew better then professional experienced IT practitioners. This article says it all http://www.guardian.co.uk/society/2011/ ... -abandoned.


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## Jacob (21 Jul 2013)

Reggie":3ao964s6 said:


> ...
> I think it's far too easy to say that these threads are the result of a campaign of denigration and demoralisation against all public services. I've based my opinions on my own personal experiences as I suspect everyone else has too, *we can't all be part of a campaign to destroy the NHS can we?*


Well yes exactly that. There has been a massive development of "blame culture" whereby the finger of suspicion is waved in all directions and effectively distracting attention for those really responsible namely the DH, Jeremy Hunt, Parliament, and ultimately ourselves for allowing this to happen. A typical example being Hunt's accusation of "culture of cruelty" in nursing. Nurses get the blame, not the management and not Hunt himself. It's so easy to be drawn in to the big moan about institutions and thereby indirectly contribute to their decline, especially as we allow them to be run down and privatised.......


> ......
> I think though that we can all agree that the public services today are a lot better than they used to be, the NHS is just infuriating because it could be a lot better.


Direct your fury at the DH and parliament, not at nurses and doctors


> ....
> I am absolutely shocked at the state of how some of the services are run, it also really does beggar belief that they haven't got a coherent IT strategy across the whole country NOW, especially considering the amount of money they've thrown at computer systems in the last 10 years.


I would blame the IT industry itself for failing to live up to its promises and produce the goods.


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## Phil Pascoe (21 Jul 2013)

i read a letter in the press a while back from a guy who was working on the N.H.S. I.T. systems, he said he was the only person in an office of 20+ people (all on well over £100,000 p.a.) who actually had any medical knowledge.
My sister worked for H.Packard in N.Z. and Aus. dealing with healthcare computer systems, and likewise she was the only person in her department who had medical qualifications - other people spent ages working on a problem, only for her to look at it and say "great idea, but it won't work" and then go on to explain why.
I was talking to a guy late one night who wrote computer progs. for motor factors, and he said he really liked what he was doing, and that he was making a very good living doing it - he had no trouble selling the progs. because they worked well. They worked well, because he had spent several years selling motor spares before he went into programming.
Just because someone can write a computer programme doesn't mean it will actually work.


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## Jacob (21 Jul 2013)

Blame culture in action here prescriptions-t71985.html :lol: a group of people moaning on about nothing at all and criticising the NHS. Reminds me of Life of Brian "what did the romans do for us" sketch.


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## Eric The Viking (21 Jul 2013)

The current market leading GP software company was set up by GPs, who wrote the software themselves in the early stages. 

As an outsider looking at NHS IT (and there is at least one insider on this forum) I see many different challenges.

One is that there is simply too much money sloshing about. Without going into detail (for commercial reasons), I am absolutely certain that much NHS primary care IT is extremely poor value. The service levels are dire (locally - can't speak for the whole country, obviously), and the financing structure makes it very easy to hide costs, rather than scrutinize them properly. I know of IT entities in the NHS that couldn't survive in the commercial world, as they're too expensive, overmanned, and yet their service levels are shamefully poor. 

At the other end of the scale, there are huge "consulting" firms working on enormous projects. You rarely, if ever, hear of cost-benefit analysis being done beforehand, and it's certainly not placed in the public domain. One of the first things I was taught on my business degree was that you must consider the opportunity cost of any activity - that's the value of doing something else instead with the resources. Another thing was that decisions should be based on information, BUT that itself has a cost: there are huge "Management Information Systems" (MIS) projects happening, but it's questionable whether the information they will produce will be actually worth the huge cost of obtaining it. 

Another issue is the silo mentality. In hierarchies, people build mini-empires, then defend them, right or wrong. The right answer here is a flatter management structure (which, incidentally is a lot cheaper too), encouragement of collaborative working, and simple measurable objectives.

Another issue is standardization and use of open source code (or lack of it!). It's proven to save money, and has the crucial advantage that, if it's not proprietary and it is open, the moral pressure is to find faults and fix them. If it's proprietary, there is another imperative too: to conceal problems in case they damage the business. There are open source projects in the NHS (or talk of them), but they are getting lukewarm support, which is costing all of us a lot of money.

Then there's the holy grail of a perfect, universal system. Blair's minions tried it. We know where that went. But the point is that 'just getting something out there that works' is often the cheapest and best solution - incremental changes, rather than endless delays. A good example of this is the interactions between GPs and hospitals, for example with patient discharge letters. Round here these still arrive on paper, and staff are employed just to scan them back into the GPs' records systems. When I queried this, I was told electronic transfers were insecure. Well PGP encryption has now been around for 20 years, it's open source and free. And I still can't send a concise email to my GP asking a question, or make a hospital booking on-line (despite Choose and Book!). Go figure. 

Sorry I'm being boring, but how can an organisation, so full of highly intelligent people - some of the best minds in the country - end up with such dumb decisions?

Beats me, and it's obviously beating them, too.

E.


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## Reggie (21 Jul 2013)

Jacob, that's unfair, people aren't trying to blame someone, they're trying to find the reason why things happen the way they do. 

If the IT was wrong, who procured it? Who failed to oversee it to a sufficient level of competence, who failed to fine companies that couldn't fulfil their duties? How did all of those healthcare professionals that are looking after the NHS fail to be heard? How about stafford? not the nhs or the nurses or doctors or managers fault, it must be the fault of the patients, darn those pesky people, dying to spite the NHS, if there's a blame culture in this country it's down to the insistence that the NHS can do no wrong, even when it's killing people unnecessarily.

I don't doubt that there are companies that don't know what they're doing with IT and health, that's why you have competent people draw up plans in the first place and employ people that do know what they're doing. £12.7bn wasted on IT, there had better be someone to blame.

Eric, you make some fine examples of the problems and being an outsider you've managed to nail most of the problems, so it's fairly easy to see that whilst there is a need for competent medical programmers, there is also a need for some common sense. The receptionists at my local GP think that reading me the first line of my address and asking me to confirm it, is good practice for data protection. I worked for a company that had to adhere to the data protection act, if any of us had used those methods, we would have lost our job, that's absolutely nothing to do with medical competence and everything to do with supposed medical people that are supposed to know what they're doing that are just plain ignorant and incompetent.


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## Harbo (21 Jul 2013)

The problem with the Gov's plan was that instead of adapting tried and tested existing systems, they tried to come up with a completely new universal system throughout the whole country.

