RugbyRebels

Sandydragon wrote:

Digby wrote:

Sandydragon wrote: I'm not sure that's a long term answer though. It would be the quickest fix but in ten years time we could be back to square one.

We might need to limit what the NHS does, especially when it comes to fat and old people, but I don't know why that sees a need to go beyond general taxation as a means to fund and the NHS being free at the point of use. The tax is essentially an insurance scheme that far outstrips what any private health insurer could attain and for all I joined BUPA a long time back I don't think it's especially helpful in the bigger picture, and really if people can pay into a private insurer they can pay more into a general pot

That's a valid option. Does the NHS need to do so much? But which services do you cut because I'm sure the papers can find plenty of examples of heart breaking stories.

Something definitely needs to change, the sad thing is that you can't have a debate on it; it's one of those topics where emotion just takes over.

The NHS really is untouchable in some people's eyes, when the reality is that it's possibly the best health service in the world but is seriously flawed in many ways. It's also become an ideological beacon for the left in which any change by a right of centre government is an attack on the idea of 'free at the point of use', rather than just an idea that might save some money that can be spent more wisely. You look at things like the Mid Staffs scandal, whistleblowers being hounded out of their jobs, locum doctors demanding upwards of £3k a shift and the recent actions by the midwives Union but any suggestion that any failings are down to NHS staff and you're accused of just wanting to privatise it. Similarly, look at the opposition to closures of services within hospitals. All the evidence shows that having centres of excellence lead to the best clinical outcome but try and suggest a cottage hospital or a specific service within a hospital is closed down and moved and heads start spinning.

On how the NHS managment can waste money saw an article online about a hospital which was quoted
£850.00 for a black-out blind which a matron then bought for £23.99 from Homebase & got a local
handyman to fit for free.

jared_7 wrote:

OptimisticJock wrote:Cancer treatment is not emergency work, how is that funded in Germany?

So having just come from Germany and stayed with a woman who runs her own specialist practice, the German system works like this:

Everyone has to have health insurance, they pay a 7% tax on their income, and their employers match it for a total of 14%.

They can pick from hundreds of insurers offering the "Public option". The government sets the price of all treatments, so basically whenever you see the doctor for whatever you just show your insurance card and the clinic will later charge the government.

If you make more than 60k a year, you have the option to not pay into the public option and get private insurance.

The standard of care there is absolutely amazing, as good as the top end of US healthcare but without the exorbitant costs. I'm not sure that is what the UK should move to buy one thing the woman I stayed with said (and she said the NHS was amazing in her opinion) was she thought it was ridiculous covering tourists (including EU tourists), which they don't do there.

I'm sort of on board with that, I don't know how much it would save (as well as make when they start charging) but I'm open to the NHS only being free for residents, citizens, or anyone paying or who has paid taxes in the U.K. Assume that's everyone with an NI number?

A suggestion on tv the other day was to insist that non U.K. Nationals have compulsory travel insurance. There will always be exceptions but that might cover many of the overseas visitor issues in a sensitive way.

Mellsblue wrote:

Sandydragon wrote:

Digby wrote:
We might need to limit what the NHS does, especially when it comes to fat and old people, but I don't know why that sees a need to go beyond general taxation as a means to fund and the NHS being free at the point of use. The tax is essentially an insurance scheme that far outstrips what any private health insurer could attain and for all I joined BUPA a long time back I don't think it's especially helpful in the bigger picture, and really if people can pay into a private insurer they can pay more into a general pot

That's a valid option. Does the NHS need to do so much? But which services do you cut because I'm sure the papers can find plenty of examples of heart breaking stories.

Something definitely needs to change, the sad thing is that you can't have a debate on it; it's one of those topics where emotion just takes over.

