the snap general election thread

gfplux

Thrugelmir wrote: »

Someone is booked into to have an MRI scan. Fails to turn up. That's 8 staff plus the machine time lost. Never to be recouped. That's the sort of issue I'm referring to. Or a busy consultant holding a clinic on a Saturday morning. For which they'll get paid a sizable amount of money plus have a staff nurse on overtime in attendance. Money wasted down the drain.

The NHS is a broad complex organisation. Probably require a couple of hundred or so KPI's. The use of available resources is the key.

Requires a broad debate as to what the NHS should provide as well. Keeping people alive for longer. Will only result in ever increasing bills. as older people require more and more medical help. That's the unavoidable fact.

Keeping personal money separate from NHS money must be broken.
Anything offered free NOW in the 21st century "appears" to have no value.
The first step is to charge for a Doctors appointment that is partly refunded upon keeping the appointment. (Complex and difficult to implement but not beyond the whit of man)
Second step. Price everything so that when receiving treatment/consultation/scan/bloods/prescription you can see the TRUE cost to the state. (again complex but could start almost immediately and be rolled out to cover every procedure within 12 months.)
Both the above would cost money to implement but the pay back would not take very long.

These are not unique ideas, frankly just lifted them from the Country I live in.

Enterprise_1701C

What I think would be a good start with the nhs is to do as a few hospitals have done, and have a gp clinic in A&E. Maybe if they are directed to the gp clinic people will start to believe that things like a stubbed toe are not a genuine emergency.

Another thing that I think should be done is to get rid of all the bloated beurocracy, the management level, that has been introduced over the years. Also, some of that should be redirected to sit down and check how everything, and I mean everything, each hospital sources and find a cheaper source, if contracts have been signed on things that are severely overpriced then those will have to be dealt with one way or another, I am sure that a little publicity on how a company overcharges the nhs just because it can could solve a problem or two.

Conrad

I don't have any evidence for this but I have this foreboding sense Corbyn is gathering momentum, no pun intended.

.string.

antrobus wrote: »

Are these any good?
http://www.productivity.nhs.uk/

I'm puzzled why people think the NHS isn't trying to be more efficient.

That was a really good input, giving that link which gives detailed benchmarks to be used by medical centres by which to judge their own performance.

The sharp end is in principle given by QIPP
http://ukpolicymatters.thelancet.com/qipp-programme-quality-innovation-productivity-and-prevention/

although that is rather high level explanation, it will be interesting (for me) to delve into the really pointed detail which hopefully will give advice on how hospitals can, for example, reduce waiting times. But that will have to wait until I get my hands on my desktop again, serious web searching is not really practical in the thing I'm using at present.

Some of the things I would be interested in are

1. Waiting times --- I start with a slightly inaccurate hypothesis but one which has enough truth in it to be taken seriously

If waiting times are stable at a certain delay time and if resources are static, the the extent of the delay is a measure of the quality of the as administration..

To explain, if the delay is static then the resources (Staff, money, facilities) are keeping pace with the demand and thus the gaps between appointments, diagnosis, etc are due to the time it takes to administer the process.

I've lived in Holland and during that time on a number of occasions had X-rays to assist diagnosis. In many of those immediately after the X-ray is as soon as I was dressed, I saw a medical person (not the super duper consultant) who was nevertheless qualified as specialist, who told me the result and whether I needed to see the consultant for further investigation . So in the couple of cases when that was the case I needed no further treatment, I was informed fully before I left the hospital and I've no doubt it was a low cost process and certainly shorter compared with that of waiting for another appointment and so on and so forth.

The point is that delay can be helped by better administration and better use of resources.

2. I have a thing about medical hierarchy in the medical profession. In the example above, the consultant was not the person who could make a judgement, it was a "lower ranked" doctor. I think more use could be made of alocating responsibilities to lower levels, all the way from giving chemists the ability to advise on medicine for some medical complaints. Also the matter of sign-off (approval for procedures, payment, whatever) is something that can produce efficiencies. That's more complicated but can produced startling improvements as I've found in my professional life. Basically it comes down to delegating responsibilities. In any large organisation, as per Parkinson, there is a tendancy for individuals to hoard responsibility for approvals.

3. The matter of "Moonlighting" where an NHS doctor can sell his/her services to private health care thereby denying the NHS patience the same service. I'm not against a symbiosis between National and Private health care, but it needs to be managed better so that the NHS benefits.

antrobus

Enterprise_1701C wrote: »

..Another thing that I think should be done is to get rid of all the bloated beurocracy, the management level, that has been introduced over the years...