My wife (a Hospital Pharmacist) was involved in this and represented our Region but was frustrated by the complexity the other parties were trying to introduce especially as a lot of Doctors and Managers we set against it.

Our local hospital had lead the way in "Hospital Information Systems" and had developed and was running successfully an electronic system for patient records and ward prescribing for many years. Records are available on computers in each ward, updated by the Doctors and Nurses and prescriptions written which were received directly in the Pharmacy. The system also covered drug/prescription stock control for quantity and costs. It was also linked to local GPs.

What should have happened was that this (or other tried and tested systems) should have been rolled out gradually to other hospitals/Areas.
Then once fully operational, access to each hospital etc could have been linked together?

Rod


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## Eric The Viking (21 Jul 2013)

Harbo":wnpkdl56 said:


> The problem with the Gov's plan was that instead of adapting tried and tested existing systems, they tried to come up with a completely new universal system throughout the whole country.
> 
> My wife (a Hospital Pharmacist) was involved in this and represented our Region but was frustrated by the complexity the other parties were trying to introduce especially as a lot of Doctors and Managers we set against it.
> 
> ...



Spot-on Rod, but that would have deprived a lot of little empire-builders of their empires!

Many years ago, long before we had kids, my wife and I were at a party, loosely for her cohort at Bristol university. Those who'd done 'simple' degrees had been 'down' for two or three years (my wife was still studying, basic medicine then being five years minimum, six if you did a pre-med year, which she did). 

I got cornered by one of her year. He'd done an arts degree - English or Art history, or similar, Desmond or third. Nothing wrong with that _per se_, but this chap had gone into the NHS in the South West as a junior administrator. He told me with glee how much power he wielded in the hospital in which he worked, and how he was able to 'push doctors around' if he needed to. He enthused about the career opportunity he'd been given.

As you can tell, I've not forgotten the incident. Call me naive, but before that I'd never been quite so shocked at someone's attitude (possibly later, when I came across a few truly nauseating individuals in politics, but that's an entirely different story). 

I remember thinking, "you won't last long!" But I was entirely wrong. 

He turned out to be the new breed. I've no idea, but he's probably on £100,000+ now in the DoH, making policy.

E.


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## Harbo (21 Jul 2013)

Sadly get that too in the Civil Service - I worked as a Consultant for a major Govt Dept in London for a couple of years - came across some real Tos..rs!

Rod


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## Cheshirechappie (21 Jul 2013)

The points above about IT failures are, of course, perfectly valid. However, the problems of the NHS are far deeper than just some computer inadequacies. Over the last year or so, we've had reports of poor care in Maidstone, Mid Staffs, Redditch, West Cumbria and most recently 11 Trusts placed in Special Measures (whatever they might be) because they may between them have been responsible for up to 13,000 unnecessary deaths.

Whatever is wrong in the NHS is clearly deep-rooted and widespread. Not surprisingly, the politicians are (to some extent) playing politics ("Not Me Guv" syndrome). Until we have some calm, common-sense debate about what has gone wrong, and what we can do to fix it, people are likely to carry on dying needlessly.

I don't particularly care whether healthcare is provided by private enterprise, under public ownership, or some blend of the two. All I want is decent care available to everybody when they need it, and without being an excessive drain on the public purse. If that means some debates about what publicly-funded healthcare provides, and what it shouldn't, then fine - lets have the debates. However, the current tendency to laud the NHS as wonderful and beyond criticism is stupid. It won't improve anything unless we admit that it isn't as good as it should be, and look for sensible ways to improve matters.


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## Reggie (21 Jul 2013)

Indeed, I mentioned earlier that I thought it was the fault of everyone involved that it is the way it is, that includes patients, politicians/civil servants and anyone else you could care to mention that has an interest. We had terrible mrsa and other infections because no one blamed anyone, it took lots of people dying to root it out and fix it.

I also heard that another part of the issue were some LHAs and practices just refusing to use the new computer systems, that's never going to be helpful.

CheshireChappie, I completely agree, we need real discussion not polarised sound bites that only serve to deflect attention. It's laughable to think that because someone legitimately criticises the NHS that they must be part of a blame culture intent on destroying the NHS, not a single person has advocated that in this thread.


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## Boxer (21 Jul 2013)

I have worked full time for the last fifteen years as a qualified health professional on the front line - both in the NHS and Social Services.
I have had direct experience of both the management and day to day service provision in both areas.
Personally I found the management of both to be so fragmented and ineffective that a couple of years ago I chose to drop back down the career ladder and return to purely clinical roles. Next year I am planning to bring my career to an end and find something else that wont drive me to an early grave.

Does this mean that the NHS is particularly badly managed ?
Well my take on it is that there are two main types of busineses in this country - 
Public Services (eg NHS & Social Services & Education) which are politically led.
Private Companies (eg banking, industry, construction and retail) which are profits led.

Personally I have seen monumentaly poor management and service provision in both types. 
Would you rather trust a politician or a banker?

If you have never had to return a faulty item, never had trouble with your banks administration and charges, never come across poor workmanship in the building trades etc etc THEN you have cause to complain about how bad public services are compared to private services. But if (like me) your life is a never ending catalogue of disatisfaction in all areas then why do you expect the NHS to be any better ?

If you want a quick improvement to the NHS then simply get rid of seventy percent of the managers and replace them with seventy percent more front line staff.
Patient care would be greatly improved and staff health and morale would soar.

However this will never happen whilst it remains led by public school politicians and doctors who have too strong economic ties to the drug companies.


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## Phil Pascoe (21 Jul 2013)

Having bosses who are not qualified in their field. This reminds of an occasion a few years ago when a friend told me a story. He was working in a factory that manufactured synthetic yarn, and a supervisor told him to load the machine with a certain raw material - he refused, explaining that it would foul up the machine. He was told in no uncertain terms that the other guy was boss, and that he should do as he was told. Fine, he said - just put your request in writing. Alarm bells should have rung, but they didn't. He duly put it in writing, the machine was loaded, switched on, and blown up. He gets summoned by the big boss and asked what on earth possessed him to do it. I was doing as instructed, he says. I don't believe anyone here would have told you to do that, that machine was worth £n 1000. You're fired. At which point he whips out the letter. It wasn't him that got fired.
The bloke concerned always boasted that he had a master's degree. Several years later, Brian found out that it was in ecclesiastical history.