The NHS really is untouchable in some people's eyes, when the reality is that it's possibly the best health service in the world but is seriously flawed in many ways. It's also become an ideological beacon for the left in which any change by a right of centre government is an attack on the idea of 'free at the point of use', rather than just an idea that might save some money that can be spent more wisely. You look at things like the Mid Staffs scandal, whistleblowers being hounded out of their jobs, locum doctors demanding upwards of £3k a shift and the recent actions by the midwives Union but any suggestion that any failings are down to NHS staff and you're accused of just wanting to privatise it. Similarly, look at the opposition to closures of services within hospitals. All the evidence shows that having centres of excellence lead to the best clinical outcome but try and suggest a cottage hospital or a specific service within a hospital is closed down and moved and heads start spinning.

Precisely. I've had some dealings with the NHS recently and for the most part the staff have been brilliant. But nit every nurse is an angel and not every hospital is well run.

I hope the nhs remains as close to untouchable as possible.

http://www.vox.com/2016/5/13/11606760/e ... ealth-care

I'm not a fan of anecdotal evidence, and I pass no judgement on the decision to take a child to casualty for what appear to be a booboo on her finger, but private seems a damn good way to ruin healthcare provision.

canta_brian wrote:I hope the nhs remains as close to untouchable as possible.

http://www.vox.com/2016/5/13/11606760/e ... ealth-care

I'm not a fan of anecdotal evidence, and I pass no judgement on the decision to take a child to casualty for what appear to be a booboo on her finger, but private seems a damn good way to ruin healthcare provision.

Would the bill be any different from the NHS? I'm sure it wouldn't be anywhere near as much but the NHS is by no means cheap. We don't know of course because we don't get billed directly - we all pay when someone's lost all sense of perspective. However, I can guarantee the parents in that story won't waste precious time and resources again. Someone using the NHS probably would do.

If you struggle to get to sleep tonight:

http://www.cps.org.uk/publications/repo ... n-Saatchi/

Sandydragon wrote:I wouldn't use the US as an example. Germany was quoted many times this week by the BBC, yet they do, so I'm led to believe, use a form of health insurance alongside taxation.

I'm all for a nhs which proves free at point of delivery treatment to all. The issue I would look at are funding in general or some of the non emergency work.

We have to look at the US as an example. They're the private interest groups looking for profit at the expense of altruistic interests. Profit and healthcare make for a terrifying combination.

Mellsblue wrote:[
The NHS really is untouchable in some people's eyes, when the reality is that it's possibly the best health service in the world but is seriously flawed in many ways. It's also become an ideological beacon for the left in which any change by a right of centre government is an attack on the idea of 'free at the point of use', rather than just an idea that might save some money that can be spent more wisely. You look at things like the Mid Staffs scandal, whistleblowers being hounded out of their jobs, locum doctors demanding upwards of £3k a shift and the recent actions by the midwives Union but any suggestion that any failings are down to NHS staff and you're accused of just wanting to privatise it. Similarly, look at the opposition to closures of services within hospitals. All the evidence shows that having centres of excellence lead to the best clinical outcome but try and suggest a cottage hospital or a specific service within a hospital is closed down and moved and heads start spinning.

The right are trying to privatise the profitable parts of the NHS by the backdoor. I cannot seriously believe that anyone could doubt that reality. Yes it needs better management but the reason the management are seemingly so incompetent is precisely because they're trying to aid the process of privatisation.
Simple divide and conquer.
When Hunt has finished his hatchet job he will become not only the most hated man in the uk,.....but he will also be be one of the richest men in the country with multiple seats on the board of US healthcare corporations.
The man is devoid of morality, you can see it in his face. I knew guys at school like him,....they stood on a socialist ticket in student politics because it garnered more votes but once his student days were over they turned into monumental knuts.
Not even slime would stick to that dweeby feck.

From today's Times:


NHS must cut waste if it wants more cash

Hospitals can save billions, says authoritative report

Chris Smyth, Health Editor

A review found huge variations in treatments, with low-performing hospitals often ignorant about methods adopted elsewhere


The NHS does not deserve more money because it wastes so much on poor care, according to the senior surgeon who has the job of driving up standards.

