UKBouldering.com

the shizzle => shootin' the shit => Topic started by: fatkid2000 on March 03, 2013, 08:13:01 pm

Title: The end of the NHS.
Post by: fatkid2000 on March 03, 2013, 08:13:01 pm
 http://www.telegraph.co.uk/health/healthnews/9901194/Scrap-NHS-competition-rules-say-1000-in-letter-to-Telegraph.html (http://www.telegraph.co.uk/health/healthnews/9901194/Scrap-NHS-competition-rules-say-1000-in-letter-to-Telegraph.html)

http://www.bbc.co.uk/news/health-21649307 (http://www.bbc.co.uk/news/health-21649307)

For the first time ever Royal Colleges are engaging in political and contractual issues regarding the future of the NHS. There is serious concern that this is the start of the break up. This is not doctors protecting themselves - the profession is trying to protect the health service but I fear it will be to no avail.
Title: The end of the NHS.
Post by: tomtom on March 03, 2013, 10:14:02 pm
Don't things come into effect on the 1st April? (It's getting a bit late...)
Title: Re: The end of the NHS.
Post by: erm, sam on March 04, 2013, 09:26:26 am
It is also not a surprise. Anybody who honestly thought this wasn't going to happen is a fucking idiot.
Title: Re: The end of the NHS.
Post by: Obi-Wan is lost... on March 04, 2013, 10:21:10 am
It is also not a surprise. Anybody who honestly thought this wasn't going to happen is a fucking idiot.
Or reads the wrong paper. A few weeks ago Mrs Obi was talking to a family friend, regular Torygraph reader. She had now clue it was even on the agenda. Good to see them now publishing something about the break up. The BBC hardly cover it either.  :wall:
Title: Re: The end of the NHS.
Post by: Jaspersharpe on March 04, 2013, 01:13:39 pm
Probably not much use but the way I see it doing something is better than doing nothing:

https://secure.38degrees.org.uk/page/speakout/nhs-section-75-legal-advice-speakout
Title: Re: The end of the NHS.
Post by: mrjonathanr on March 04, 2013, 08:28:55 pm
^^ Was Going to post the 38* link. Click on it and add your name.

It would be constructive if the vote stalled till after 2015 when the vultures will be out of office.

Interesting that the UKB home page with its intro

Quote
Welcome to ukb. Forum threads promoted to this page are ones we think are important or significant. 

leads on the Dead Fit Birds poll but omits the privatisation of the NHS.
Title: Re: The end of the NHS.
Post by: GCW on March 04, 2013, 09:57:51 pm
Where to start?  There are so many facets!
Title: Re: The end of the NHS.
Post by: ukb on March 05, 2013, 06:48:32 am
Interesting that the UKB home page with its intro
Quote
Welcome to ukb. Forum threads promoted to this page are ones we think are important or significant. 
leads on the Dead Fit Birds poll but omits the privatisation of the NHS.
Happy now?
Title: Re: The end of the NHS.
Post by: psychomansam on March 06, 2013, 08:56:12 pm
The healthcare apocalypse is being slowed down

http://www.bbc.co.uk/democracylive/house-of-commons-21673110 (http://www.bbc.co.uk/democracylive/house-of-commons-21673110)
Title: Re: The end of the NHS.
Post by: mrjonathanr on March 06, 2013, 10:16:39 pm

Happy now?

Yep. That's better  :2thumbsup:
Title: Re: The end of the NHS.
Post by: fatdoc on March 06, 2013, 10:44:04 pm
 :agree:

Respect fatkid2000

It's all about to go Pete tong....

Watch this spec peeps..
Title: Re: The end of the NHS.
Post by: crimp on April 25, 2013, 12:03:50 am
Tonight the house of lords has approved the privatisation of the NHS, in what seems a very strange almost news blackout about it.
Title: Re: The end of the NHS.
Post by: crimp on April 25, 2013, 09:34:11 am
 :wavecry:

bye bye NHS

http://www.mirror.co.uk/news/uk-news/section-75-last-ditch-bid-stop-1852287 (http://www.mirror.co.uk/news/uk-news/section-75-last-ditch-bid-stop-1852287)

You would think this would be massive news everywhere. Why is it barely being reported.

Can we have a turning in his grave smiley for nye bevin please!
Title: Re: The end of the NHS.
Post by: slackline on April 25, 2013, 09:50:53 am
Not massively surprising as I expect many sitting in the House of Lords have conflicts of interest.
Title: Re: The end of the NHS.
Post by: crimp on April 25, 2013, 09:58:03 am
Not massively surprising as I expect many sitting in the House of Lords have conflicts of interest.

hi buddy.

Not surprising at all. Many do indeed have vested interests.

I find the lack of reporting odd though.

Still, bristol royal infirmary is getting a 5 million pound mini shopping mall.

We'll just have to make sure we don't get any chronic unprofitable diseases in future.
Title: Re: The end of the NHS.
Post by: benpritch on April 25, 2013, 10:02:18 am
I'm with you on the non reporting, barely a murmur. Only a couple of mentions on twitter. Weird really. How can one of our greatest institutions disappear without anybody noticing?
Title: Re: The end of the NHS.
Post by: slackline on April 25, 2013, 10:05:45 am
This may be the final nail in the coffin, but it seemed pretty much inevitable to me after all attempts and campaigns failed last year.

 :wavecry:
Title: Re: The end of the NHS.
Post by: Obi-Wan is lost... on April 25, 2013, 10:09:29 am
Similarly to the power industry, in a few years we will see Serco, Virgin et al creaming more massive profits from the NHS, service will be the same or worse, and MP shareholders will be on their boards on massive salaries and dividends. There will be little or no 'competition' for the public to benefit from.

There will be a lot more of this...
http://www.careukselfpay.com/treatments (http://www.careukselfpay.com/treatments)

Notice that Dupuytrens is in that list.
Title: Re: The end of the NHS.
Post by: GCW on April 25, 2013, 11:54:03 am
The whole swathe of NHS reforms has been unilateral on the government's side. 

NHS111 was always going to be a disaster, we all said it would be a disaster but it was bulldozered through.  And it's a disaster.

Commissioning wasn't something GPs wanted, it was pushed upon them. 

The changes to the GP contract weren't agreed by the GPs or the BMA, they were unilaterally altered by the Government.