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## RogerS (21 Jul 2013)

Jacob":qwykn4rj said:


> Reggie":qwykn4rj said:
> 
> 
> > ...
> ...



Sorry but you cannot excuse Labour from having a massive finger in the debacle-pie. You only have to read the recent reports to see that they swept a huge amount of stuff under the carpet or suppressed it's coverage.


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## RogerS (21 Jul 2013)

phil.p":297m3xum said:


> i read a letter in the press a while back from a guy who was working on the N.H.S. I.T. systems, he said he was the only person in an office of 20+ people (all on well over £100,000 p.a.) who actually had any medical knowledge.
> My sister worked for H.Packard in N.Z. and Aus. dealing with healthcare computer systems, and likewise she was the only person in her department who had medical qualifications - other people spent ages working on a problem, only for her to look at it and say "great idea, but it won't work" and then go on to explain why.
> I was talking to a guy late one night who wrote computer progs. for motor factors, and he said he really liked what he was doing, and that he was making a very good living doing it - he had no trouble selling the progs. because they worked well. They worked well, because he had spent several years selling motor spares before he went into programming.
> Just because someone can write a computer programme doesn't mean it will actually work.



Phil...you don;t need to have any medical knowledge to program an IT system. You DO need stakeholders....people who DO have medical knowledge who can articulate what their requirements are and you need someone...the systems analyst or business analyst who is able to interpret them. You also need decent project management and exceedingly good change management.


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## RogerS (21 Jul 2013)

Reggie":2gs8qpnh said:


> ...
> I don't doubt that there are companies that don't know what they're doing with IT and health, that's why you have competent people draw up plans in the first place and employ people that do know what they're doing. £12.7bn wasted on IT, *there had better be someone to blame*.
> 
> ..



That one is easy.

Blair.


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## RogerS (21 Jul 2013)

Harbo":dq6ierih said:


> .....
> What should have happened was that this (or other tried and tested systems) should have been rolled out gradually to other hospitals/Areas.
> Then once fully operational, access to each hospital etc could have been linked together?
> 
> Rod



In principle, what you are suggesting makes sense. However, it could well have been that the IT infrastructure/programs/database used by your hospital was not scalable to the size of the NHS. That would have been a very valid reason for not adopting it.

The basic premise (being able to walk into any NHS outlet and being able to access ones details) was flawed.


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## Phil Pascoe (21 Jul 2013)

Roger S - you are right of course - I should have written that differently. I meant the people who design the progammes rather than the people who write them.


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## Reggie (22 Jul 2013)

Expecting to access the same information from any nhs outlet is not flawed, it's not an aspirational thing, it's something that should just be happening already, there are plenty of systems rolled out countrywide that give us access to all manner of complex information.


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## Jacob (22 Jul 2013)

Interesting article here about how NHS dissatisfactions are being exploited and very probably not to our advantage.
http://www.guardian.co.uk/politics/2013 ... y-lobbying


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## Cheshirechappie (22 Jul 2013)

Jacob":1zrbcqp7 said:


> Interesting article here about how NHS dissatisfactions are being exploited and very probably not to our advantage.
> http://www.guardian.co.uk/politics/2013 ... y-lobbying




Not sure what point you're trying to make, Jacob. After reading the article, I don't really see how "NHS dissatisfactions are being exploited". It just seems to be a leaked document with some rather bland statements like "59% of the population don't mind whether healthcare is delivered by private enterprise or public service as long as everyone gets the best available care" (which just seems like a pragmatic statement of the blindingly obvious, connected to a randomly generated percentage number). Then there are some of the usual political soundbites which mean about as much as most political soundbites. The usual Westminster Bubble arguments about practically nothing.

Where's the 'exploitation'?


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## RogerS (22 Jul 2013)

Cheshirechappie":2grxxej2 said:


> Jacob":2grxxej2 said:
> 
> 
> > Interesting article here about how NHS dissatisfactions are being exploited and very probably not to our advantage.
> ...



Jacobland?


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## Jacob (22 Jul 2013)

Cheshirechappie":2gvfb91o said:


> .....
> Where's the 'exploitation'?


The exploitation comes after creating a climate of dissatisfaction (with the help of the media esp. the Daily Moan) and so reducing resistance to privatisation. Given a boost by cack handed re-organisations, tightened budgets, blame culture etc etc. 
Run the thing down, denigrate and demoralise the staff, flog it off, flog off the assets, get taxpayers money to run an inefficient private sector service at much greater cost. When they go bust more taxpayers money goes to bail them out. Gravy train!
Lobbyists do this sort of thing for a living. Look how effective they have been on the booze and nicotine front recently. "Unpaid" parliamentary advisers getting mega bucks from the companies they lobby for. It's blatantly obvious that Lynton Crosby (and the others) have no interest in democratic politics for the public good. At least union lobbyists represent a fair chunk of the working population, not just distant big businesses and shareholders.


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## RogerS (22 Jul 2013)

Jacob":1fc3pkpf said:


> ..... At least union lobbyists represent a fair chunk of the working population, not just distant big businesses and shareholders.



Bull. 

'Fair chunk'.....since when did 'fair chunk' mean 20% of the employed? 

I'll ignore the rest of your ramblings. Took you off Ignore...wish I hadn't.


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## AES (22 Jul 2013)

@Jacob:

I cannot disagree with at least some (even most?) of your conclusions here Jacob, but to suggest that "union lobbyists" are always only out for the good of their members????????

Well, you're either extremely naive or you're lamentably ill-informed. There are many, many well-documented cases where "union lobbyists" have not proven to be any less selfless than the political lobbyists (and politicians) you complain about.

I suggest that by now you should really have started to learn (assuming you're anything more than about 6 years old) that this world of ours is not just a case of blacks and whites (whichever house you cast your various protagonists into)!

If you are reacting true to well-established form (at least on this Forum Jacob), then you will either post a reply of "rubbish", or, even better, not post a reply to this at all!

AES


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## Cheshirechappie (22 Jul 2013)

Jacob":1wxfd8pg said:


> Cheshirechappie":1wxfd8pg said:
> 
> 
> > .....
> ...