The health service must put its house in order before asking for extra taxpayers’ cash, said Tim Briggs, who is conducting the most comprehensive clinical efficiency audit of the NHS yet undertaken.

His review found huge variations in the cost and quality of common treatments, with low-performing hospitals routinely ignorant about superior methods adopted elsewhere.

The NHS could save hundreds of millions, if not billions, a year if the best and most efficient practices were applied across the country, Professor Briggs concluded.

His programme is backed by the health secretary, Jeremy Hunt, who urged hospitals yesterday to act on the findings, as well as Simon Stevens, the head of NHS England.


More than 300,000 patients a year are needlessly admitted to emergency surgery beds when they do not need an operation, Professor Briggs’s team found after visiting every hospital in the country.

If all hospitals copied the best units by getting a consultant to run tests quickly, many of these patients would be sent home immediately, freeing up a ward in each hospital and saving the NHS £108 million a year. “I’ve now been to every single trust in England, Wales, Scotland and Northern Ireland and there is significant waste out there,” Professor Briggs told The Times. “I do not think at the moment we deserve more money until we put our house in order and we actually make the changes that will improve the quality of care.”

Waiting times are lengthening as hospitals struggle to treat rising numbers of patients with finances that have not kept pace with an ageing population. Many in the NHS have used the inconclusive general election result to press the case for more money.

Yet Professor Briggs and the leading surgeon John Abercrombie report that in bowel-cancer surgery alone death rates vary from zero to 14 per cent, while hospitals are spending £23 million a year too much by keeping in patients for ten days when the best send them home in five days.

Some hospitals are paying 350 times more for basic surgical equipment than others for no clear reason, while there is no consensus about the best way to carry out some common procedures.

Today’s general surgery report is one of the first instalments in a project looking at 34 specialisms covering 90 per cent of hospital activity and Professor Briggs said there were “huge gains to be made”. For example, infection rates in hip replacements are 25 times higher in some hospitals than others, he found. “If you could get the infection rate across the country down to 0.2 per cent just in hip and knee replacements, you’d save the NHS every year £250 million [to] £300 million, just by improving the quality of care,” he said.

Mistakes in childbirth cost the NHS more than £400 million a year in legal claims, yet some hospitals pay out only £75 per birth rising to £6,980 at the worst performer, Professor Briggs found.

While saying that social care was different, Professor Briggs insisted that the NHS had to make sure that “every pound of taxpayers’ money was spent to the best effect. Then, once we’ve got that, we can speak to the politicians as the population ages about whether the NHS needs more money. But at the moment there are significant changes we can make to improve our practice that will allow us to do a lot more work with the amount of money we have.”

Mr Hunt urged hospitals to adopt the findings, saying: “By reducing variation we can improve care and eliminate waste at the same time. As this excellent work led by Professor Tim Briggs shows, some hospitals are already working smarter with their money to save time and get better outcomes.”

Mr Stevens has demanded more efficiencies as part of a £22 billion savings programme but has also argued that cost-cutting will not be enough on its own to do everything the NHS wants.

Professor Briggs began his “getting-it-right-first-time” programme in orthopaedic surgery and it has been formally adopted as a national scheme by NHS Improvement, the financial regulator, where he is now national director of clinical quality and efficiency.

Specialists in each area gather data from hospitals then sit down and discuss individual results with clinical staff in each unit, learning from the best and helping poor performers improve. “Just putting it in a drawer and forgetting about it is no longer an option,” he said.

I was reading that this morning, it's not going to go down well. Sure there are examples of poor spending, but clearly there are many examples of insufficient spending too.

Of course it's a matter of both. However, if you listen to a lot of groups/bodies you'd believe that pumping in another £x billion is all that is needed.
There's also the argument of why give extra money to such a wasteful organisation - though, of course, when it comes to people's lives and health this only holds so much water - and if all you do is keep pumping more money in when asked where is the incentive for the organisation to become more efficient.

