NHS Fiasco

Frank,

I quite agree. It simply is not necessary to have a degree for much of what goes on. And certainly not of the "Meeja Studies" types.

When I look back at my career, such as it was, I had three "O" levels and a C&G Full Technological Certificate. And yet, through an amount of self-study, I did some low-level electronic design, was involved in some prototype telecom engineering, and produced a routing plan which when the manager who requested it, saw it, he said "I like it. Do it!" Not bad for someone with my low level of formal education and no degree in sight.

Having said that, I have three children: my daughter, six 'O' levels worked for HMRC ending up as a VAT Inspector: elder son gained a MPhys 2:2, taugh for a few years and now runs his own business: my younger son should never have gone to university - he gained a third Bsc in Physics and hasn't used it.

Peter G. Shaw

I think there is quite a hierarchy of nursing staff, not all are qualified to the highest level. The term nurse is applied probably incorrectly to all the staff who provide a patients requirements. The person who washes you and changes the bedding is probably at the lower end and the person who sets up and monitors the equipment that keeps an eye on you and deals with drips and medication is probably at a higher level. There used to be quite a variety of uniforms and hats that went with the individual roles but it seems hard to tell these days, fortunately since I parted with my appendix at 17 I have not spent a night in hospital, a very painful kidney stone sorted itself out within a couple of hours of arriving at a triage unit at about 3am, no shortage of staff at that time of night, it was like a Grand Prix pit stop with people on every side, luckily the night surgery doctor managed to bypass A&E and sent me to a triage unit in the relevant department who didn’t seem to have much on at that time of night, full marks to him for sorting that out.

Mike

Edited By Mike Poole on 11/12/2022 22:45:12

The provision of healthcare is horribly expensive, with no obvious limit, given continuing scientific advances, greater demand, and no evidence that people are really interested in making much effort to preserve their health. No government can afford to fund something like the NHS 'adequately', because the money will always be used up. Likewise, no government would ever want to be seen to be rationing healthcare. Therefore Something Must Be Done!

Mrs Thatcher was apparently horrified to discover that the NHS effectively ran as a 'black box', into which vast amounts of money poured, but no-one really knew where it went. The workings of the black box were mysterious to those outside. And so the NHS was made into a pseudo-business, with 'purchasers' and 'providers', in the hope that the government's money could be tracked a bit more easily. Also, any rationing now became something that could be blamed on the purchasers, and the purchasers could beat up the providers for being inefficient. Divide and rule!

In order to operate this massive pseudo-business (the NHS was Europe's biggest employer at the time), a huge number of 'managers' and administrators was required. Many of these were pulled from health-delivery positions (nurses, occupational therapists, and so-on), exacerbating clinical staffing problems. They, at least, had some understanding of how things worked. Others were brought in from industry and who-knows-where, and rapidly demonstrated that they didn't understand the nature of the beast. Health care doesn't work like a typical business pyramid, where those nearest the top (the higher management) control the money flow. Instead, (and this is of course a gross simplification) people like doctors could, at a stroke, initiate horribly expensive treatment, arrange expensive tests and occasionally make ghastly and expensive mistakes. And they practiced with scant regard for (financial) cost.

And so the proportion of people employed by the NHS, who were not directly delivering health care, ballooned. The NHS, pre-Thatcher spent far less than other health care systems on 'administration. Post-Thatcher, the non-deliverers syphoned off enormous amounts of money as salaries, new, plush office space, etc., but the NHS's funding did not increase to cover this. Bureaucracy is expensive, and, in a system like this, where the 'shop floor' workers really take the decisions which summate to enormous amounts of money, outwith the control of the paper-pushers, bureaucracy just gets in the way. As an example, a 'business case' is required to justify the purchase of any significant item of medical equipment. Just demonstrating a medical need won't do. Who are the experts in the NHS? Who have the power? Why are the clinical staff so unhappy?

