Mervyn King:Labour not responsible for crash

prowla

BobQ wrote: »

The reason why we need less beds is partly on the graph. We do more operations without the need for overnight stays so they may not even need a bed. Others might need a bed for a few hours rather than an overnight stay. Maternity and Geriatric procedures are more effective so have less need for longer stays. We no longer treat learning disabilities as something best addressed in a hospital.

If you want to "blame" Labour for reducing beds give them credit for investing in the technologies that enable less beds to be used and enabling more patients to be treated per bed.I suggest that if you do more operations you may well need more staff?

Fair point about the number of managers increasing, not sure of the reasons although I think if the total number of staff increases you may need more managers.

Like you I am concerned about all these managers, but one of the things I noted two years ago when I accompanied a patient who was lying on a trolley outside the A&E room. I was standing a few metres form a whiteboard which had two senior nurses debating the reasons why the patient I was with could not be admitted at that point. Their discussion (which had gone on when my friend was second and third in the trolley queue about those patients) was not about medical issues, it was purely about why a porter was not available, why a bed upstairs was blocked, when they would get a break, and many other things. I recall thinking that this was something a manager should be sorting out and not wasting the time of the clinical staff.

I wasn't blaming Labour for reducing beds; I really just added that in as something of possible interest.

And I know they got into a habit of sending people home asap, probably not least because you are more likely to catch something in a hospital, so best to get out of there.

But I wonder what the correlation is between more doctors/nurses and less beds (and more admin staff)?

And on the more doctors, I wonder if that is more doctor hours or additional doctors due to reduced hours, or ad-hoc consultants being counted as "a doctor", or what?

We also have the anecdotal information about more staff on wards and suchlike, but were there less wards (due to less beds) and thus more staff available?

These headline "more" vs "less" figures really need to be inspected to see what they actually mean.

Koicarp

prowla wrote: »

I wasn't blaming Labour for reducing beds; I really just added that in as something of possible interest.

But I wonder what the correlation is between more doctors/nurses and less beds (and more admin staff)?

And on the more doctors, I wonder if that is more doctor hours or additional doctors due to reduced hours, or ad-hoc consultants being counted as "a doctor", or what?

We also have the anecdotal information about more staff on wards and suchlike, but were there less wards (due to less beds) and thus more staff available?

These headline "more" vs "less" figures really need to be inspected to see what they actually mean.

In my own trust there was a massive increase in numbers of Dr's which was required to put them into a "normal" shift pattern in line with working time directive.
There was a big increase in admin/number crunchers to provide evidence against targets.
In 1997 we had one manager between senior sister and director of nursing- this was the same in 2010, but now there are 3.
Increase in nursing numbers whilst reducing beds is because care is still being delivered, but it is more often in the patient's home/community clinics. This cuts down on some costs, but increases others- I often spend 2 hours of a shift on the road between patient's homes (my own role became community based in 2012).

Thrugelmir

BobQ wrote: »

That may or many not be the case but it is not an answer to the question of how a global financial crisis in 2008 creates an "opportunity". All it created was a situation where he was unlikely to have been able to get reelected. So I doubt he saw it as an opportunity.

It is very easy to argue that the wheels would have come off in any case, but Brown did what the electorate wanted in the period he was Chancellor, he created a stable economy and restored health and education from the abyss that Thatcher and Major were leading it into. All this political cr!p about the leaking roof is absurd.

In 2005 the Conservative Manifesto even said " Over the period to 2011-12, we will increase government spending
by 4 per cent a year, compared to Labour’s plans (on current trends) to increase spending by 5 per cent a year."

This was not an argument that things were going terribly wrong, it was a commitment to spend a little less than Labour. At the same time they were planning to spend more on defence, police and pensions and the same on heath and education. As usual there were different views on the size of the public sector but neither party was advocating radical change compared to the other.

I'll depart this aspect of the debate with a quote from Socialist Appeal - The Marxist Voice of Labour and Youth dated 16th October 2008.

Brown and ‘light touch’ regulation.

But the damage has been done. Thanks in part to government policy, the British economy is terribly vulnerable to the continuing economic crisis. As the Economist commented (11.10.08), “The underlying problem is that Britain’s economy was vulnerable even before the credit crisis struck. Much of its recent growth had been driven by the City, and based on a financial model whose defects have now been brutally exposed. Consumer spending had held up despite sluggish disposable income because homeowners could borrow against increasing housing wealth. That drove the household saving ratio down to almost a 60-year low (in fact, it turned negative) in the first quarter of 2008. Exports, despite the falling pound, will struggle to take up consumers’ slack, for Britain’s main trading partners are also running into trouble.”

The crisis has not been overcome. On the contrary, it is moving to a new, deeper phase. In the coming years Brown’s mantra of ‘no return to boom and bust’ will come back to haunt him. The deepening recession will demonstrate that his stewardship of the British economy has been an utter failure.

Of course credit should also be awarded to a certain unelected guy by the name of Ed Balls who was the architect of light touch City Regulation. In his 8 year reign as Special Advisor to the Treasury.

prowla

Koicarp wrote: »

In my own trust there was a massive increase in numbers of Dr's which was required to put them into a "normal" shift pattern in line with working time directive.
There was a big increase in admin/number crunchers to provide evidence against targets.
In 1997 we had one manager between senior sister and director of nursing- this was the same in 2010, but now there are 3.
Increase in nursing numbers whilst reducing beds is because care is still being delivered, but it is more often in the patient's home/community clinics. This cuts down on some costs, but increases others- I often spend 2 hours of a shift on the road between patient's homes (my own role became community based in 2012).

