Amount of private work NHS hospitals can take to rise from 2% to 49%

Cleaver

Graham_Devon wrote: »

Likewise, would people want a blood test or smear done at 4am in the morning at their GP surgery?!

True. But for working people a Monday to Friday 9 to 5 GP surgery isn't much use is it? To be fair, our's is open until 8pm two nights a week. But weekend opening would be handy wouldn't it?

vivatifosi

Cleaver wrote: »

True. But for working people a Monday to Friday 9 to 5 GP surgery isn't much use is it? To be fair, our's is open until 8pm two nights a week. But weekend opening would be handy wouldn't it?

Mine's open to 8pm, not sure how many nights a week and alternate Saturday mornings. They are really good to get an appointment with. Similarly my dentist (private) also has one late evening and I think one Saturday a month.

It's a sign of the times I think. Organisations seem even less inclined to allow people time off to go to the docs or dentists now.

Pennywise

Cleaver wrote: »

Would enough patients want minor surgery or an outpatients appointent at 3am to make it cost effective to run? I doubt it, hence why they don't in any major health system.

No, 24/7 isn't my vision, but what's wrong with weekends and early evenings? You could easily double the "working hours" without working through the night? 8-4 five days a week is 40 hours per week. Having the same hours at weekends and extending the hours to 12 per day, i.e. 8 to 8 would more than double that to 84. I'm sure lots of people would have happy to have blood tests, xrays, scans etc at 7pm in the evening or on a Sunday morning if it meant that they wouldn't have to wait as long. It may even be more convenient for them and shock/horror, they may be willing to pay to choose a convenient appointment slot.

Kennyboy66 wrote: »

apart from some very specialist equipment (MRI scanners, CT etc), the constraint is not the space or theatre time - it is the people who operate and staff it. The comparison between Fords or Toyota running 24/7 is not really valid. You may as well ask why advertising agencies don't have a night shift or weekend shift to utilise the expensive office space.

OK, I'll accept a lack of specialists means you'd have trouble finding staff to work out of normal hours. That's a separate issue. But surely the planners could have designed NHS buildings and facilities that could be shared? Whenever I go to the GP's surgeries, most of the consulting rooms are not used, same with our local hospital - walk down a corridor and it's just one room after another unused at that time, and several seating areas with no-one around. It does seem that there's no sign of any "dual" usage of rooms or facilities - presumably because all the specialists want to work 8-4 so there's a shortage of facilities during those hours - but if you changed it to two shifts, you could have two teams using the same rooms/equipment. Take ultrasound scans - I know of at least five rooms with ultrasound scanners in our local hospital - I've been in them all - in one in the ENT dept), I was the only person being scanned that session - the scanner guy was late and I was sat alone in a waiting area for a couple of hours - he eventually came, scanned me, locked up the room and went away again. Yet, the ultrasound scanner in the radiology unit is always busy and has waiting lists of several weeks. Doesn't make sense at all to have one scanner working its socks off with long waiting lists and another on another floor barely used at all. That's where I see private work really helping - get that underused scanner in use for more time, and in the process, get some readies into the NHS coffers.

olly300

WhiteHorse wrote: »

Waiting time for Dr.ABC, working as an NHS consultant, 6 months. Said I'll go private, waiting time 7 days.

Something doesn't add up.

Other staff and facilities.

I'm having an operation in January. I had to wait 2 months on the NHS.
Privately I would have the operation within 2 weeks if I was ready. However most of my friends and family who have private operations schedule their operations for a month later.

The only real benefit for private health care schemes is for sports injuries as if you are lucky and your doctor does bother to send you to a physio you have to wait anything from 2-8 weeks rather than a couple of days.

olly300

Pennywise wrote: »

No, 24/7 isn't my vision, but what's wrong with weekends and early evenings? You could easily double the "working hours" without working through the night? 8-4 five days a week is 40 hours per week. Having the same hours at weekends and extending the hours to 12 per day, i.e. 8 to 8 would more than double that to 84. I'm sure lots of people would have happy to have blood tests, xrays, scans etc at 7pm in the evening or on a Sunday morning if it meant that they wouldn't have to wait as long. It may even be more convenient for them and shock/horror, they may be willing to pay to choose a convenient appointment slot.