The essential problem is that the government can't won't fund the monster that has been created. IIRC, in the late '90s, the cost of a new district hospital was (optimistically) considered to be around 50 million pounds - about the cost of one of the RAF's Harriers.

I am at present trying to phone my local hospital. I rang at 9.05am, I was told that I was 3rd in line. I'm still on the phone and have just been told by automated voice that I am now 15th in line. Tried on line and can only find the same phone number.

Have stopped trying to ring in to arrange a telephone consultation, despite the cost of petrol it's cheaper to drive to the surgery and arrange it over the counter than wait on the phone.

Before the masses scream about the waste of money on PPI and contracts issued to 'Mates' due to the pandemic, they should be looking back to the decades of internal fraud. Perhaps an opertune time to repeat the series of TV programmes that highlighted the NHS internal investigation department.

NO government is prepared to grasp the nettle and give it a d*mn good shaking, the bush would intertwine and protect itself. Wonder if we would then need to spend more on unemployment ??

Regards Ian

For me, and I do stress for me, the problem starts at the GPs and their problem started with the 2006 contract negitiated by Andy Burnhanm and Patricia Hodge. This gave a substantial payrise and took away GP cover for out-of-office-hours. This allowed for GPs to go part time and why not work a 4 day week for £80k+ instead of 5 days for £100k+.
Now the GPs are nearly inaccessible fat-cats and we have nonsense like 111. A&E is full because there is nowhere else to go.
So, to fix it, I think we either have to fix GPs or sack them and restart. A place next to A&E which deals with the less urgent stuff and the worried-well which is cloggin up A&E would be my preference.
I find myself agreeing with most of what SOD says so verbally, except I really don't believe it's my fault.
I really think we will not get far in improving things until someone defines the boundaries of the NHS. There is plenty going on at the perphery which should be outside the responsibility of NHS - we all know what they are but are too woke to say it. If we can get back to the core, essential stuff then there is hope IMHO. Telephone appointments are a short term way of easing things - if you can get one (3 hours over 3 days to get to talk for 5 mins last week).

Sorry to say the idea that things can be fixed with a d*mn good shaking seems stupid to me. It means the NHS should be fixed by a team of Baby Batterers!

In my experience carefully targetted surgical strikes are far more effective than ignorant angry lashing out. Lashing out makes me feel better, but the answer is almost always wrong, causing even more trouble in the long run.

The PPI scandal is an example: in order to get quick results, politicians overrode the usual government procurement rules. 'Obviously' a bunch of time-wasting bureaucrats were getting in the way. Sadly, this opened the door to a host of fraudulent and incompetent suppliers and about £9Bn of taxpayers money was wasted. Then it was decided to not pursue the wrongdoers, which many voters still find hard to understand.

Dave

I posted earlier on this thread about if my cat needed treatment from our vet as to the stark difference if the NHS was involved. Unfortunately I had to take my cat to the vet this morning, vet took blood samples and the results were available this afternoon, there was an anomaly with his liver results, he is booked in for 8.30 tomorrow morning for an anaesthetic and ultrasound of his liver; how can the NHS ever become that responsive, there is a very long way for the NHS to go. Hoping that the results of my cats ultrasound are good news but a sense of foreboding tells me that it won’t be, still if he needs surgery I know he will have it as soon as is practicable, probably no longer than a couple of days. Dave W

Yes, drive to the surgery if you can - you'll get what you nearly want, quicker.
There has to be clear water between the NHS and the government. I know NHS managers are rediculously well paid, and have the opportunity of blaming the government when they mess up, with few defined deliverables to be measured against.
I know the NHS management were totally responsible for the PPE crisis - they didn't have the bank of PPE they were supposed to have had for emergencies. Guilty.
I also know the "bunch of time-wasting bureaucrats" SOD talks about, I think meaning the opposite, in NHS procurement actually are as described, and certainly have plenty of procedures - we may have just got the stuff by now.
NHS management were not banging on anybody's door to put it right - they were just able to pass the buck and the government were daft enough to take it, instead of kicking their rump hard and remembering at bonus time.
Like I say - I know.