"....creating a climate of dissatisfaction...." - Jacob, we've had the Maidstone scandal, the Mid Staffs scandal, the Redditch scandal, the care of the elderly scandal, the West Cumbria scandal and most recently the 'up to 13000 unnecessary deaths across 14 NHS Trusts' scandal. There's no need to create a climate of dissatifaction, because the NHS clearly isn't universally as good as it should be. Staff are demoralised already, there's no need to demoralise them further. Quite the reverse, in fact.

What politicians SHOULD be doing, on our behalf, is not having stupid political arguments about who said what when. They should be co-operating to find out WHY the NHS isn't as universally good as it should be, and doing something about setting things right.

I moved house in 2005, and consequently had to register with a new dentist. It was difficult finding an NHS dentist willing to take new patients at that time, but I found one. A few months later, said dentist decided to go private (as many did in 2006, following changes made to NHS dental contracts by the DofH.) Not wishing to go through the rigmarole of finding yet another dentist, I signed up for private dental insurance, though not particularly willingly at the time. Best thing I ever did, dentally. The standards of care by the same dentist and hygenists, in the same clinic, are markedly better than anything I've ever had from the NHS. Private care, when it's done properly, does work very well, I've found.

The same may well be true for other parts of the NHS. Opposing private sector involvement out of blinkered political ideology may well be condemning us to the worst sort of Eastern Bloc mediocrity, because such an organisation has no incentive to 'serve' anybody but it's own interests.

I don't care how healthcare is delivered, provided everybody has access to good care when they need it. I think my attitude is not untypical of the population at large. Until the whole of the political establishment accepts that and acts in OUR interests, we're going to carry on with healthcare provision which is sometimes grossly sub-standard. Silly political side-shows aimed at suppressing the facts about what the NHS is delivering don't, in the end, help either you or me. 

Similarly, sweeping statements that Lynton Crosby (or Len McCluskey, or Mark Serwotka, or Uncle Tom Cobbley) 'have no interest in democratic politics for the public good' just obscure the search for actual facts, and a measured debate about those facts. It's the kind of political discourse that's utterly beneath you, but sadly prevalent among some discussing politics.

Jacob, do you think that the scandals I outlined above (Mid Staffs, Redditch, 13,000 unnecessary deaths etc etc) should be debated properly, or ignored? Are they acceptable in a publicly provided service?


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## Jacob (22 Jul 2013)

For example - Unison has about 1.3 million members. Lobbying for that many people seems to be not only democratic but essential and very likely to benefit a much greater number of working people with roughly the same interests. More the better!
Lynton Crosby is a lobbyist for tobacco industry which kills more people than all the other dangerous drugs and alcohol put together. Or in other words - a murderous parasite at the heart of government.
PS The tobacco industries impact on public health has been far more disastrous than say, the Taliban, Al qaeda and the IRA put together - just to get it into perspective!




> ....Jacob, do you think that the scandals I outlined above (Mid Staffs, Redditch, 13,000 unnecessary deaths etc etc) should be debated properly, or ignored? Are they acceptable in a publicly provided service?..


Yes of course they should be debated properly and are not acceptable. My point is that the responsibility or these things ultimately rests with the DH and Hunt, who contrive to distract attention by blaming any/everybody else ("culture of cruelty" amongst nurses!! etc). Your dental problems are due to withdrawal of support for NHS dentistry and the politicos are responsible for this, not the "system", or the dentists.


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## Cheshirechappie (22 Jul 2013)

Jacob, if you'd been following the health debate at all, you'd know that many of the scandals outlined above arose precisely because there seems to have developed a 'culture of cruelty' (or at least, a 'culture of indifference') among some (not all) nurses. We also know that whistleblowers highlighting problems were routinely dismissed, with or without large payoffs and gagging clauses), rather than have their complaints investigated. Blaming Hunt doesn't wash, since some of the incidents outlined in the recently published reports went back to 2005.

The Labour party are currently very wary of using Unite as a battering ram, since it was disclosed that about 30% of Unite members are conservative voters. There's also the scandal of Unite members being signed up as Labour party members without their knowledge, so that their block vote could be used to elect Unite officials as parlimentary candidates. Lobbying arguments cut both ways.

It's true that responsibility for addressing the problem lies with Hunt. I don't have much confidence in his sorting them out, but I have even less confidence in a Labour Health Secretary sorting them out, precisely because the Unions wouldn't allow it. Remember the 1970s and British Leyland? That didn't end well, did it?


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## Cheshirechappie (22 Jul 2013)

Jacob":19g93ez6 said:


> Interesting article here about how NHS dissatisfactions are being exploited and very probably not to our advantage.
> http://www.guardian.co.uk/politics/2013 ... y-lobbying



It would seem that the Guardian article quoted above may have contained some errors. The presentation was made to MPs of all parties, not to private healthcare providers. It was organised, not by Lynton Crosby, but by Westminster Advisers, a lobbying company headed by a Blairite Labour supporter, Dominic Church.

http://order-order.com/2013/07/22/crosb ... n-commons/


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## RogerS (22 Jul 2013)

Well researched, Cheshire Chappie. You can always rely on the Guardian to provide well researched, totally unbiased opinion and articles. 

As a slight aside, we all know that the Guardian bangs on and on about privacy etc. Well, I have a cookie tracking blocker on my browser that blocks tracking cookies and tells me how many on each page of a site as I browse. Most websites have around 3-5. The Guardian max'd out at 14 ! So much for integrity. Mr Guardian.


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## Phil Pascoe (22 Jul 2013)

Come on, we all know the the Gruaniad is always right. The only papers that publish lies are the Mail and the Telegraph.


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## Jacob (22 Jul 2013)

Cheshirechappie":z2fw31qi said:


> Jacob":z2fw31qi said:
> 
> 
> > Interesting article here about how NHS dissatisfactions are being exploited and very probably not to our advantage.
> ...


Guido Fawkes and some sleazebag Blairite labour MP don't make much difference to the general drift. Drug pushers and NHS asset strippers. We'd be better off with Abu Qatada lobbying from the inside. Come back beardy - all is forgiven!


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## RogerS (22 Jul 2013)

Have to admit, Jacob, that your ramblings really crack me up. Great laugh....many thanks.


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## Reggie (23 Jul 2013)

It's clearly a problem that the NHS is used to promote agendas, I'm constantly wary of all media outlets, Jacob probably thinks I'm a mail reader (this isn't a dig at you Jacob), in actual fact, I don't read newspapers at all as a first source of information, if a story interests me then I'll visit various web outlets to get a range of opinions on the story before I form any kind of opinion.