Thanks.

So, the increase in the number of doctors was not an increase in the number of hours of doctor services, but rather increased manning to cover a reduction in the hours on duty.

Now I happen to think that that is sensible, but it does not necessarily mean increased service, and so the numbers of doctors increasing is (a) not an indicator of increased capacity, and (b) not evidence of increased funding being directed at doctors treating patients.

On the admin side, then, the fact that the numbers and stats were now required meant that a whole sub-industry had to be created to deal with them; heaven knows what that cost.

That's an interesting point about the travel factor in community-based care; evidently there is an cost saving gained by getting the patient out of hospital and not having to provide the facilities for them there, but on the other side, it means that the designated travelling nurse may only be able to see a handful of patients in a working day.

The knock-on effect of that is that there may be more nurses required simply to cater for the logistics of getting about and the inefficiencies of seeing patients in diverse locations.

So again, the fact that more nurses were recruited may not reflect improved or more efficient care.

Looking at the above, we cannot simply say that Labour inherently care more about the NHS because they put more (of our) money into it and/or increased staffing, because those numbers are not measures of the service delivered.

CLAPTON

prowla wrote: »

Thanks.

So, the increase in the number of doctors was not an increase in the number of hours of doctor services, but rather increased manning to cover a reduction in the hours on duty.

Now I happen to think that that is sensible, but it does not necessarily mean increased service, and so the numbers of doctors increasing is (a) not an indicator of increased capacity, and (b) not evidence of increased funding being directed at doctors treating patients.

from the data offered, there may or may not be an increase in 'Doctor' hours
we simply don't know


what is certain is that if Dr hours per doctor decrease due to EU legislation (or what ever reason) then we need more doctors to maintain the previous level of capacity.

On the admin side, then, the fact that the numbers and stats were now required meant that a whole sub-industry had to be created to deal with them; heaven knows what that cost.

doubtless true that you have no idea at 'what cost'; nor do you know what value the administrators add.


For scientific evidenced based medicine, data is essential.

That's an interesting point about the travel factor in community-based care; evidently there is an cost saving gained by getting the patient out of hospital and not having to provide the facilities for them there, but on the other side, it means that the designated travelling nurse may only be able to see a handful of patients in a working day.

The knock-on effect of that is that there may be more nurses required simply to cater for the logistics of getting about and the inefficiencies of seeing patients in diverse locations.

So again, the fact that more nurses were recruited may not reflect improved or more efficient care.

again you have absolutely no idea if there is overall an improvement in patients outcomes in relation to resources by releasing patients earlier from hospital and treating them in the community.

Looking at the above, we cannot simply say that Labour inherently care more about the NHS because they put more (of our) money into it and/or increased staffing, because those numbers are not measures of the service delivered.

absolutely correct : but we do know that the trend to have shorter hospital stays, close 'mental' hospitals and have more community based care was started in the 1980/90s and has continued unabated since 2010.

prowla

CLAPTON wrote: »

from the data offered, there may or may not be an increase in 'Doctor' hours
we simply don't know

what is certain is that if Dr hours per doctor decrease due to EU legislation (or what ever reason) then we need more doctors to maintain the previous level of capacity.

doubtless true that you have no idea at 'what cost'; nor do you know what value the administrators add.

For scientific evidenced based medicine, data is essential.

again you have absolutely no idea if there is overall an improvement in patients outcomes in relation to resources by releasing patients earlier from hospital and treating them in the community.

absolutely correct : but we do know that the trend to have shorter hospital stays, close 'mental' hospitals and have more community based care was started in the 1980/90s and has continued unabated since 2010.

Yes to all of that; my point is that we cannot simply then judge a government on whether it apparently spent more on the NHS and/or increased the number staff on the payroll.

Indeed, we cannot even say that increased spending/staffing means an improved NHS.

TickersPlaysPop

Another element to your NHS discussion...

Supply and demand.

Supply of a health service, and the demand from a number of people. So when looking at the figures, we need to see 'demand' metrics.

CLAPTON

prowla wrote: »

Yes to all of that; my point is that we cannot simply then judge a government on whether it apparently spent more on the NHS and/or increased the number staff on the payroll.

Indeed, we cannot even say that increased spending/staffing means an improved NHS.

obviously so : the observation is not limited to Labour administrations.

there are of course plenty of metrics about throughput and waiting time

prowla

CLAPTON wrote: »

obviously so : the observation is not limited to Labour administrations.

there are of course plenty of metrics about throughput and waiting time

Sure; it's just that a lot of people seem to tout the numbers in particular as some sort of proof that Labour do more for the NHS than anybody else.

But again with waiting times you have to look at what they actually mean, for example:

• Waiting lists to get onto waiting lists.
• Being told to ring in n weeks time to make a follow-up appointment, rather than booking one there and then.
• Surgeries not releasing bookings until the morning of the same day.
• Seeing a doctor/consultant and then booking the next stage of a treatment, rather than pre-booking a timetabled plan.

So, again, if you measure something then you affect the thing your are measuring; in the above cases, the service providers may well have reduced the waiting lists statistics, but we can't tell by that whether they actually delivered an improved service.

antrobus

Yes.

I do think that the people are missing the point.

The question would not be; did the 1997-2010 Labour government boost spending on the right things that actually did some good. The question would be; how they paid for it.

We could (for example) have a gold-plated NHS if we wanted one. So long as we are willing to pay for it through our taxes. New Labour's big mistake (as I think Austin Mitchell put it) was trying to build a Scandinavian type welfare state with US tax rates.