The NHS has though improved its spending in many, many instances, although yes there's still a long way to go, so again it's mixed picture and I simply doubt the sanity of dropping a blanket ruling onto a mixed picture. And really I doubt there are organisations the size of the NHS that don't entail large levels of waste, and there's no solution in having myriad small enterprises covering a large scale endeavour, to an extent waste is always going to happen.

It's also a stick to beat the government with if they really want to say no more money for areas being inefficient, what of the waste on headhunters to secure almost no trade negotiators to date for Brexit, does that mean Brexit can't have more spent? And actually given everyone knew it was the Kiwis, Canadians and Australians who'd just have large scale negotiations and would have staff who we might hire how did possibly need to employ a ny private company to gouge needles money from the public purse? So does that mean no more money for government?

Digby wrote:The NHS has though improved its spending in many, many instances, although yes there's still a long way to go, so again it's mixed picture and I simply doubt the sanity of dropping a blanket ruling onto a mixed picture. And really I doubt there are organisations the size of the NHS that don't entail large levels of waste, and there's no solution in having myriad small enterprises covering a large scale endeavour, to an extent waste is always going to happen.

It's also a stick to beat the government with if they really want to say no more money for areas being inefficient, what of the waste on headhunters to secure almost no trade negotiators to date for Brexit, does that mean Brexit can't have more spent? And actually given everyone knew it was the Kiwis, Canadians and Australians who'd just have large scale negotiations and would have staff who we might hire how did possibly need to employ a ny private company to gouge needles money from the public purse? So does that mean no more money for government?

Yes it has improved and well done where it has. That there are still three figure percentage differences in procurement when this issue was raised years ago is a worry. It's such a simple thing to remedy. Even more of a worry is that medical best practice isn't shared. Which is just down right ridiculous, whether you look at it from a financial or, more importantly, a clinical point of view.

I'm of course against waste anywhere. Saying other areas are wasteful as a defence against the NHS being wasteful is silly.

Mellsblue wrote:

Digby wrote:The NHS has though improved its spending in many, many instances, although yes there's still a long way to go, so again it's mixed picture and I simply doubt the sanity of dropping a blanket ruling onto a mixed picture. And really I doubt there are organisations the size of the NHS that don't entail large levels of waste, and there's no solution in having myriad small enterprises covering a large scale endeavour, to an extent waste is always going to happen.

It's also a stick to beat the government with if they really want to say no more money for areas being inefficient, what of the waste on headhunters to secure almost no trade negotiators to date for Brexit, does that mean Brexit can't have more spent? And actually given everyone knew it was the Kiwis, Canadians and Australians who'd just have large scale negotiations and would have staff who we might hire how did possibly need to employ a ny private company to gouge needles money from the public purse? So does that mean no more money for government?

Yes it has improved and well done where it has. That there are still three figure percentage differences in procurement when this issue was raised years ago is a worry. It's such a simple thing to remedy. Even more of a worry is that medical best practice isn't shared. Which is just down right ridiculous, whether you look at it from a financial or, more importantly, a clinical point of view.

I'm of course against waste anywhere. Saying other areas are wasteful as a defence against the NHS being wasteful is silly.

I'm not defending waste in the NHS. I'm saying if you want to say no more money for areas being wastefeul that probably means no more money for any department as they're all wasteful.

And even supposing we deal with every instance of waste currently to be found in UK public service (and we ignore that to go tat far would probably be wasteful) you'd likely find new instances of waste had cropped up anyway. So it's an ongoing challenge to address waste, this latest announcement makes it seem like there's a hill one can ascend and that'd be an end to it, or if not it's not clear why such policy would only be directed at the NHS.