One thing that has come from this discussion though is that we all want the same thing, a working NHS. The biggest battle for all of us will be getting people to stop polarising around public vs private. Once the 2 factions stop fighting each other and work together then we'll all move forwards. I think that's something that has been seen in practice in the coalition, almost, something I'd like to see more of between all 3 parties, government should be inclusive, not exclusive. It may seem rose tinted but I firmly believe that working together for positive outcomes is far more productive than fighting against each other for negative results.


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## RogerS (23 Jul 2013)

Reggie":2dlk1my4 said:


> It's clearly a problem that the NHS is used to promote agendas, I'm constantly wary of all media outlets, Jacob probably thinks I'm a mail reader (this isn't a dig at you Jacob), in actual fact, I don't read newspapers at all as a first source of information, if a story interests me then I'll visit various web outlets to get a range of opinions on the story before I form any kind of opinion.
> 
> One thing that has come from this discussion though is that we all want the same thing, a working NHS. The biggest battle for all of us will be getting people to stop polarising around public vs private. Once the 2 factions stop fighting each other and work together then we'll all move forwards. I think that's something that has been seen in practice in the coalition, almost, something I'd like to see more of between all 3 parties, government should be inclusive, not exclusive. It may seem rose tinted but I firmly believe that working together for positive outcomes is far more productive than fighting against each other for negative results.




+1


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## John51 (23 Jul 2013)

*It may seem rose tinted but I firmly believe that working together for positive outcomes is far more productive than fighting against each other for negative results.*

Accepting that the opposition 'might' have a point seems to be a no-no for many Brits. 'If I can prove you wrong that proves I'm right' sort of thing.


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## Reggie (23 Jul 2013)

They seem to forget that the NHS is about people, not politics, point scoring solves nothing, real solutions do. You know at the end of it all, it really doesn't matter who does the job, public or private, the positions still need to be filled, services provided, to a level of care and for a price.


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## finneyb (24 Jul 2013)

Reggie":13rm7ii5 said:


> They seem to forget that the NHS is about people, not politics, point scoring solves nothing, real solutions do. You know at the end of it all, it really doesn't matter who does the job, public or private, the positions still need to be filled, services provided, to a level of care and for a price.



Agreed. To do this we need to start seeing the NHS as a universal insurance premium rather than a collection of buildings and people; it provides care when you need it be that in the public or private sector. The universal insurance premium is were the NHS wins over the likes of the US system where up to now there is an opt out and people can and do carry their own risk - that's OK until the proverbial really hits the fan eg cancer in the under 65's and they become bankrupt paying for their own treatment. ( In US over 65's are treated under Medicare, but there are still significant costs to be paid by the individual)

The universal insurance premium that we ALL pay now approximates to £2,000 pa per person (£120 billion NHS budget/ 60 million population). Of course, it's paid each and every year even if you don't need the treatment - but that's what insurance is all about - risk management.

Brian


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## RogerS (24 Jul 2013)

I was talking about this last night with a doctor friend of mine. One thing that came out is that compared to many years ago, almost without exception all hospitals now follow strict protocols...that's box-ticking to you and me..and it is here that most of the waste in the NHS occurs. Needless tests are carried out because they are demanded by the protocols and there seems to be no margin for an intelligent and common-sense approach.

However, hospitals do not have the same protocols for the same 'illness/emergency'! Enter the 'Post Code Lottery'. Compare and contrast the experience of his 84 year old mother-in-law at Peterborough Hospital...admitted with bleeding from her back passage (and according to my friend, he would immediately start thinking of the possibility of cancer) ...but was promptly discharged after minimal tests and told to go to her GP. Peterborough is under extreme financial pressure in no small part due to the relatively high immigrant population compared to Worcester where my own 85 year-old mother-in-law went and who went through a battery of tests because that was what their protocol demanded.


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## Modernist (24 Jul 2013)

RogerS":1k2l7zby said:


> Peterborough is under extreme financial pressure in no small part due to the relatively high immigrant population compared to Worcester where my own 85 year-old mother-in-law went and who went through a battery of tests because that was what their protocol demanded.



I wasn't aware the the % immigrants was a factor in NHS funding.

Re cull of NHS managers the efficiency of the system depends entirely on the effectiveness of it's management. This needs to be a tiered structure but the key word is effective ie managed with common sense and teeth where required. One problem is the constant interference of ill informed politicians who are having a similar devastating effect on education.


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## RogerS (24 Jul 2013)

Modernist":2r4qf7bz said:


> RogerS":2r4qf7bz said:
> 
> 
> > Peterborough is under extreme financial pressure in no small part due to the relatively high immigrant population compared to Worcester where my own 85 year-old mother-in-law went and who went through a battery of tests because that was what their protocol demanded.
> ...



No one said it was. Suggest you leave your preconceptions/bias behind. Simple fact...larger demand due to the high numbers of immigrants and many not speaking English therefore more demand for translators who are not always available when required...leading to delays....leading to a more inefficient NHS.

.[/quote]


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## Cheshirechappie (24 Jul 2013)

Modernist":1fi0nv8n said:


> RogerS":1fi0nv8n said:
> 
> 
> > Peterborough is under extreme financial pressure in no small part due to the relatively high immigrant population compared to Worcester where my own 85 year-old mother-in-law went and who went through a battery of tests because that was what their protocol demanded.
> ...



When, in a publicly owned service, things are not as good as they should be (e.g. Mid Staffs, Redditch, 13000 avoidable deaths etc.) then it damn well IS the duty of politicians to intervene. The public services are run on our behalf, and paid for by us, so our elected representatives should be acting on our behalf to ensure that inadequate service is improved. Those schools and hospitals doing a good job can be left to get on with it (except for regular inspection and monitoring to ensure that they continue to do a good job), those that are not should, on our behalf, be sorted out.

Politicians also owe us the duty of ensuring that our taxes are spent wisely. A publicly-provided service should be as good as, or better than, the equivalent service provided privately for the same cost, otherwise the taxpayer is not getting value for money. If public funds are not being used efficiently, politicians should intervene to see that they are.

Would you willingly pay a high price for a sub-standard service?


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## Modernist (24 Jul 2013)

RogerS":2escyts8 said:


> Modernist":2escyts8 said:
> 
> 
> > RogerS":2escyts8 said:
> ...


[/quote]

Clearly you said it was Roger.

I don't see any preconceptions in my comments as I have not commented previously. If more translators are required then the management should be in a position to provide them. If the system is geared to need then it should be able to respond.



> When, in a publicly owned service, things are not as good as they should be (e.g. Mid Staffs, Redditch, 13000 avoidable deaths etc.) then it damn well IS the duty of politicians to intervene. The public services are run on our behalf, and paid for by us, so our elected representatives should be acting on our behalf to ensure that inadequate service is improved. Those schools and hospitals doing a good job can be left to get on with it (except for regular inspection and monitoring to ensure that they continue to do a good job), those that are not should, on our behalf, be sorted out.
> 
> Politicians also owe us the duty of ensuring that our taxes are spent wisely. A publicly-provided service should be as good as, or better than, the equivalent service provided privately for the same cost, otherwise the taxpayer is not getting value for money. If public funds are not being used efficiently, politicians should intervene to see that they are.
> 
> Would you willingly pay a high price for a sub-standard service?



Unless of course the constant intervention of politicians was part of the cause of the problem in the first place. Management of NHS functions should be carried out by competent managers who's own performance is appraised regularly as in outside industry.


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## Cheshirechappie (24 Jul 2013)

Modernist
Unless of course the constant intervention of politicians was part of the cause of the problem in the first place. Management of NHS functions should be carried out by competent managers who's own performance is appraised regularly as in outside industry.[/quote said:


> Who is holding the managers of the Mid Staffs NHS Trust to account? Who should should deal with the inadequate performance of the 14 NHS trusts in which up to 13,000 avoidable deaths occurred? Why did the Care Quality Commission - the quango supposedly appointed to do just that - apparently suppress reports of inadequate service, and when that came to light, who should deal with the CQC?
> 
> Oh - and as an aside - who is paying for all this? What would happen if such scandals had occurred in private hospitals?


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## Phil Pascoe (24 Jul 2013)

No, N.H.S. management shouldn't provide interpreters - anyone needing one should bring their own or pay for one. It's daft things like that that eat up the money. Try going to any other country and expecting them to pay for interpreters.


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## Jacob (24 Jul 2013)

Cheshirechappie":19mapj3m said:


> Modernist
> Unless of course the constant intervention of politicians was part of the cause of the problem in the first place. Management of NHS functions should be carried out by competent managers who's own performance is appraised regularly as in outside industry.[/quote:19mapj3m said:
> 
> 
> ...


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## Cheshirechappie (24 Jul 2013)

Jacob":2f459s6h said:


> CQC is another example of politicos evading responsibility . Setting up enquiries, commissions, calling in "hit teams" etc etc are ways of appearing to be doing something but in fact shutting everybody up in the short term and passing the buck and hoping the issue will be forgotten or bogged down forever.
> Similarly with trusts, free schools, academies etc etc all devious tricks.



I'm not sure that I understand this comment.

"CQC is another example of politicos evading responsibity." Er - how that, then?

"Setting up enquiries, commissions, calling in "hit teams" etc etc are ways of appearing to be doing something but in fact shutting everybody up in the short term and passing the buck and hoping the issue will be forgotten or bogged down forever." What should the politicos do, then?


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## RogerS (24 Jul 2013)

Note that Jacob continues to use terms that are pejorative towards the current Government. Terms such as trusts, academies etc.

Clearly forgetting that the recent report by Professor Jarman laid much of the blame at the doorstep of the last Labour Government. And I see yet another £500 million IT project instigated by Labour has hit the buffers and been abandoned.... Honestly Labour shouldn't go anywhere an major IT project!

Brian (Modernist)....there is a difference between 'funding' and 'costs'. Surely you know that? Your preconceptions could be taken to be that you imply a racist bias to my comment.


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## Jacob (24 Jul 2013)

Cheshirechappie":2vdc1l8z said:


> ....
> 
> "CQC is another example of politicos evading responsibity." Er - how that, then?


There you go - you can't spot the trick! That's the whole point.


> "Setting up enquiries, commissions, calling in "hit teams" etc etc are ways of appearing to be doing something but in fact shutting everybody up in the short term and passing the buck and hoping the issue will be forgotten or bogged down forever." What should the politicos do, then?


Make difficult decisions themselves and get their ministries to take on some more direct responsibility for things. Lead from the front in other words. It's not just a lefty thing - Aneurin Bevan, Attlee, Churchill. Even Thatcher had *****x even though she was an out and out disaster.


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## Cheshirechappie (24 Jul 2013)

Jacob":35qzfgr7 said:


> Cheshirechappie":35qzfgr7 said:
> 
> 
> > ....
> ...



OK Jacob - for the benefit of us thickos who can't 'spot the trick' with regard to the CQC, would you be kind enough to explain exactly what it is?

When the politicians 'make difficult decisions thenselves', should it be on the basis of something a Special Adviser told them, something they heard in the Westminster Arms, voices in their heads, or the report of an enquiry set up to gather, record and assess the evidence of what went wrong and make reccommendations about doing things better?


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## Modernist (24 Jul 2013)

RogerS":22ukbhdw said:


> Note that Jacob continues to use terms that are pejorative towards the current Government. Terms such as trusts, academies etc.
> 
> Clearly forgetting that the recent report by Professor Jarman laid much of the blame at the doorstep of the last Labour Government. And I see yet another £500 million IT project instigated by Labour has hit the buffers and been abandoned.... Honestly Labour shouldn't go anywhere an major IT project!
> 
> Brian (Modernist)....there is a difference between 'funding' and 'costs'. Surely you know that? Your preconceptions could be taken to be that you imply a racist bias to my comment.



We agree on that then.

Re IT, the industry from day 1 has had a cynical beanfeast at the expense of the taxpayer which continues unabated whichever party is in power. I am not sure there have been any "successful" gov IT projects but plenty of the reverse. Some salesmen (old ones) are still drinking the profits of decimalization. The millennium bug proved remarkably absent on the day and the Police, NHS, MOD and Civil Service generally have had a never ending series of money squandering schemes with little or nothing to show. In my own county there has been more than one occasion when schools could not even exchange emails owing to the incompetence of the selected contractors.


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## RogerS (25 Jul 2013)

Modernist":1gj7gpfn said:


> RogerS":1gj7gpfn said:
> 
> 
> > Note that Jacob continues to use terms that are pejorative towards the current Government. Terms such as trusts, academies etc.
> ...