See a theme?
Title: Re: The end of the NHS.
Post by: andy_e on April 25, 2013, 11:57:48 am
(http://www.petergoodearl.plus.com/laceygreen/prestwood05/steamring/pict0223_20050702.jpg)
Title: Re: The end of the NHS.
Post by: crimp on April 25, 2013, 12:18:00 pm
Virgin - half price return rail ticket with every bypass

Tesco - buy 2 dialysis sessions, get 3rd free

Sainsbury - nectar points with every chemo

Kwik fit - will take used kidney in part exchange for any organ transplant

Title: Re: The end of the NHS.
Post by: fatkid2000 on April 25, 2013, 03:43:12 pm
There's an ongoing theme. Mr Hunt is forever blaming GPs for the lack of ooh &'A&E attendance. There was a junior health minister who stated radio 4 that there is no ooh service. That is utter rubbish. The enormous increase in A&E is not just due to GPs.

Under the new NHS arrangements we virtually got no practice income this month. We're down by thousands and the partners virtually got no pay.

This coupled with an enforced contract, a stack of new work.

A thing called AQP - I.e virgin bidding for our work. Don't be surprised if your local NHS services disappear.

The DoH has no interest in quality and only cares about box ticking.

5 years and it will be gone. Country needs to decide NHS or trident?

I suspect I'll be richer if it gets privatised but the country's health will be far worse.
Title: Re: The end of the NHS.
Post by: crimp on April 25, 2013, 04:12:11 pm
Trident is so much shit.

After last night, i am already planning a medicine bank to run alongside our estate food bank.
Title: Re: The end of the NHS.
Post by: SamT on April 25, 2013, 05:04:03 pm
Clearly Eddie Mair deems the story of the real heroes of telemark more news worthy than this... unbelievable. :-\
Title: Re: The end of the NHS.
Post by: psychomansam on April 25, 2013, 05:12:22 pm
Similarly to the power industry, in a few years we will see Serco, Virgin et al creaming more massive profits from the NHS, service will be the same or worse, and MP shareholders will be on their boards on massive salaries and dividends. There will be little or no 'competition' for the public to benefit from.

There will be a lot more of this...
http://www.careukselfpay.com/treatments (http://www.careukselfpay.com/treatments)

Notice that Dupuytrens is in that list.

Interesting that CareUK list four locations in the UK, but fail to mention Luxembourg, where there profits go, tax-free(avoided)
Title: Re: The end of the NHS.
Post by: fatdoc on April 25, 2013, 05:12:44 pm
I'm not a big conspiracy subscriber, nor a believer in the illuminati...

( apart from the fact that all the pyramids on the Earth are alien docking stations ;) )

But.... This  Is really rather *odd*

Oh....


And we are going to have piss poor healthcare...

Title: Re: The end of the NHS.
Post by: GCW on April 25, 2013, 05:18:56 pm
It partly harks back to this thread (http://ukbouldering.com/board/index.php?topic=20298.0), unilateral decisions, doctors made out my the government to be money grabbing whining people etc etc.

Well, this is just the start.
Title: Re: The end of the NHS.
Post by: psychomansam on April 25, 2013, 05:20:39 pm
http://www.bbc.co.uk/news/health-21772143 (http://www.bbc.co.uk/news/health-21772143)
More than a third of GPs on the boards of new NHS commissioning groups in England will have a potential conflict of interest, an investigation suggests.

The British Medical Journal analysed 83% of the 211 boards, which will play a key role in from April, and says potential conflicts will be "rife".

A code of conduct says board members must remove themselves from decisions if they could benefit from the outcome.

The NHS Commissioning Board (NHSCB) says it will issue final guidance soon.

The BMJ says 426, or 36%, of the 1,179 GPs it looked at - who are in executive positions on boards - have a financial interest in a for-profit health provider beyond their own practice.

Their interests range from senior directorships in firms set up to provide services such as out-of-hours GP care, to shareholdings in large private health firms, such as Harmoni and Circle Health.
Title: Re: The end of the NHS.
Post by: psychomansam on April 25, 2013, 05:25:48 pm
http://greenparty.org.uk/news/2013/03/05/suffolk-conservative-party-bankrolled-by-private-care-homes-firm/ (http://greenparty.org.uk/news/2013/03/05/suffolk-conservative-party-bankrolled-by-private-care-homes-firm/)
DAVID  Ruffley MP’s Conservative constituency association received a £10,000 donation from the wife of the chairman of the company (Care UK) to which it later handed control of the county’s 16 care homes, Suffolk Green Party can reveal.
__

http://www.mirror.co.uk/news/uk-news/nhs-reform-leaves-tory-backers-105302 (http://www.mirror.co.uk/news/uk-news/nhs-reform-leaves-tory-backers-105302)
THE private health bosses set to profit from the Tory NHS shake-up are today unveiled as party donors.

A Mirror investigation found the tycoons bankrolled David Cameron with over £750,000.

Hedge fund boss John Nash is one of the major Conservative donors with close ties to the healthcare industry.

He and wife Caroline gave £203,500 to the party over the past five years. The cash included £21,000 which was given directly to Health Secretary Andrew Lansley to bankroll his office before the Conservatives took power. At the time the Lib Dems slammed the payments as a “staggering conflict of interest”.

The City tycoon was chairman of Care UK, which makes most of its money from the NHS, when most of the donations were made. Mr Nash continued to work as a consultant to the firm, which provides walk-in centres, GP surgeries and other specialist services, after selling his majority stake to a private equity firm last year.

The “hedgie” is also a founder of City firm Sovereign Capital, which runs a string of private healthcare firms. Fellow founder Ryan Robson is another major Tory donor who has given the party £252,429.45.

His donations included £50,000 to be a member of the party’s “Leader’s Group”, a secretive cash-for-access club. The would-be MP, who tried but failed to get selected as the election candidate in Bracknell, is managing partner at Sovereign Capital.


p.s. With regards to the news thing. I'm finding it rather bewildering too. Never before have I so regularly been forced to resort to the Mirror! Our media is truly shocking. What a piss-poor political climate we live in. Yet people tell me off if I get frustrated or angry!?


Title: Re: The end of the NHS.
Post by: GCW on April 25, 2013, 05:31:41 pm
Which is one of the various reasons GPs stated commissioning by GPs was a stupid idea and should NOT happen.  It's not possible to be the CCG and the provider without a conflict of interest.....  unless the services aren't sourced from within the NHS.......