There are services you can have in the evening. I've had a smear test in the evening but at a women's health clinic not a GP surgery. The clinic was in a local hospital which doesn't have an A&E but just runs clinics for routine procedures.

The issue with blood tests is that the lab needs to receive them that day. So all blood tests at all the GPs surgeries I've ever been at that have done them have always done them in the morning.

Lab staff do work shifts but they are there in the night for emergency patients not routine patients.

Pennywise wrote: »

OK, I'll accept a lack of specialists means you'd have trouble finding staff to work out of normal hours. That's a separate issue. But surely the planners could have designed NHS buildings and facilities that could be shared? Whenever I go to the GP's surgeries, most of the consulting rooms are not used, same with our local hospital - walk down a corridor and it's just one room after another unused at that time, and several seating areas with no-one around. It does seem that there's no sign of any "dual" usage of rooms or facilities - presumably because all the specialists want to work 8-4 so there's a shortage of facilities during those hours - but if you changed it to two shifts, you could have two teams using the same rooms/equipment.

My present GP surgery just has "consulting. rooms. The rooms are used by a GP or a nurse. It's a bit impersonal as the staff member doesn't personalise their room as they are allocated any room to work in on a particular day.

Plus my current GP and my previous one did commuter clinics. They opened up the surgery at 7.30am on 2-3 days of the week to see patients before they went to work.

In the old days my childhood GP use to have evening surgeries between 7pm-9.30pm as well as morning ones between 9am and 11am This meant he or his partner on bad nights didn't stop work until 11.30pm. He lived above the surgery and his wife was one of the receptionist but the other people didn't.

Pennywise wrote: »

Take ultrasound scans - I know of at least five rooms with ultrasound scanners in our local hospital - I've been in them all - in one in the ENT dept), I was the only person being scanned that session - the scanner guy was late and I was sat alone in a waiting area for a couple of hours - he eventually came, scanned me, locked up the room and went away again. Yet, the ultrasound scanner in the radiology unit is always busy and has waiting lists of several weeks. Doesn't make sense at all to have one scanner working its socks off with long waiting lists and another on another floor barely used at all. That's where I see private work really helping - get that underused scanner in use for more time, and in the process, get some readies into the NHS coffers.

The problem in the NHS is different hospitals and surgeries have different practises. So while your local hospital could be under using stuff other hospitals and surgeries around the country aren't.

grizzly1911

Cleaver wrote: »

1. Less management. But the public need to get the idea of men with clipboards out of their head as we need less nursing managers, physio managers, radiology managers as well as less 'standard' managers. Every profession in the NHS has been over-professionalising their roles.

Forgetting their title that would suggest they don't actually do anything which I doubt is actually the case.. Rather than manager they will become "Senior". I would prefer to get rid of the clipboard brigade to some extent as I would prefer to have someone with experience of the job,1.) assisting the decision making process and 2.) to lend a hand when things go wrong or their backs are against the wall. Oh and to stop 2.) below

2. Leave people alone to do their jobs and stop rearranging everything. Staff don't know thier objectives one week to the next.

3. Although we need less managers, stop assuming that doctors and nurses are always the best people to manage the process of patients moving through a system. The best people to do this are good administrators who spend 100% of their time doing it and can be paid more cheaply with less training.

4. Get rid of SHAs, they're not required. The government abolished them but has now done a very quiet u-turn and has allowed the original ten to merge in to four. So same thing but with a massive and expensive merger process over the next two years. Seems logical

5. Stop these silly national, massive projects. Rather than, for example, telling every NHS organisation that they have to be on the same £10bn BT computer system simply tell them what their system needs to be compatible with and let them procure their own. Totally agree, doomed to failure and overspend.