Easy to retrospectively pick apart decisions made during an unprecedented crisis. The media were screaming for something to be done to resolve the PPE shortage, the Civil Service were operating at a glacial rate and the usual professional critics were poised to find fault.

Might be worth comparing the NHS experience to other public health services around the world. Certainly, all the complaints here would apply just as much in my neck of the woods (Ontario) and, I suspect, other jurisdictions.

I don't think these services scale well to ever increasing patient volumes. There is a sweet spot somewhere (that we passed decades ago) and it's been downhill from there.

Have to disagree with both Clive and A Smith. Their analysis is flawed, for example it was the Civil Service who actually delivered PPE, not the go-faster short-cut rule breaking that wasted £9Bn. Unlike A Smith I don't think the government were panicked into foolish decisions by the media and 'professional critics', whoever they might be. Be even worse if the government had reacted to pressures of that sort - weak and foolish.

One other example. I'm startled by Clive's certainty that the NHS were supposed to have enough PPE in stock to handle the crisis. What, warehouses full of millions of the right sort of masks ready for an emergency that had never happened on that scale before? When it's known masks aren't effective against other viral infections? It seems an unlikely precaution, and no one else in the world had enough masks either.

I dislike the defence that what went wrong was all someone else's fault. A big boy did it and ran away! In my book, the government are fully in charge and have been so for over a decade. Governments are responsible for what they do and fail to do. Not good in my opinion to deny failure, even if you are a committed loyalist! It's because when things go wrong, the causes have to be addressed, not swept under the carpet to save face. And politically motivated flag waving is a rotten way of solving technical problems.

In case anyone thinks I'm anti-conservative, it's just that they happen to be running the UK at the moment. Actually I'm against underperforming governments of all persuasions. I concentrate on competence and delivery whilst ignoring propaganda and spin. Democracy breaks unless politicians are held to account by the electorate. For me there are no sacred cows.

Dave

Unfortuanateley Dave the NHS is seen as a sacred cow, no one party dare sort it out if that is actually possible! Whoever is in power can do 'no right' according to the opposition, the only way forward is to have a cross party committee to try to achieve a consensus on improving the NHS, at the moment it is going downhill fast for many many reasons.

Tony

Double post

Edited By Tony Pratt 1 on 15/12/2022 18:52:30

I have long held a niggling suspicion that the NHS and other public services are in a pickle because successive governments of all flavours love to tinker, experiment, invent "initiatives" and play Cliche Bingo with them; rather than acting on advice from anyone - in those services or indeed within Parliament and the Civil Service - who actually understands the work.

The do have Parliamentary Select Committees that exist to inform and advise the policy-makers, but do the latter take that advice or is it lost in partisanship and balance-sheet games?

Unfortunately, unlike that other victim of the initiatives-brigade, education; the NHS is the victim of its own success. By cruel irony, it is helping "us" make more and more of us, all living longer but not necessarily in much better health because we survive the once-killer illnesses to allow the nastier, crueller ones at us.

To be fair though the NHS does recognise this, hence its various health advice, screening and vaccination schemes; while the 111 service is well-meant but might be worse than useless for the patients of an individual surgery that does not operate it efficiently.

'

The quality does seem to vary considerably around the country, if this discussion is a clue to that.

I have had both knees replaced (in Dorset County Hospital, and before The Pestilence), assorted other bits sorted, various injections, blood-tests, screenings and the like; and always had very good care delivered very efficiently.

I have also had to use the 111 service, perfectly satisfactorily despite the usual torture-by-music common to all call-centres. Once when still in a lot of pain and difficulty moving after falling very heavily on a concrete yard the previous day. The upshot was an ambulance half an hour later, to take me for a hip X-ray.That showed nothing broken, but I still needed physiotherapy help and time for what was probably something torn, to heal.