The fact it was forced through makes you wonder why we are being set up to fail.
Title: Re: The end of the NHS.
Post by: SamT on April 25, 2013, 05:43:59 pm

http://socialinvestigations.blogspot.co.uk/p/mps-with-or-had-financial-links-to.html?m=1 (http://socialinvestigations.blogspot.co.uk/p/mps-with-or-had-financial-links-to.html?m=1)
Title: Re: The end of the NHS.
Post by: Obi-Wan is lost... on April 25, 2013, 07:28:47 pm
http://www.taxresearch.org.uk/Blog/2013/04/25/last-night-the-lords-voted-to-privatise-the-nhs-and-this-is-why/ (http://www.taxresearch.org.uk/Blog/2013/04/25/last-night-the-lords-voted-to-privatise-the-nhs-and-this-is-why/)

(http://www.taxresearch.org.uk/Blog/wp-content/uploads/2013/04/Screen-shot-2013-04-25-at-17.59.41.png)
Title: Re: The end of the NHS.
Post by: slackline on April 25, 2013, 07:45:10 pm
That graph misses out Cuba which, whilst its not an OECD country, would be an outlier on the left of the plot, they spend very little, but have long life-expectancy ($251/capita mean life expectancy of 77.23 years (http://en.wikipedia.org/wiki/Healthcare_in_Cuba#Present)).....and they have a nationalised health service.


All stuff I've waffled about before in Economics, Growth and Finite Resources (http://ukbouldering.com/board/index.php/topic,19178.msg343484.html#msg343484) (and no doubt elsewhere  :-[ ).
Title: Re: The end of the NHS.
Post by: slackline on April 26, 2013, 06:12:37 am
Maybe, but I expect the motivation there is not the quality of healthcare.  Those who stay should live as long as 'mericans without having a huge amount spent on their healthcare.  :greed:

Over testing & over prescription are rife under insurance based health systems and have no demonstrable benefit to longevity (which is only one way of measuring the health of a nation).

P.S. - Good link ;)
Title: Re: The end of the NHS.
Post by: fatkid2000 on April 26, 2013, 07:54:35 am
When the president of the RCGP starts getting involved on political matters it shows how pissed of GPs are with the government.

She's suppose to stick to academic matters / professional standards and not get involved in contractual issues.

http://www.pulsetoday.co.uk/commissioning/commissioning-topics/urgent-care/rcgp-chair-challenges-hunt-for-using-gps-as-scapegoat-over-ae-failings/20002743.article#.UXokSUoxgbA (http://www.pulsetoday.co.uk/commissioning/commissioning-topics/urgent-care/rcgp-chair-challenges-hunt-for-using-gps-as-scapegoat-over-ae-failings/20002743.article#.UXokSUoxgbA)
Title: Re: The end of the NHS.
Post by: GCW on April 26, 2013, 08:22:19 am
We had an excellent Out of Hours service in this area. When the powers that be decided to move to 111, loads of the the triage nurses etc were made redundant for the big launch.  NHS111 goes live, can't cope with the demand and ends up referring loads of people on to A+E or what remains of OOHs.  Because patients can not be triaged more than once, all those referred on have to be seen - A+E couldn't cope.  Out Of Hours was then contracted to re-employ those made redundant and mop up the work for a while.

Speaking to the LMC this brings up an interesting discussion.  The NHS111 project has a 1 year contract and is already planned to be got rid of- in fact it was known the contract wouldn't be renewed after a year before NHS111 went live.

So NHS111 went to the cheapest bidder.  Then the cheapest bidder has had to be paid a hell of a lot more money to get their inadequate service up to speed, meaning they are no longer the cheapest bidder.  How does that sit with the whole idea of competition law and tendering of services?
Title: Re: The end of the NHS.
Post by: GCW on May 05, 2013, 08:49:18 am
Yet another inaccurate GP bashing article from Camilla Cavendish in the Times last Sunday- niceto see a few balanced replies today. Am I cynical or have Government lies become the new truth?  Watch out Guy Montag, the Hound has been released.
Title: Re: The end of the NHS.
Post by: mrjonathanr on May 05, 2013, 11:36:54 am
Am I cynical or have Government lies become the new truth? 

If you want people to believe a lie, make it a really big one and repeat it, as some German once said. The govt has been doing this ad nauseam to undermine the welfare state for some time now. Strivers vs skivers, anyone?
Title: Re: The end of the NHS.
Post by: GCW on May 05, 2013, 12:12:04 pm
I wouldn't be surprised if 111 had been designed to be a disaster in order to blame GPs to then force us to take out of hours back at a practice level. Which would be doomed to fail.
Title: Re: The end of the NHS.
Post by: mrjonathanr on May 05, 2013, 03:58:38 pm
Some elements might be cock-up, some policy, but the overall goal of ensuring the expertise of private health care is increasingly needed to the extent that it becomes the norm is the end-game, I have no doubt.

The objective is the destruction of the welfare state, period.
Title: Re: The end of the NHS.
Post by: fatdoc on May 08, 2013, 04:38:56 pm
I wouldn't be surprised if 111 had been designed to be a disaster in order to blame GPs to then force us to take out of hours back at a practice level. Which would be doomed to fail.

 :agree:

And with Mrj....

Title: Re: The end of the NHS.
Post by: GCW on May 08, 2013, 05:02:36 pm
We discussed this at the LMC today.  That single point will be a line in the sand.
Title: Re: The end of the NHS.
Post by: fatkid2000 on May 08, 2013, 08:48:03 pm
Four of my partners will retire early if that happens. That's half of our GPs - bye bye best primary care in the world.
Title: Re: The end of the NHS.
Post by: GCW on May 08, 2013, 11:51:19 pm
A huge number of experienced GPs will retire due to all of this nonsense. And what will we be left with?  A load of salaried doctors, part time female partners and people about to retire who don't give a shit.

A recipe for..........
Title: Re: The end of the NHS.
Post by: fatdoc on May 09, 2013, 12:04:01 am
 :'(
Title: Re: The end of the NHS.
Post by: slackline on May 09, 2013, 07:09:31 am
A huge number of experienced GPs will retire due to all of this nonsense. And what will we be left with?  A load of salaried doctors, part time female partners and people about to retire who don't give a shit.

A recipe for..........

Why are part-time female partners a problem?
Title: The end of the NHS.
Post by: GCW on May 09, 2013, 08:00:56 am
Being part time mostly means you have less of a hand in the management aspects of the Practice (not proportionate to LTFT ratios). You are much less likely to get involved with external meetings etc. meaning you are somewhere between salaried and partnership levels of involvement. Currently more females than males are being recruited, and it is often seen as a good way to balance a career and family. The majority of part timers are women.
Title: Re: The end of the NHS.
Post by: GCW on May 09, 2013, 08:10:53 am
Do you think it's a coincidence that all the recent changes affect Partners than Salaried doctors?  Or is that to make it more attractive to be an employee and not your own boss?  If everyone is salaried we have no teeth, no power. That's the crux of all this. Make us all employees. Then what? We get subcontracted to Kaiser Permanente?
Title: Re: The end of the NHS.
Post by: crimp on May 09, 2013, 09:31:10 am
The IT Crowd Emergency # (http://www.youtube.com/watch?v=qfWO5Kkzv74#ws)
Title: Re: The end of the NHS.
Post by: Lund on May 09, 2013, 09:39:01 am
Mr Hunt is forever blaming GPs for the lack of ooh &'A&E attendance.