Is there are a bloated bureaucracy? Has it got worse over the years?

Enterprise_1701C wrote: »

....Also, some of that should be redirected to sit down and check how everything, and I mean everything, each hospital sources and find a cheaper source, if contracts have been signed on things that are severely overpriced then those will have to be dealt with one way or another, I am sure that a little publicity on how a company overcharges the nhs just because it can could solve a problem or two.

What you mean to say is that NHS trusts should have a purchasing system. It takes a bit of effort to get one up and running, and you need a purchasing manager to make use of the data. But it can save you multiple squids.

Don't blame the suppliers if a trust can't be bothered to work out the price of a 20 pack of BIC Cristal ballpoint pens.:)

Thrugelmir

antrobus wrote: »

Don't blame the suppliers if a trust can't be bothered to work out the price of a 20 pack of BIC Cristal ballpoint pens.:)

How many products and external services does the NHS use?

The procurement team for the UK's research councils go as far boat and airplane building as a comparison. Not just a question of buying drugs and bandages these days.

Spidernick

Thrugelmir wrote: »

How much of your time to you give for free to charitable causes? Or do you relieve your conscience by donating £30 to Children In Need by text. There's many many people who do an awlful lot without trying to make media headlines for their own image.

You picked on the wrong person there pal, as I help two very different charities, on top of a full-time job. What do you do, then? Anyway, it's not about me and you: I'm saying that whatever Burnham does wouldn't satisfy the likes of you, so give the man a break.

Are you saying that Cameron does a lot for charity in his own time?

BobQ

antrobus wrote: »

Are these any good?
http://www.productivity.nhs.uk/

I'm puzzled why people think the NHS isn't trying to be more efficient.

Thanks. As you say they are trying to improve efficiency. I suspect any large organisation spends a lot of effort doing the same, including in the private sector. Its so easy to cite individual examples but the NHS does their work with a lot of public scrutiny.

kabayiri

BobQ wrote: »

Make them wait till the end of the clinic?

What metrics would you use to measure efficiency?

Every single capital project, either in the NHS or outside it, should have measurable targets.

Otherwise, how do you learn the lessons and not continue to repeat the mistakes in to the future?

An example. We should all be familiar with the NHS IT project which ran for about a decade from 2003 to 2013.

There's over £12 billion pound of spend right there.

Did the project achieve it's goals then?

Well, even as early as 2007 the government attracted criticism for their "apparent reluctance to audit and evaluate the programme"".

It seems not.

It's not like this hadn't happened before. In the early 90s the several billion pound OR project resulted in dismally low delivery.

...and you wonder why I have low trust in governments to deliver value for money!

BobQ

Thrugelmir wrote: »

Someone is booked into to have an MRI scan. Fails to turn up. That's 8 staff plus the machine time lost. Never to be recouped. That's the sort of issue I'm referring to. Or a busy consultant holding a clinic on a Saturday morning. For which they'll get paid a sizable amount of money plus have a staff nurse on overtime in attendance. Money wasted down the drain.

On the face of it I agree but what level of non-attendance is tolerable? If a hospital schedules 10 MRI scans in a day, the non attendance of one patient is undoubtedly a cost (in terms of an opportunity to give an MRI scan to someone else). It a patient forgets or cannot be bothered then I agree something should be done (although not convinced a financial penalty is the best policy). But if a patient wakes up and is unwell, has a family crisis etc, how fair is it to penalise them?

The NHS is a broad complex organisation. Probably require a couple of hundred or so KPI's. The use of available resources is the key.

Requires a broad debate as to what the NHS should provide as well. Keeping people alive for longer. Will only result in ever increasing bills. as older people require more and more medical help. That's the unavoidable fact.

Some truth in that but sometimes treatment can be made less expensive than previously and reduce costs and preventative measures can also help. Also if people are expected to work longer is it unreasonable to expect them to die sooner?

I agree it is not all about cost, efficient use of resources matter too. But the fact is we spend 8.5% of our GNP on public and private healthcare which is less than EU nations like France, Germany which are increasing their spend while we are reducing ours.

I agree that there are choices to be made but the present policy seems to be to allow the NHS to decline at a time we are being told that our economy is doing so well.

https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally