Computer says no ...

[paulrbarnard]

Does anybody outside the system actually understand how the various trusts,commissions,authorities and colleges all manage to function together as a more or less cohesive whole?

Does anyone inside?

 

[paulrbarnard]

Most organisations employing and/or providing a service to large numbers of people have dedicated teams dealing with diversity. It's the same point as I made earlier in relation to PR managers - they are unlikely to be spending their time hugging trees and are more likely to be embroiled in keeping their NHS Trust on the right side of the rafts of legislation that did not apply 30 years ago.

The NHS does get things wrong (and sometimes horribly so) but on the whole I feel they do a great job. We overlook the expansion in the demand that they deal with - some of which is driven by a greater sense of entitlement in society.

Another way of looking at the opening issue is perhaps to be grateful that a further vaccination is available at no direct cost and just accept the minor inconvenience of needing to wait a few days to be eligible to book an appointment. IMHO it falls very much into the category of being a first world problem.

If you are in critical need they do a fantastic job, second to none in most cases. If your not critical it is very poor compared to my experience in Germany and Canada.

 

[Phil Pascoe]

If they had more nurses you could have been cared for and left the hospital but as it was nobody had the time to focus on you with seeming a low need for support? It was nothing to do with nurses, just generalised disorganisation. That's little to do with money.

Incidentally, I do wish people wouldn't say "resources" (apparently a nice clean word) when all they mean is money (a very dirty word). Of course, "we need much better resources" sounds a lot better than "cough up, we need a shed load more of your cash".

Another wasted day in hospital -
I saw the doctor in the evening and he told me when I'd seen a foot specialist in the morning I could go home. The morning came and went and I spoke to a nurse. I could have told you you wouldn't see anyone this morning, she said. Why's that? I asked. Because they do ward rounds in the afternoon and out patients in the morning. I wasted a hospital bed day for nothing.
Some weeks later I saw my consultant (with whom I still correspond and have a beer or two once in a while) and said I had an idea that could save the hospital possibly £100,000s p. a. across the hospital I told him the story and eyes went heavenward. I can see where this is leading ... Yes, I said, do the ward round early in the morning and empty the beds, get more patients in. It would suit working outpatients better as well - working people would find 3pm - 5pm appointments far more convenient than mid morning ones. That is so obvious when you think about it, he said, I'll bring it up at the next board meeting ............ when unfortunately it'll be ignored as I'm not a manager just a senior consultant. I'll try, anyway.
No longer possessing the relevant feet I don't know whether it was ever followed up. I must remember to ask him.

 

[Phil Pascoe]

If you are in critical need they do a fantastic job, second to none in most cases. If your not critical it is very poor compared to my experience in Germany and Canada.

Yes. They were absolutely brilliant when my 20 y.o. son died from myocarditis (caused by covid). No way would I knock the people (barring a couple) but the system is a shambles.

 

[Tortoise]

I suspect it's fully governed by the rules being strictly implemented in the IT systems, without any capability for the receptionists to apply a sensible over-ride (.....within a further set of limits). Providing flexibility would of course cost more and put even more of our money into the hands of the consultancies who write the software.

 

[Tortoise]

If they had more nurses you could have been cared for and left the hospital but as it was nobody had the time to focus on you with seeming a low need for support? It was nothing to do with nurses, just generalised disorganisation. That's little to do with money.

Incidentally, I do wish people wouldn't say "resources" (apparently a nice clean word) when all they mean is money (a very dirty word). Of course, "we need much better resources" sounds a lot better than "cough up, we need a shed load more of your cash".

Another wasted day in hospital -
I saw the doctor in the evening and he told me when I'd seen a foot specialist in the morning I could go home. The morning came and went and I spoke to a nurse. I could have told you you wouldn't see anyone this morning, she said. Why's that? I asked. Because they do ward rounds in the afternoon and out patients in the morning. I wasted a hospital bed day for nothing.
Some weeks later I saw my consultant (with whom I still correspond and have a beer or two once in a while) and said I had an idea that could save the hospital possibly £100,000s p. a. across the hospital I told him the story and eyes went heavenward. I can see where this is leading ... Yes, I said, do the ward round early in the morning and empty the beds, get more patients in. It would suit working outpatients better as well - working people would find 3pm - 5pm appointments far more convenient than mid morning ones. That is so obvious when you think about it, he said, I'll bring it up at the next board meeting ............ when unfortunately it'll be ignored as I'm not a manager just a senior consultant. I'll try, anyway.
No longer possessing the relevant feet I don't know whether it was ever followed up. I must remember to ask him.

