NHS and politicians

[John51]

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.

 

[JakeS]

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

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.

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! ;-)

 

[RogerS]

No enterprise needs more than 5 layers of management.

....

The Army? Navy?

 

[Jacob]

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 crap provided by a privatised service. Not a life threatener but unnecessary and a sign of things to come.

 

[Jacob]

....
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 .

 

[Reggie]

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.

 

[RogerS]

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.

 

[Jacob]

...
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.

 

[Phil Pascoe]

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.

 

[Jacob]

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.

 

[Eric The Viking]

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.

 

[Reggie]

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.

 

[Harbo]

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

 

[Eric The Viking]

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

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.

 

[Harbo]

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

 

[Cheshirechappie]

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.

 

[Reggie]

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.

 

[Boxer]

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.

 

[Phil Pascoe]

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.

 

[RogerS]

...
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.

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.