Don't necessarily blame the IT contractors. Politicians and civil servants will always buy the lowest cost. At the end of the day it is they who carry the can. Also the politicians and civil servants are past masters at never defining exactly what it is that they require. Also past masters at moving the goalposts part way through. And then again just before the Go-Live date.

I can tell you of one Govt IT project that was a success. IAFS. Immigration Asylum Fingerprint System. Also Eurodac...that was an EU wide fingerprint system that went live across all countries in the EU ....on time to the day. mmmm..now I wonder who was involved project managing the Uk end ? :-"


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## Jacob (25 Jul 2013)

Cheshirechappie":q60ml7mw said:


> Jacob":q60ml7mw said:
> 
> 
> > Cheshirechappie":q60ml7mw said:
> ...


Polticos get the credit for setting up a guard dog. Dog gets the blame for having no teeth. The institutions themselves get all the blame for their failings. Politicos have neatly sidestepped responsibility. 
It's an old trick performed everywhere. A committee sets up a sub-committee, which may be an efficient way of dealing with an issue, but could just be a way of kicking it into touch. Or delegate responsibility to an silly person and you know nothing will be done. Set up an enquiry - costs millions, takes years, nothing happens. Everybody gets the blame except the politicos.


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## Cheshirechappie (25 Jul 2013)

That's not exactly a ringing endorsement of publicly owned services, is it, Jacob? 

It is, sadly, a fairly accurate portrayal of how the vested interests entrenched in some of the public services protect their interest - their continuing pay and pensions, and those of their mates - without bothering too much about the pesky taxpayers or users of the service. It happened with education until Gove shook the system up and allowed many more schools to manage themselves, thus cutting out the entrenched cohorts of the 'education establishment' in both Whitehall and LEAs (which has the added advantage of cutting the overall cost of education - you still have the schools and teachers, but not the paperpushers and meetings wallahs). The schools now have every incentive to high standards, because people won't send their children there if standards are low. No longer do people have to send their children to a bog-standard comprehensive (to use Alistair Campbell's phrase) just because the LEA tells them to, and won't provide a better alternative. 

Perhaps we might be better off with more of the NHS left to private enterprise. At least if a private company messes up, they either go bust and leave their competitors to pick up the business, or lose their contract to one of their competitors. Quite a good incentive to do things to a decent standard - provided, that is, those commissioning and monitoring the service on behalf of the public actually discharge their responsibilities honourably, and don't cover things up as the CQC apparently did. Private companies are usually better at dealing with complaints, too. If they just ignore complaints, as some NHS Trusts have tended to do, they get a bad reputation, and people will use alternative services.

All in all, choice is a good thing for people using services (and buying goods). The good providers thrive and grow, the bad shrivel and go bust.


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## Jacob (25 Jul 2013)

Cheshirechappie":rtauytv3 said:


> That's not exactly a ringing endorsement of publicly owned services, is it, Jacob?


Oh yes it is. Far better to have a powerful and responsible ministry at the top rather than fragmenting things the way things are done now - which has a not very well hidden agenda of piecemeal privatisation.


> It is, sadly, a fairly accurate portrayal of how the vested interests entrenched in some of the public services protect their interest - their continuing pay and pensions, and those of their mates - without bothering too much about the pesky taxpayers or users of the service. It happened with education until Gove shook the system up and allowed many more schools to manage themselves, thus cutting out the entrenched cohorts of the 'education establishment' in both Whitehall and LEAs (which has the added advantage of cutting the overall cost of education - you still have the schools and teachers, but not the paperpushers and meetings wallahs). The schools now have every incentive to high standards, because people won't send their children there if standards are low. No longer do people have to send their children to a bog-standard comprehensive (to use Alistair Campbell's phrase) just because the LEA tells them to, and won't provide a better alternative.
> 
> Perhaps we might be better off with more of the NHS left to private enterprise. At least if a private company messes up, they either go bust and leave their competitors to pick up the business, or lose their contract to one of their competitors. Quite a good incentive to do things to a decent standard - provided, that is, those commissioning and monitoring the service on behalf of the public actually discharge their responsibilities honourably, and don't cover things up as the CQC apparently did. Private companies are usually better at dealing with complaints, too. If they just ignore complaints, as some NHS Trusts have tended to do, they get a bad reputation, and people will use alternative services.
> 
> All in all, choice is a good thing for people using services (and buying goods). The good providers thrive and grow, the bad shrivel and go bust.


I see you have been caught hook line and sinker! It's all very plausible the way you put it - but extremely dubious at the same time. Basically there is no incentive for the private sector to supply services which people can't pay for (health and education). This means the state (us) must pay, whether or not the supplier is private or state run. So privatisation is fundamentally nonsense in many cases. Take "free" schools for a simple example. :shock:


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## Cheshirechappie (25 Jul 2013)

The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.

If more privitisation, by either the front door or back door, or even by the windows, brings improved service to patients, then let's try it. GP services have always been privately owned and contracted to the NHS, and until their contracts were changed so that they didn't have to bother with after hours care, it worked OK. Change that back again, and maybe increase the number of GPs where they are under pressure, and it would probably be even more OK. Applying the same principle to some hospitals would almost certainly drive up their standards, which is all that most people want - decent healthcare when they need it. Most people don't really care who provides the service, as long as it works to a decent standard.

"There is no incentive for the private sector to supply services that people can't pay for..." - Well, not true, since as stated, GP practices are, and always have been, small businesses contracting to the NHS.

By the way, a 'free' school is to which you are free to send your children if you choose (and if they have enough places - most seem to have filled all available places very quickly, which ought to tell you something). Where existing schools are doing a good job, there's no point setting them up. None at all round our way, since almost all the schools are good anyway.


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## Jacob (25 Jul 2013)

Cheshirechappie":1m9f766c said:


> The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.


Exactly. They are less powerful and are delegating responsibility. The current trend is to disperse power, "roll back the state", "de-regulate" etc and we are seeing the results.


> If more privitisation, by either the front door or back door, or even by the windows, brings improved service to patients, then let's try it.


Big "if". Ask yourself what condition state provision for health and education was like before 1947 or the various education acts. Did the private sector fill the gap?