In a similar vein, the online booking system I use operates only during surgery hours, so using it interrupts my working day. I sometimes wonder how the people in the surgery would react if supermarkets, other retailers, eBay & banks etc followed the same approach.

 

[Phil Pascoe]

Yes, I don't know about my new surgery but it used to irritate me that I couldn't send an email out of hours - I didn't expect it answered, I just wanted to get it out of the way. Computer says no again.

 

[worn thumbs]

I accept the "minor inconvenience", I merely pointed out how bloody stupid the system is and question why idiocy like this is allowed to persist.
I appreciate they have to keep within the law - I know people who have employed total morons just because they have to meet targets. Personally I'd much rather they employed the best people than worry about said people's colour or sexuality, but my thinking obviously needs correcting.

The NHS does get things wrong? 21/22 it cost us £2,600,000,000 in negligence claims. An estimated £1,290,000,000 lost to fraud and theft.

If only that vast amount of money had gone in the jam jar that pays for "resources".....

 

[SammyQ]

No way would I knock the people (barring a couple) but the system is a shambles.

Totally, utterly, unvaryingly agree Mr Pascoe, Sir.

I won't break down the reasons why, because that would be construed as political comment. The sad fact is, the N.H.S. is, by-and-large, an organisation staffed clinically by competent, caring and dedicated individuals, beset, impeded and restricted by short-sighted, self-important (and self-serving) politicians who then enabled a whole unecesary class of trenchant 'implementers', whose manipulations seriously degrade our medical provision.

 

[RogerS]

Does anybody outside the system actually understand how the various trusts,commissions,authorities and colleges all manage to function together as a more or less cohesive whole?

Well, yes, a bit. I am fortunate to be in the catchment area of Northumbria Trust. They are completely joined up with Social Care. It is seamless. OK.we have a stipend added on to our Council tax to cover this. But what it does mean is no or minimal bed-blocking, for example. No ambulance queues waitig outside A&E.

 

[Terry - Somerset]

Sadly I have some experience of the inside of hospitals from a patient perspective. I don't think there is any single problem that reduces the quality of the service from being as good as it could be for the money spent.

Front line healthcare staff generally seem to work under considerable pressure. However it is clear many are resistant to change even when it can improve patient care. Healthcare assistants clearly saw change as a threat to jobs, not an opportunity to provide better care.

Last time I was discharged the hospital had made a significant change to the process. Rather than waiting on ward for pharmacy they had set up a separate discharge room with coffee and sandwiches available where discharging patients could wait. Not sure who initiated the change - but a good idea.

The number of non-frontline clinical staff who seem to work under far less pressure has increased. It may be that all make a worthwhile contribution to patient care, but I cannot help but feel some of the roles are very marginal.

That hospitals need managing is inescapable in my opinion. A regional NHS trust may employ 5000 staff with costs of £250m. They need buildings management, legal, HR, project management, finance, communications, IT, technical maintenance etc etc.

In days long past the doctor was supreme, no one questioned outcomes. We assumed docs were doing the best for their patients. Measure and report outcomes and it becomes clear that non-medical staff are key to running any enterprise effectively - even a hospital.

Whether a diversity manager is essential may be debateable - but both the staff and patient mix can include a wide range of religious, sexual, cultural backgrounds. Failing to manage this properly will risk litigation at a non-trivial cost.

A purely personal view - before writing out bigger cheques the existing deficiencies should be addressed. Otherwise extra funds risk simply compounding existing inefficiencies rather than improving outcomes.

 

[flying haggis]

The procedures in hospitals for enabling patients to leave when they are told they can are dire. I was told at 10 in the morning I could leave that day but didnt get out till 7 in the evening as I needed to take away my meds (including injections that nobody told me about until the meds were handed to me!!) I had to wait for a doctor who i had never seen and she had not seen me during my stay, to write up my notes. It got to the stage that I just told them to post the notes to me and being told thats not allowed and me saying well I shall just leave anyway without them till they miracously appeared!!
So all that time I was "bed blocking" thereby denying another patient earlier treatment. As has been said the clinical care is top notch and the admin side is bottom notch.
Another aside. My MIL had to have a pacemaker checkup and as she cant get into a car any more we arranged patient transport for her who got her there well before her appt time. (in fact she was actually seen and told she could go before her official appt time) but she then had to wait for over two hours for transport to take her home. Speakingto the driver later it transpired that they had been given 4 patients to collect at the same time but all lived in different directions from the hospital...................