Do you provide an out of hours service?

Many years ago, my father (a GP) did visits out of hours.  Some of those in the practice that didn't like doing home visits didn't and paid the deputising service.  Eventually so many used the deputising service that he got abuse from other doctors for wanting to provide a service personally to his patients (his view was this was why he went into general practice after all).  Then the DS got canned and replaced with a system where you couldn't opt out - you were not able to do your own visits, it was all centralised into a different OOH service.  This was largely because the deputising service was too expensive - it cost loads and sharing the cost around more would be cheaper.

The new OOH service meant you didn't see your own doctor.  It also meant that instead of your doctor getting up in the middle of the night, you had a load of doctors in a building somewhere, sky TV to amuse them in the quiet bits of the middle of the night shifts, drivers to drive them around when the patient couldn't get to the centre, etc. etc. - quite a lot more expensive than my Dad getting up in the middle of the night.  He had to be up more too - but he got even more money to help his pension for his efforts (working 15 hour days in your 50s, good effort).  And he got sky TV which was a real eye opener to someone who never bought into it.  He had no idea what he was missing.  Fucking loves CSI.

Now, as a user, I can see how hard it is to use though.  You don't know your doctor, you're not sure how to use it in the first place, so if my one year old (for example) were to come down with a fever I would think the only option would be A&E.

20 years ago I would have rung my doctor - a number I know - and got an answering machine giving my Dad's number.  A cheaper, better, friendlier service.

From where I'm sitting, this part of it all got fucked because GP's didn't want to get up in the middle of the night.

Educate me?  I could be totally off here.  I don't think I am though.
Title: Re: The end of the NHS.
Post by: jfw on May 09, 2013, 11:45:26 am
Does anyone have "their own" doctor anymore? - I never have in Sheffield - just whoever is available in the practice on the time I could (eventually) get an appointment.

A lot of the time it wouldn't matter  - but I had a period of chronic night time cough a few years back where I kept going back and seeing a.n.other doctor , explaining from scratch what the symptoms were/ history was/ what was tried with the previous doctor(s).
Title: The end of the NHS.
Post by: GCW on May 09, 2013, 01:05:10 pm
The new contract effectively made OOH non viable for GPs. The OOHs system for visits now has a navigator that goes with the GP. I'm not sure how many young female GPs would be happy doing a home visit alone at 3am?  And for an individual practice to employ a navigator is impossible.
Title: Re: The end of the NHS.
Post by: slackline on May 21, 2013, 09:14:18 am
Informed consent or opt out, neither seem to apply (http://www.guardian.co.uk/technology/2013/may/17/private-firms-data-hospital-patients).

And yet non-commercial entities are as mentioned denied access to the data.  :greed: :greed: :greed:
Title: Re: The end of the NHS.
Post by: jfw on May 21, 2013, 09:20:34 am
http://you.38degrees.org.uk/petitions/stop-selling-our-nhs-records-to-private-companies-1 (http://you.38degrees.org.uk/petitions/stop-selling-our-nhs-records-to-private-companies-1)

signed this for what its worth
Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 09:44:46 am
An alternative guide to the new NHS in England (http://www.youtube.com/watch?v=8CSp6HsQVtw#ws)
Title: Re: The end of the NHS.
Post by: GCW on July 01, 2014, 10:21:15 am
Rule 1:  Penalise GPs for missing cancer diagnoses, they should be investigating more.
Rule 2:  Penalise GPs for referring too many patients.

Go figure why the whole thing is about to implode.   :coffee:
Title: Re: The end of the NHS.
Post by: Ru on July 01, 2014, 11:31:55 am
From where I'm sitting, this part of it all got fucked because GP's didn't want to get up in the middle of the night.
Educate me?  I could be totally off here.  I don't think I am though.

Sort of. There was a massive GP recruitment crisis, in part because no-one wanted to do a job that involved getting up in the middle of the night, amongst other things. To solve the crisis they gave GPs the option of opting out of OOH and taking a pay cut. They accepted. Recruitment crisis solved in the short term, OOH problem created (note, it wasn't a case that there were no problems before - having GPs do OOH is only viable if there are enough GPs).

Since then a few other things have changed - GPs are responsible for the management of many more chronic diseases, patient numbers have increased, pay is being cut, targets are being increased, patient demands have increased, working hours have increased along with work density, management support has been removed and cash flow problems have been created by sacking everyone that knew what they were doing in the PCT finance departments that payed the practices.

So no-one wants to be a GP anymore. Many are leaving to go abroad, some are retiring early, training posts are unfilled. And now they want them to do OOH again, without paying them for it. And blame them for failing to make enough cancer referrals. Whilst cutting the number of referrals for cancer they are allowed to make. And so on.
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 12:33:05 pm
Basically as long as we wil continue to treat people who get fat for the inevitable consequences of their fecknlessness the system will never be able to cope; we need politicians to say that the NHS can't do everything for all, all the time and free at the point of need; ohh yes and old community hospitals & etc  which are no longer fit for purpose will ahve to close.

Let's start by having the presumption of a charge @A&E which is written off if the attendance required A&E attendance.  We already have the proceses in place to recover costs from insurers and while the revenue it would raise would be minimal it would stop the inundation of people at A&E who simply don't need to be there.
Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 12:44:14 pm

Let's start by having the presumption of a charge @A&E which is written off if the attendance required A&E attendance.  We already have the proceses in place to recover costs from insurers and while the revenue it would raise would be minimal it would stop the inundation of people at A&E who simply don't need to be there.

Good luck training the population to understand the biology and first aid/medicine required to be able to self-assess whether its worthy of attending accident and emergency (yes there are some cases which are very obvious, but many that are not quite so clear cut and require qualified medical assessment).  I feel sorry for those without sufficient funds to afford such a charge who delay attending when they should have because they wouldn't be able to afford to pay such a charge and subsequently suffer far worse than had they attended at an earlier point.
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 01:21:17 pm
The suggestions that are bandied about by A&E doctors is that something like 30-40% of attendances at A&E are clearly not merited, I wonder if the docs on here could comment as to whether this proposition is reasonabe?

A classic example are those who attend A&E after a minor road traffic collision and are sent home with a photocopied sheet and some over the counter pain pills; they 'evidence' their injuries by the A&E attendance, the NHS charges the insurer of the liable party £690 and A&E is unnecessarily congested.

I think most people genuinely know when there's cause to attend A&E and when there isn't.
Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 01:29:39 pm
Do away with the ability to claim for non-injuries and you won't see those people pointlessly filling up A&E.  Address the cause not the symptom.