(That fall was by tripping violently over a small step, and basically diving head-first across the yard, but luckily landing on my hip and shoulder, not my head. Had I fallen forwards and somewhat diagonally, I would have dived head-first into my steam-wagon chassis. Less far to fall but possibly causing serious head and face injuries from the many sticky-uppy, angly bits of metal, tools and so forth...)

'

There is a very strange, looming headache for health services anywhere. It seems a lot of people are turning to all sort of quack-doctors, medical scare-stories, conspiracy-fantasies, and Home Hypochondriac Helps on t'Net; sources of no genuine medical value. So when the victims of these finally seek real help, it may have to be much more complicated treatment for diseases now well-advanced; a burden to both themselves and to the service.

See for example, Radio Times for next Tuesday (2oth): BBC R4, 12.04; The New Gurus - this episode sub-titled The Urine Man from its example of one such quack, who drinks his own for reasons presumably the programme will clarify. At dinner-time.

+++++

The ringers on here may find the preceding programme, starting at 11:30, more edifying. In the 3-part Laura Barton's Music Notes that morning's episode will be about bell-ringing.

Oh well, live and lean. Apparently, it is easy to make the correct decisions during an unprecedented crisis.

If I was going to fix things I would start with the BMA and dump the lot of them

Cuba has 9 doctors per 1000 people

UK has 2.5 doctors per 1000 people

The BMA is the core of the problem and they have created a crippling shortage of medical professionals

A new setup, the UKMA, for people who want to be doctors and help society

and leave the BMA to fester in a corner as bait for the politicals and moneygrabbers

Edited By Ady1 on 17/12/2022 10:55:58

Unfortuneatly the uk has drifted into a situation where an awful lot of the population do not want to work,and a fewer number have no intention have working,it can be virtually impossible to sack anyone and very little disipline,Last weekends Telegraph had an article on the benefits system and showed how much money people on benefits can get it was obscene in my mind compared to the pitance OAP s receive, it eeds a big stick to get the unemployed working. Recent experience with the NHS is dismal,to relieve my wife from extreme pain we have spent an awful lot of cash(enough to buy 10 reasonable Bridgeports) to have private treatment though private treatment is not as good as it was,as they expand due to demand some of the poor staff from the NHS have got into their system. Visit any NHS establishment and there are various staff wandering around carrying bits of paper so that they appear to be doing something and so many are over weight in a system which tries to encourage the public to loose wight to improve their health,I do agree with the comments of why do nurses have to have degrees,why should someone who wants to be a nurse be barred because they simply cannot afford to get a degree,and the ones who do get degrees dont want to do the dirty end of the job , As for 111 they are a waste of time, quicker to go to A&E, my wife was in some pain following an op and one weekend all she wanted to know was could she safely take double the dose of tablets,after ages on the phone all she asked could a doctor advise her via the phone ,simple one might think,oh no the 111 operator insisted that and ambulance be sent with two crew,they examined her and then phoned a doctor and got the answer that it was ok to double the dose,the ambulance crew did their job, but as we are out the sticks,that simple answer cost a round trip of 25 miles for that ambulance and crew ,absolute waste of NHS funds, I often think that when I see government ministers and NHS chiefs on the tv the come over in their manner and speech as not up to the job,being in command of a vast incompetent empire with no risk of loosing their job unless they go to a party in no 10.

Nurses have degrees for two reasons in my view. Firstly when a significant uplift to salary was required some decades ago it was agreed to provided there was a corresponding increase in productivity though upskilling. Secondly, the senior nurses now do many of the jobs that were previously done by doctors, which effectively releases the higher paid Doctors to do the things only they are qualified to do. The lower end ( no pun intended) work is done by ward assistants who feed, clean and generally care for the patient’s non medical needs.

This all seems quite reasonable to me.
regards Martin

Edited By Martin Kyte on 17/12/2022 12:13:54