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## RogerS (25 Jul 2013)

Jacob":1om3gwtj said:


> Cheshirechappie":1om3gwtj said:
> 
> 
> > The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.


Exactly. They are less powerful and are delegating responsibility. The current trend is to disperse power, "roll back the state", "de-regulate" etc and we are seeing the results.


> Tosh. Read Jarman's report and you will see that it was just as bad under Labour.


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## Cheshirechappie (25 Jul 2013)

"Did the private sector fill the gap?" - in healthcare before 1947.

Yes, it did, actually. Healthcare provision was better in 1947 than it was in 1907, which was better than it was in 1847, which was better than it was in 1807......


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## Jacob (25 Jul 2013)

Cheshirechappie":ti1iw3bd said:


> "Did the private sector fill the gap?" - in healthcare before 1947.
> 
> Yes, it did, actually. Healthcare provision was better in 1947 than it was in 1907, which was better than it was in 1847, which was better than it was in 1807......


Oh right. So the NHS was completely pointless? That's a new one.


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## Modernist (25 Jul 2013)

As one of the largest organisations the NHS is too large to micro manage from above. It is obvious authority must be delegated and only overall policy should come from above together with the results of monitoring. Monitoring should go up one level above authority and (I say again) it needs teeth, where poor practice is observed. 

The consultants of course have the whole system by the balls so they need to be sorted out by someone with the necessary courage.


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## Cheshirechappie (25 Jul 2013)

Jacob":zen4272z said:


> Cheshirechappie":zen4272z said:
> 
> 
> > "Did the private sector fill the gap?" - in healthcare before 1947.
> ...



Total state control is not the ONLY way of ensuring that everybody gets good healthcare. Three countries (out of several others) rated better at healthcare provision than the UK are France, Australia and Singapore, none of which uses a state-only system.

If you want a personal opinion as to whether the NHS is pointless, the answer is that it is only worthwhile if it works better than an equivalent private or public/private blend costing the same amount of money. It currently costs £120bn (this year's budget), or about £2000 for each person in the UK. if you were paying £2000 a year in health insurance, would you regard Mid Staffs, Redditch, 13,000 avaoidable deaths etc. etc. as just one of those things you have to accept? Of course you wouldn't.

The whole point of the debate is what the politicians should be doing to improve the NHS (the OP wanted us to get away from the tick-box culture, specifically). Getting more competition into the provision of healthcare services might well improve them - that approach seems to be well received by the users of education, though it's a bit soon to be sure whether educational attainment has improved (though I'm fairly sure it will).

Give people choice. Works very well with - for example - food production and distribution. Can you imagine a National Food Service? Ration books, and queues for your weekly cabbage? What you eat decided for you by a faceless bureaucrat in Whitehall?


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## Cheshirechappie (25 Jul 2013)

Modernist":2gj2y6of said:


> As one of the largest organisations the NHS is too large to micro manage from above. It is obvious authority must be delegated and only overall policy should come from above together with the results of monitoring. Monitoring should go up one level above authority and (I say again) it needs teeth, where poor practice is observed.
> 
> The consultants of course have the whole system by the balls so they need to be sorted out by someone with the necessary courage.



Competition would help here, too. If there's not enough supply in a market, others can come in to mop up the excess demand.

Why successive governments have caved in to the BMA since 1947 is a source of mystery to me. After all, they hold the purse-strings.


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## Jacob (25 Jul 2013)

Cheshirechappie":2n6u2j4i said:


> .......
> Total state control is not the ONLY way of ensuring that everybody gets good healthcare. .....


Well you would have to provide an example of state with zero state control and full health care for all. There isn't one. 
There is no alternative to state provision for those who can't afford private healthcare or insurance (except charity of course). The good news of course is that state provision is extremely cost effective.
But the issue here isn't about state control - it's more the very strange ideological notion that private business is more efficient and can do these things better. Sometimes it can, sometimes not. Markets don't always work for everybody. If they did there would be no discussion needed - the demand for healthcare has been there from the beginning. Why have markets not satisfied this in the past. and why would they now?


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## Jacob (25 Jul 2013)

Cheshirechappie":d0901frt said:


> ...
> Competition would help here, too. If there's not enough supply in a market, others can come in to mop up the excess demand.....


Why would they if there is no profit in it?


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## Phil Pascoe (25 Jul 2013)

A screwdriver bit is 99p in the local hardware shop. An acquaintance of mine works in purchasing for a health authority, and he was saying one day that these would be perfectly good for use in a theatre as they were easily sterilised before use, and then were single use anyway. But no, because a deal has been done somewhere along the line, they have to go to one particular supplier of medical paraphernalia who charge £16 for one.
Imagine this thousands of times across a broad spectum, and see where the money goes.


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## Cheshirechappie (25 Jul 2013)

Jacob":8cu230zw said:


> Cheshirechappie":8cu230zw said:
> 
> 
> > .......
> ...



Jacob, I think you are being deliberately disingenuous.

There are options that combine state funding with private insurance. The three I quoted above (France, Australia and Singapore) do that. It's not a question of all or nothing - as you very well know.

OK - how about the 'strange ideological notion' that only the state could provide healthcare (note - in the UK it doesn't; GP services have never been under state control, even if they are predominantly paid by the state). Like I said, imagine a National Food Service.


I've had enough of this strange, circular discussion into which I've allowed myself to be sucked, wasting far more time than it warrants. As far as I'm concerned, I want what I believe most people in the UK want, healthcare that gives people what they need when they need it, without avoidably killing (or injuring) them, and without excessive cost to the taxpayer. What we have at the moment has clearly, in parts (not universally), failed to do that. 

Whether the answer is state controlled or partly privatised matters not a jot to me, as long as it works. It's down to the politicians to serve the public, and if they decide to try part privatisation, that's fine by me as long as it delivers. If that means that, on our behalf, they have to take on the entrenched vested interests of the health establishment, the BMA and the Unions, then they should. It would make a pleasant change - politicians of all stripe have caved in to this unholy trinity for far too long. I am not wedded to a strange, outdated and failed ideological notion that only the state can do anything. The state does some things quite well; it has been utterly abysmal at other things - controlling the means of production did not work, for example.

As to your other comment, "Why would they if there's no profit in it?" - have you seen how much Consultants get paid? Do you not think some would take the view that earning 5% less would still be OK?

Right, Jacob, you can now have your dearest wish - the last word. I'm off to get some work done.


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