Digby wrote:

Mellsblue wrote:

Digby wrote:The NHS has though improved its spending in many, many instances, although yes there's still a long way to go, so again it's mixed picture and I simply doubt the sanity of dropping a blanket ruling onto a mixed picture. And really I doubt there are organisations the size of the NHS that don't entail large levels of waste, and there's no solution in having myriad small enterprises covering a large scale endeavour, to an extent waste is always going to happen.

It's also a stick to beat the government with if they really want to say no more money for areas being inefficient, what of the waste on headhunters to secure almost no trade negotiators to date for Brexit, does that mean Brexit can't have more spent? And actually given everyone knew it was the Kiwis, Canadians and Australians who'd just have large scale negotiations and would have staff who we might hire how did possibly need to employ a ny private company to gouge needles money from the public purse? So does that mean no more money for government?

Yes it has improved and well done where it has. That there are still three figure percentage differences in procurement when this issue was raised years ago is a worry. It's such a simple thing to remedy. Even more of a worry is that medical best practice isn't shared. Which is just down right ridiculous, whether you look at it from a financial or, more importantly, a clinical point of view.

I'm of course against waste anywhere. Saying other areas are wasteful as a defence against the NHS being wasteful is silly.

I'm not defending waste in the NHS. I'm saying if you want to say no more money for areas being wastefeul that probably means no more money for any department as they're all wasteful.

And even supposing we deal with every instance of waste currently to be found in UK public service (and we ignore that to go tat far would probably be wasteful) you'd likely find new instances of waste had cropped up anyway. So it's an ongoing challenge to address waste, this latest announcement makes it seem like there's a hill one can ascend and that'd be an end to it, or if not it's not clear why such policy would only be directed at the NHS.

Except that has been more money.

Yes, there is waste everywhere and it's impossible to remove all waste. But, when it's things such as three figure percentage differences in procurement and not sharing best clinical practice - things infuriatingly simple to fix, things that were highlighted ages ago and really things that shouldn't need an external report to highlight - then may be a stick is required.

Mellsblue wrote:

Digby wrote:

Mellsblue wrote: Yes it has improved and well done where it has. That there are still three figure percentage differences in procurement when this issue was raised years ago is a worry. It's such a simple thing to remedy. Even more of a worry is that medical best practice isn't shared. Which is just down right ridiculous, whether you look at it from a financial or, more importantly, a clinical point of view.

I'm of course against waste anywhere. Saying other areas are wasteful as a defence against the NHS being wasteful is silly.

I'm not defending waste in the NHS. I'm saying if you want to say no more money for areas being wastefeul that probably means no more money for any department as they're all wasteful.

And even supposing we deal with every instance of waste currently to be found in UK public service (and we ignore that to go tat far would probably be wasteful) you'd likely find new instances of waste had cropped up anyway. So it's an ongoing challenge to address waste, this latest announcement makes it seem like there's a hill one can ascend and that'd be an end to it, or if not it's not clear why such policy would only be directed at the NHS.

Except that has been more money.

Yes, there is waste everywhere and it's impossible to remove all waste. But, when it's things such as three figure percentage differences in procurement and not sharing best clinical practice - things infuriatingly simple to fix, things that were highlighted ages ago and really things that shouldn't need an external report to highlight - then may be a stick is required.

I suspect that isn't far from the norm, and it's something which isn't always that easy to fix, or at least many of the fixes come with big spends too which rather defeats their being implemented. I don't see any way it's practically possible to get every spend in something as large as the NHS all pulling in the same direction, though there should always be the intent to reduce waste and see if best practice might be copied elsewhere. And I'm only saying if that's the standard to apply, i.e. that we withhold additional money in the face of waste then it's an interesting yardstick and a rod they're making for their own back, really there's just no need to say anything that daft.

And I would again note much of the extra money has been found by robbing the capital spend budget to cover the operational shortfall. And that long term that's going to add to the supposed inefficiency Hunt wants to strike at. Mind the idea that Hunt is at odds with himself only gets him into the same place as everyone else.