I'm no clinician, but I can think of one condition which could easily be construed as not worthy of attendance yet is actually quite life-threatening if not treated quickly.....appendicitis.

Title: Re: The end of the NHS.
Post by: Jaspersharpe on July 01, 2014, 02:19:12 pm
What about getting a saucepan stuck on your head?
Title: Re: The end of the NHS.
Post by: GCW on July 01, 2014, 02:54:58 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\
Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 03:00:41 pm
What about getting a saucepan stuck on your head?

That would depend on how urgently its need for cooking dinner.
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 04:20:54 pm
Do away with the ability to claim for non-injuries and you won't see those people pointlessly filling up A&E.  Address the cause not the symptom.


I'm no clinician, but I can think of one condition which could easily be construed as not worthy of attendance yet is actually quite life-threatening if not treated quickly.....appendicitis.

There's plenty that would like to see an end to soft tissue injuires, but just because you have no bony injury doesn't mean that you haven't been injured. 

Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 04:26:37 pm
Your previous post implied to me that many were simply getting a doctors note to claim insurance, not that that they weren't genuinely injured, which is why I was suggesting preventing the litigation culture that seems to have grown over the last decade or two.
Title: Re: The end of the NHS.
Post by: psychomansam on July 01, 2014, 04:35:43 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective. And we can afford it. Admittedly we could do with a few more billion, perhaps by building less trident subs or perhaps making the odd TNC actually pay tax on UK income. But clearly this government isn't worried about saving or making money. Indeed, their changes to higher education, healthcare and possibly even benefits, all seem to be costing us more. And they've basically let the city and TNCs go feral on their watch.  They've also now basically given up even pretending they've improved the NHS.

The NHS is struggling in some places, purely because of unnecessary and ideological budget cuts (as you say), but it's perfectly viable and very cost effective.

---
 The National Health Service has been praised as the world's best health-care system by an international panel of experts who said it was superior to those found in countries which spend far more on health.

The study, entitled “Mirror, Mirror on the Wall,” also described US healthcare provision as the worst globally. Despite investing the most money in health, the US refuses care to many patients without health insurance and is also the worst at saving the lives of people who fall ill, it found.

The Commonwealth Fund, a Washington-based foundation produced the report. The fund is respected around the world for its analysis of the performance of different countries' health systems. It examined 11 countries, including detailed data from patients, doctors and the World Health Organisation, the Guardian reported.

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," the fund's researchers conclude in their 30-page report. Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.
http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html (http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html)
---
You can call that selective usage of data, subjective interpretation or whatever the fuck you want, and I don't believe our system is the best in the world, but it's a bloody brilliant system and it is highly cost effective. Unviable? As long as you ignore all the evidence.
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 04:49:24 pm
Your previous post implied to me that many were simply getting a doctors note to claim insurance, not that that they weren't genuinely injured, which is why I was suggesting preventing the litigation culture that seems to have grown over the last decade or two.

Yep; that's about the size of it, they've been in a minor bump and want their compo and they know it assists their claim if they go to A&E.

As for the litigation culutre, unfortunately its largely come about due to Labour's removal of civil legal aid and legislation allowing 'no win, no fee'.
Title: Re: The end of the NHS.
Post by: GCW on July 01, 2014, 04:57:58 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 05:06:13 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective. And we can afford it. Admittedly we could do with a few more billion, perhaps by building less trident subs or perhaps making the odd TNC actually pay tax on UK income. But clearly this government isn't worried about saving or making money. Indeed, their changes to higher education, healthcare and possibly even benefits, all seem to be costing us more. And they've basically let the city and TNCs go feral on their watch.  They've also now basically given up even pretending they've improved the NHS.

The NHS is struggling in some places, purely because of unnecessary and ideological budget cuts (as you say), but it's perfectly viable and very cost effective.

---
 The National Health Service has been praised as the world's best health-care system by an international panel of experts who said it was superior to those found in countries which spend far more on health.

The study, entitled “Mirror, Mirror on the Wall,” also described US healthcare provision as the worst globally. Despite investing the most money in health, the US refuses care to many patients without health insurance and is also the worst at saving the lives of people who fall ill, it found.

The Commonwealth Fund, a Washington-based foundation produced the report. The fund is respected around the world for its analysis of the performance of different countries' health systems. It examined 11 countries, including detailed data from patients, doctors and the World Health Organisation, the Guardian reported.

"The United Kingdom ranks first overall, scoring highest on quality, access and efficiency," the fund's researchers conclude in their 30-page report. Their findings amount to a huge endorsement of the health service, especially as it spends the second-lowest amount on healthcare among the 11 – just £2,008 per head, less than half the £5,017 in the US. Only New Zealand, with £1,876, spent less.
http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html (http://www.telegraph.co.uk/health/nhs/10907823/Britains-NHS-is-the-worlds-best-health-care-system-says-report.html)
---
You can call that selective usage of data, subjective interpretation or whatever the fuck you want, and I don't believe our system is the best in the world, but it's a bloody brilliant system and it is highly cost effective. Unviable? As long as you ignore all the evidence.

Utter one eyed lefty fuckwittery of the highest order.

1. Tuition fees and the removal of the cap / review was a Labour policy, legislated for by Labour, implemented by Labour and the TOR for the review set by Labour who agreed to be bound by the outcome.

2. The majority of the changes to the NHS in respect of private providers etc were legislated for by Labour.  No party has a good record of reform of the NHS and I can't see that the current mob are any worse than the previous few goverment's.

3. There have been more loopholes closed by Boy George than probably any other chancellor.  Your grasp on history is simply tenuous at best re regulation.

4. In case you haven't noticed the government have introduced a cap on non disabled benefits claimants and sought to restrict criteria for claiming.  Whether universal benefits 'saves' money in the long term is something we'll only be able to assess in 10 years or so.

5. ideological, blah blah, blah. The NHS is a wonderful institution and probably the least worst model for delivering healthcare on almsot any measure, but that doesn't make it perfect.  There's a culture of covering up failures, excusing dysfunctional practice and overlooking what are self evident risks, IT & infrastructure have probably never been well managed and procurement has always been bedeviled by fraud & etc.

The problem is that increased inputs in terms of £bn do not result in improved outputs in terms of patient care and so on.  the NHS needs radical reform in respect of the delviery of services to the increasingly aged population, the estate in many areas is simply not fit for purpose and there needs to be a culture change in respect of errors and failures (look a the trend of MDU & MDF payments for negligence etc).