6. It's a taboo subject, but the nursing structure isn't fit for purpose. We just don't need all these hugely qualified nurses on £30k, £40k or £50k. Each ward should have a business manager and a nurse manager. The nurse managers makes clinical decisions, the business manager makes business decisions for the ward. Under them you don't need a myriad of senior nurses at various pay grades anymore. That comment will never make you popular though... But you've already said we need to get rid of all these managers? Whatever structure you put in place you need to give some degree of differentiation based on knowledge, experience, proficiency, "results" etc. to motivate your staff. Happy to see some rationalisation providing it transparently happens top to bottom. Many hospitals already rely on voluntary helpers.

7. Here's a biggy. People need to start taking responsibility for their own health and, if they don't, they should be charged. Why should people be able to eat themselves to obesity and expect free treatment? Or smoke 30 a day and expect free cancer treatment? Or drink themselves into oblivion and take up A&E time and a medical bed? It's controversial but I think the next ten years will see the idea of personal health responsibility become a hot social issue in the same way that drinking and driving and recycling have all become social issues in the past couple of decades.

I am with you on the eating bit. The other two are more difficult because the Government license them and tax them heavily.Duty on tax on a packet of fags being around £4 -5 if I have interpreted the revenue correctly.

8. Shut hospitals. Care will be provided more and more in people's homes. We don't need all these expensive hospitals.

I also think that hospitals should fully charge for any treatment provided for overseas visitors or those that have no NI history, be that fat Uncle Sam on holiday or those that turn up in this country to deliberately gain treatment or maternity care.

Edit:- Also don't forget a number of roles that a number of functions that would have previously been done by highly paid doctors are now done by those "senior "nurses and radiographers etc.

Graham_Devon

Cleaver wrote: »

True. But for working people a Monday to Friday 9 to 5 GP surgery isn't much use is it? To be fair, our's is open until 8pm two nights a week. But weekend opening would be handy wouldn't it?

It's certainly useful, but that service was handed over to the Out of Hours service. You'd need to cut some of the funding from that and pass it back to GP surgeries.

On the same point however, it was handed over partly due to lack of use at weekends. I know its useful for the surgery to be open at the weekend, but not sure it's financially viable to be so. Guess it varies from place to place.

olly300

grizzly1911 wrote: »

I also think that hospitals should fully charge for any treatment provided for overseas visitors or those that have no NI history, be that fat Uncle Sam on holiday or those that turn up in this country to deliberately gain treatment or maternity care.

That's one very important issue that should really be chased up in hospitals around the country but particularly in cities.

Unfortunately health care staff don't feel it's their duty to chase people for payment, and they have all been taught and have the ethos that they should treat first.

To be fair I rather they did treat emergency overseas people first before chasing them for payment but were a bit more like hospitals in some other European countries where people can't leave the hospital or arrested until they paid their bill.

kabayiri

Cleaver wrote: »

...
5. Stop these silly national, massive projects. Rather than, for example, telling every NHS organisation that they have to be on the same £10bn BT computer system simply tell them what their system needs to be compatible with and let them procure their own.
...

I think we would all agree with this.

But the other problem relates to the pace of change. Change in something as large as the NHS can take years and years to implement.

Politicians always insist that the change be implemented in a single term of office - usually ruling out the last year.

After 18 months the NHS IT project was 2 years behind schedule! It's clear the timescales dictated by politicians are often pie in the sky.

I don't see why we don't have more regional development with standards to maintain compatibility.

grizzly1911

WhiteHorse wrote: »

Waiting time for Dr.ABC, working as an NHS consultant, 6 months. Said I'll go private, waiting time 7 days.

Something doesn't add up.

Depends on the criticality of the condition, the type of condition versus number of specialists and a doubtless location/cost.

Where I live waiting times are a lot less than that even for routine matters.

On one occasion (walking critical) I was seen in the morning, saw the consultant in the afternoon and was operated on two days later.

My elderly mother with balance problems, from time to time, takes months between visits.