 

[mc281]

I accept the "minor inconvenience", I merely pointed out how bloody stupid the system is and question why idiocy like this is allowed to persist.
I appreciate they have to keep within the law - I know people who have employed total morons just because they have to meet targets. Personally I'd much rather they employed the best people than worry about said people's colour or sexuality, but my thinking obviously needs correcting.

The NHS does get things wrong? 21/22 it cost us £2,600,000,000 in negligence claims. An estimated £1,290,000,000 lost to fraud and theft.

I still question our factual knowledge about the NHS (and any other service we.can criticise) versus a perceived popular and general need to moan about anything and everything.
It's easy to comment without insight on forums and we can all attest to that!
I have said for at least the last 20 years that our wish to have everything perfect whilst having a zero percentage cost increase will eventually run most community infrastructure into the buffers. It even has an acronym... NIMBP..... Not in my back pocket!
I'm not trying to force an argument with anyone but let's all remember the adage "you can't have your cake and eat it".... I think we have crumbs left!

 

[mc281]

Sadly I have some experience of the inside of hospitals from a patient perspective. I don't think there is any single problem that reduces the quality of the service from being as good as it could be for the money spent.

Front line healthcare staff generally seem to work under considerable pressure. However it is clear many are resistant to change even when it can improve patient care. Healthcare assistants clearly saw change as a threat to jobs, not an opportunity to provide better care.

Last time I was discharged the hospital had made a significant change to the process. Rather than waiting on ward for pharmacy they had set up a separate discharge room with coffee and sandwiches available where discharging patients could wait. Not sure who initiated the change - but a good idea.

The number of non-frontline clinical staff who seem to work under far less pressure has increased. It may be that all make a worthwhile contribution to patient care, but I cannot help but feel some of the roles are very marginal.

That hospitals need managing is inescapable in my opinion. A regional NHS trust may employ 5000 staff with costs of £250m. They need buildings management, legal, HR, project management, finance, communications, IT, technical maintenance etc etc.

In days long past the doctor was supreme, no one questioned outcomes. We assumed docs were doing the best for their patients. Measure and report outcomes and it becomes clear that non-medical staff are key to running any enterprise effectively - even a hospital.

Whether a diversity manager is essential may be debateable - but both the staff and patient mix can include a wide range of religious, sexual, cultural backgrounds. Failing to manage this properly will risk litigation at a non-trivial cost.

A purely personal view - before writing out bigger cheques the existing deficiencies should be addressed. Otherwise extra funds risk simply compounding existing inefficiencies rather than improving outcomes.

At last.... Reasoned comment.... Well said.

 

[Keith Cocker]

It isn't, it's very badly managed.

It’s hugely short of resources. That’s unarguable. Is it badly managed? That could be argued and probably true in some places and some areask

They're not short of resources - money - if they can afford diversity managers.

pathetic.

 

[Phil Pascoe]

Pathetic but true.

 

[MikeJhn]

It's the same in all large organisations outside the professionally qualified, the "Peter Principle" applies.

 

[worn thumbs]

I believe we now have one person in every 15 working in the NHS.Some clearly posting on this thread,but how many more can we reasonably expect to add to the number and eliminate the logjams?

 

[paulrbarnard]

I believe we now have one person in every 15 working in the NHS.Some clearly posting on this thread,but how many more can we reasonably expect to add to the number and eliminate the logjams?

That’s a lot higher than I expected. I wonder what the ratio is for public vs private employment.

Wow just googled it. It’s almost 1:4. I’m amazed.

 

[mc281]

That’s a lot higher than I expected. I wonder what the ratio is for public vs private employment.

Wow just googled it. It’s almost 1:4. I’m amazed.

I think that highlights how little we are prepared to pay. Before you ask.... No I'm not in the NHS and never have been remotely so except when I've needed their amazing care!