None of this will happen without aggressive political action and the flaccid drivel that you and others like you come out with make the necessary reforms more difficult to scope and deliver.

if the type II diabetes bombshell hits us then we're going to need a f--king mircale to cope with the increased numbers, expenditure does not go up in a linear progression with the average age of the population.

in shorth the NHS was designed for a different time and metaphorically a different place, the UK and its population has changed radically in so many ways and yet the NHS has as a whole remained preserved in aspic.
Title: Re: The end of the NHS.
Post by: Sloper on July 01, 2014, 05:09:59 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?

Indeed.  The perfect system is unobtainable.  If I 'need' to see my GP why can't I just turn up and see him (and I mean him, not one of his colleagues) regardless of the time of day or day of the week?  What you mean I can't, you Tory bastards.  :-\

Title: Re: The end of the NHS.
Post by: slackline on July 01, 2014, 06:14:25 pm
Bottom line is that patient demand is going up


I think this is an interesting point and ties into the A&E (mis-)use.

What is driving the increase in patient demand? 

There has been a slight increase in the population size over the last 50 years, and the standard of medical care in terms of what can be treated is has vastly improved, but this isn't necessarily for the common things, rather its for rare conditions.

Life expectancy has increased as a consequence of improved treatments for communicable diseases and as a consequence the population is ageing well, and the incidence of heart disease, cancer, type II diabetes, dementia (catch all term for the broad spectrum) have all increased as a consequence.

This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

I don't have any real answers, but will say that recommendations for how money is spent within the NHS on different treatments is for the large part governed by The National Institute for Health and Care Excellence (NICE) (http://www.nice.org.uk/) which takes an evidence base approach.



As an aside the continual Tory v's (Nu-)Labour to-ing and fro-ing bashing is pretty pointless, its clear that current Labour party do not represent the values the party held 70+ years ago when the established the NHS.
Title: Re: The end of the NHS.
Post by: psychomansam on July 01, 2014, 06:42:00 pm
Unlimited free access to the NHS is no longer viable, but privatisation/ payment is such a hot political potato it will have to be brought in via the back doo by making the system fail.  Oh, hang on   :-\

The claim that it's not viable is DailyFailesque bullshit. It is viable. In fact it's highly cost-effective.

Let me clarify.

Primary Care can not continue to be free at the point of access for unlimited access.  Funding is going up for secondary care.  It is being cut for primary care and the workload is going up.

Secondary Care does not have open access to unlimited numbers (except for A+E).  You can't just turn up at outpatients and demand for a same day appointment.

Our recent LMC survey showed that a proportion of GPs are having to lay off staff due to practice finance changes, and it's only going to get worse.

You want an 8 til 8 service?  On the same money?  With the same number of GPs?  I'm interested to know how you think that'll work.

Bottom line is that patient demand is going up, staffing and money is going down and the opposite is true in the hospitals.

So how is it viable and Daily Mail bullshit?

It's viable because it's extremely cost-effective and the current problems at the front end are just being caused by a lack of funding. Yes, that funding could become a means-tested cost at point of service, but it could equally continue to be funded via taxation. We're going to pay for it one way or another, and there's no solid reason to suggest we need to change the way we fund it. The current government's attempts at synthesising a crisis are reversible.
Title: Re: The end of the NHS.
Post by: GCW on July 01, 2014, 09:16:03 pm
I'm not sure you are au fait with the background to all this, you sound a little uninformed.
Effectively, the reversibility is very doubtful as this path has been followed for a lot longer than you realise.
Title: Re: The end of the NHS.
Post by: psychomansam on July 01, 2014, 11:04:23 pm
I'm reasonably well informed.
I was only actually talking about reversing real-term funding cuts to front line services.
I'm aware of the creep that's been occurring regarding outsourcing and restructuring and wasn't actually talking about that, although I'd say some of it is probably still worth assessing with regards reversal. But I'm under the impression that these are contributing less to the difficulty in keeping up with demand.
Obviously you can play with some things. It might well be worth changing the targets and allowing triage of A&E arrivals so that the 'abusers' don't have to be dealt with within 4 hours. And there's plenty of questionable paperwork all round, especially I think for GPs. I think the whole notion of targets being tied to payments and penalties is a mixed bag. I'm not saying it's bad overall, but there perhaps needs to be recognition that it can lead to problems in some cases, and can push struggling services into debt. Last time I checked, schools in special measures got a funding boost to help them improve. Currently it seems you get the opposite in the health service, or is there something I don't know?
Title: Re: The end of the NHS.
Post by: GCW on July 02, 2014, 12:20:40 am
I'm reasonably well informed.

I thought I was until I got more deeply involved in the running of the CCGs and then you realise you know squat. The path for the NHS has been in place for 20 years, gradually building and conniving. The 2004 contract was part of it, the new contract extends it. Who runs the commissioning boards? 

Sign up to the "Your GP is so battered they haven't the time to care" campaign, it may be your last chance to save the NHS as you know it.   http://bma.org.uk (http://bma.org.uk)
Title: Re: The end of the NHS.
Post by: Sloper on July 02, 2014, 07:51:00 am
Bottom line is that patient demand is going up


I think this is an interesting point and ties into the A&E (mis-)use.

What is driving the increase in patient demand? 

There has been a slight increase in the population size over the last 50 years, and the standard of medical care in terms of what can be treated is has vastly improved, but this isn't necessarily for the common things, rather its for rare conditions.

Life expectancy has increased as a consequence of improved treatments for communicable diseases and as a consequence the population is ageing well, and the incidence of heart disease, cancer, type II diabetes, dementia (catch all term for the broad spectrum) have all increased as a consequence.

This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

I don't have any real answers, but will say that recommendations for how money is spent within the NHS on different treatments is for the large part governed by The National Institute for Health and Care Excellence (NICE) (http://www.nice.org.uk/) which takes an evidence base approach.



As an aside the continual Tory v's (Nu-)Labour to-ing and fro-ing bashing is pretty pointless, its clear that current Labour party do not represent the values the party held 70+ years ago when the established the NHS.

Part of the cause of the increase in demand is because there are no charges at the point of use; for many years there was probably a meme that you didn't trouble the doctor unless you were properly unwell, that meme has now mutated into a meme of 'if I don't get it now I'll complain'.

You are of course correct when you say the Tory bashing doesn't help, but the Tories could announce the gold plating of hospitals and the likes of Sam would slate the proposals because it's an ideological drive to fatten the NHS up for sale.
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 09:47:41 am
Sloper's on board with the DailyFail. It's them lazy oiks who go to a doctor for nowt.

I'm on board with the evidence: Yes, we have a mere 10m extra people, but the baby boomers are aging, which is costing us.

Growing numbers of elderly people also have an impact on the NHS, where average spending for retired households is nearly double that for non-retired households: in 2007/08 the average value of NHS services for retired households was £5,200 compared with £2,800 for non-retired.  These averages conceal variation across older age groups, with the cost of service provision for the most elderly likely to be much greater than for younger retired people.  The Department of Health estimates that the average cost of providing hospital and community health services for a person aged 85 years or more is around three times greater than for a person aged 65 to 74 years.
http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-money-in-public-services/the-ageing-population/ (http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-money-in-public-services/the-ageing-population/)
Title: Re: The end of the NHS.
Post by: abarro81 on July 02, 2014, 10:03:39 am
This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

Good post
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 10:12:46 am
This, to me at least, seems to be the crux that the continual thrust for "cures" (together we can beat cancer/heart-disease/dementia) which pro-long life expectancy isn't the right direction to be heading.  For me as a person touching middle-age (fuck I am feeling old writing that)  I've fairly good prospects for another decade or three at least, and this would improved if I gave up smoking as the government would like everyone to do.  However, adding another five to ten years to the end of my life doesn't really appeal to me because at that stage my body or mind (or both) will be deteriorating.  For me quality is far more important than quantity and I think society would benefit from a shift of focus away from longevity to focusing on quality of life.

I've said before that you can't change a society, only individuals who make up that society, but I really think that if there was less focus on living as long as possible and having as good a standard of life as possible with the time available it would be a better way of spending money within the NHS.

Good post

Hehe. I was ignoring it. You're right, there are some good points here. Obviously NICE take this into account already, but I agree we need much more focus on it.
I was ignoring it because I was avoiding taking the mick out of slackline, who clearly values his own rationality, for being yet another smoker with a ridiculous and self-deceiving justification for his addiction. But since you've drawn attention to it:
Smoking doesn't prevent you living the last years of your life while watching your mortal coil fall apart. It virtually guarantees it. And makes it happen sooner.

Oh, and because it's Slackline, here's a link to a study: http://www.eurekalert.org/pub_releases/2008-10/jaaj-mwn100908.php (http://www.eurekalert.org/pub_releases/2008-10/jaaj-mwn100908.php)
Title: Re: The end of the NHS.
Post by: slackline on July 02, 2014, 10:24:37 am
I was ignoring it because I was avoiding taking the mick out of slackline, who clearly values his own rationality, for being yet another smoker with a ridiculous and self-deceiving justification for his addiction.

I don't need to justify my choice to smoke to anyone, thanks, so quit patronising me. 

There is nothing inherently  wrong with having addictions, everyone does, be it legal (caffeine, gambling, alcohol, tobacco, excessive indulgence in food) or illegal ([INSERT DRUG OF CHOICE]).  As long as you aren't a burden on those around you or society as a whole who gives a shit whether people are deceiving themselves.

But since you've drawn attention to it:
Smoking doesn't prevent you living the last years of your life while watching your mortal coil fall apart. It virtually guarantees it. And makes it happen sooner.


There is no "nice" way to die, and so what if it happens sooner, by not smoking you also virtually guarantee your mortal coil is guaranteed to fall apart too.  At least you won't be a burden on your relatives or society as a whole.
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 10:35:00 am
There are reasons to suggest you do need a justification. You're supporting a harmful industry and implicitly normalising a form of long-term self harm for a start. Someone who loves you might have their own reasons. But hey, most people drink excessively and you could say the same for that.
However, I wasn't suggesting you do need a justification. I was just saying you attempted one, poorly.

I also wasn't making an argument about addictions in general, as much as they're philosophically interesting.

I was stating the obvious about the likely effects of smoking on your quality of life, while backing that up with evidence. You are continuing to ignore this, in an apparent state of denial.
Title: Re: The end of the NHS.
Post by: slackline on July 02, 2014, 11:13:09 am
There is no denial here, I know full well what the effects of smoking are thanks what with being a medical statistician.  You know nothing about the quality of my health/life and how my smoking affects it (you don't know how much I smoke either, simply that I do).  Despite knowing the problems associated with smoking I still choose to do so.


Regardless it wasn't an attempt to justify why I choose to smoke.  I was stating that using "you'll live longer" as a reason not to smoke is pointless because everyone dies and having an ageing population because we're all supposed to be living healthier lives is creating huge problems for society.


And yes most things are philosophically interesting, but thinking about things really deeply rarely gets much done.
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 04:26:17 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html (http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html)

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.
Title: Re: The end of the NHS.
Post by: GCW on July 02, 2014, 04:48:26 pm
Believe what you like, let's review it in five years.   :shrug:
Title: Re: The end of the NHS.
Post by: Sloper on July 02, 2014, 05:18:41 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html (http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html)

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 07:30:49 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html (http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html)

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.

Ah, so the problem with the NHS is that it's not profitable enough. Of course. Presumably we should move more toward the US model? They, after all, have a hugely profitable health sector.

Or perhaps the problem is one of creating the right interfaces between public and private in a mixed economy - creating the right balance of power between public interest and private capital.

Frankly, I don't think any of these are the problem. The health service is already highly cost-efficient. If it's starting to get overwhelmed, then what it really needs a bit more money.

I'd start by getting rid of the high-interest debt crippling lots of hospitals.
Title: Re: The end of the NHS.
Post by: slackline on July 02, 2014, 07:57:04 pm
Ah, so the problem with the NHS is that it's not profitable enough.

Its actually quite useful for the NHS to generate some profit as they can then invest in research via their research arm, the National Institute for Health Research (http://www.nihr.ac.uk/Pages/default.aspx) which has any number of funding streams (http://www.nets.nihr.ac.uk/funding) (Health Technology Assessment (http://www.nets.nihr.ac.uk/programmes/hta), Research for Patient Benefit (http://www.ccf.nihr.ac.uk/RfPB/Pages/home.aspx/), Efficacy and Mechanism Evaluation (http://www.nets.nihr.ac.uk/programmes/eme) etc.) or  funding the Research Design Service (http://www.rds.nihr.ac.uk/) which exists to assist and improve clinicians and researchers research grant proposals to the various NIHR funding streams so that the quality of the research funded and conducted is higher.

More profit would mean more research could be funded, leading to improved care, treatment and services.
Title: Re: The end of the NHS.
Post by: psychomansam on July 02, 2014, 10:44:44 pm
Ah, so the problem with the NHS is that it's not profitable enough.

Its actually quite useful for the NHS to generate some profit as they can then invest in research via their research arm, the National Institute for Health Research (http://www.nihr.ac.uk/Pages/default.aspx) which has any number of funding streams (http://www.nets.nihr.ac.uk/funding) (Health Technology Assessment (http://www.nets.nihr.ac.uk/programmes/hta), Research for Patient Benefit (http://www.ccf.nihr.ac.uk/RfPB/Pages/home.aspx/), Efficacy and Mechanism Evaluation (http://www.nets.nihr.ac.uk/programmes/eme) etc.) or  funding the Research Design Service (http://www.rds.nihr.ac.uk/) which exists to assist and improve clinicians and researchers research grant proposals to the various NIHR funding streams so that the quality of the research funded and conducted is higher.

More profit would mean more research could be funded, leading to improved care, treatment and services.

Interesting. A good argument for encouraging health tourism perhaps? That said, I'm all for funding research, but there's no reason it actually needs a different source of funding than the rest of the NHS. Of course, there's a much bigger debate about how medical research should be funded and distributed.
Title: Re: The end of the NHS.
Post by: Sloper on July 03, 2014, 12:15:56 pm
http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html (http://www.telegraph.co.uk/news/politics/pmqs/10941213/PMQs-sketch-Dave-and-Ed-play-the-numbers-game.html)

An entertaining little article. It shows how a clear case for privatisation has been laid out along with a clear explanation of the current 'crisis' being drummed up.

Or not.

You seem to misunderstand how capitalism works, generally it involves making a profit or going bust.  Much i.e. >90% of non primary care in the NHS does is quite simply not suited to profit making (other than the bits that were sold off by Labour) and when you throw in the cost of professional indemnity insurance and over heads unless HMG is royally arse fucked by the suppliers (see Labour's contracts to the PSTC) then even the contracting out isn't going to be profitable.

But you carry on believing what you believe, it's not as if facts or reason are going to trouble you.

Ah, so the problem with the NHS is that it's not profitable enough. Of course. Presumably we should move more toward the US model? They, after all, have a hugely profitable health sector.

Or perhaps the problem is one of creating the right interfaces between public and private in a mixed economy - creating the right balance of power between public interest and private capital.

Frankly, I don't think any of these are the problem. The health service is already highly cost-efficient. If it's starting to get overwhelmed, then what it really needs a bit more money.

I'd start by getting rid of the high-interest debt crippling lots of hospitals.

No the problem is not that the NHS is 'not profitable enough' it is because the majority of the services that it offers are not suited to making a profit. Of course in the short term one can export parts of the service to non NHS providers who may make a profit, but this extraction will only be viable in the short term and is not the same as a 'privatisation'.

You seem to be picking a fight with yourself here; I am not advocating the sale of the NHS or that we should move towards a system which reflects the US system, I know that's what you'd like to believe I think, but your confections know no bounds do they?

The NHS system is shockingly efficient and effective in some areas and almost unbelievably inefficient and dysfunctional in other areas; including estates management, antifraud, procurement, planning, regulation and so on.  Recognising these problems and discussing potential solutions does not mean that you are plotting the down fall of the NHS; rather that you're seeking to ensure that it 'delivers'.

Now let's have a test of your lefty credentials (and no googling); who said 'it matters not if the cat is black or white; if it catches mice it is a good cat'?
Title: Re: The end of the NHS.
Post by: webbo on July 03, 2014, 12:46:22 pm
Tom.
Title: Re: The end of the NHS.
Post by: Sloper on July 03, 2014, 03:52:07 pm
Kitten or Jones?
Title: Re: The end of the NHS.
Post by: webbo on July 03, 2014, 03:58:09 pm
I thought at first it was Sylvester but he was more in to birds.
Title: Re: The end of the NHS.
Post by: GCW on August 23, 2014, 12:32:44 am
Physician Associates?  Two years training to pretend to be a doctor but you can't prescribe medication?  Yet another nail in the coffin .....
Title: Re: The end of the NHS.
Post by: Sloper on August 23, 2014, 09:54:04 am
All the professions have been eroded by similar moves, most legal matters are now dealt with by people who aren't qualified lawyers.

It never ends well.
Title: Re: The end of the NHS.
Post by: Andy B on August 23, 2014, 03:41:12 pm
Teaching Assistants and Learning Mentors in education.
Title: Re: The end of the NHS.
Post by: tomtom on August 23, 2014, 04:56:09 pm
Maybe we should have something similar for MP's?
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 23, 2014, 05:21:12 pm
Let's call them SPecial ADviserS. Although SPecIal adVserS might be a suitable alternative.
Title: Re: The end of the NHS.
Post by: Sloper on August 23, 2014, 06:03:02 pm
Politics should not be a profession, it should be something that people do as an adjunct to a profession (or trade like teaching) on a part time basis.

The 'professionalisation' of politics is one of the reasons so many of our politicians are so second rate.
Title: Re: The end of the NHS.
Post by: tomtom on August 23, 2014, 06:19:56 pm
In HE we already have Teaching Assistants as well as lecturers etc.. Though generally seen as useful as they do the grunt work allowing us to drink coffee, grow beards, climb at raven Tor and generally put the world to rights.

The doctors one is funny though - as you already have a series of differently trained health professionals from paramedics up to highly specialised nurses etc..
Title: Re: The end of the NHS.
Post by: fatdoc on August 23, 2014, 10:11:32 pm
in this context.. though hard to reconcile.. i agree Sloper...
Title: Re: The end of the NHS.
Post by: GCW on August 24, 2014, 07:51:02 am
Teaching Assistants and Learning Mentors in education.

It isn't really comparable Andy. 5 years at Uni and then at least five years on the job training. If you look at previous experience, eg Nurse "Consultants", it becomes clear who ends up carrying the can.
Title: Re: The end of the NHS.
Post by: Andy B on August 24, 2014, 09:25:11 am
I wasn't meaning it was comparable, I was just giving another example of the erosion of a profession as Sloper had stated above my post. Unless of course you agree with Sloper that teaching isn't a profession.
Title: Re: The end of the NHS.
Post by: lagerstarfish on August 24, 2014, 09:31:09 am
it's more of a hobby where you get some of your expenses refunded, innit?
Title: Re: The end of the NHS.
Post by: Andy B on August 24, 2014, 09:37:44 am
I want my plywood back off you now.
Title: Re: The end of the NHS.
Post by: GCW on August 24, 2014, 09:38:57 am
Ah, I see. All fits with the conspiracy theory though.
Title: Re: The end of the NHS.
Post by: Sloper on August 24, 2014, 04:23:27 pm
in this context.. though hard to reconcile.. i agree Sloper...

Any more of that and you'll be referred to a FTP hearing for re-education ;)

I wouldn't be at all surprised if we start to see a bit of dog whistle politics about fat cat doctors and the outrage of a consultant surgeon with a merit award earning £120k + a private practice vs a health care assistant on £12.5k.

We say the introduction of PCSO's and the bollocks to count them as Police Officers, we've seen the assault on legal aid and the debauchment of the legal profession, medicine is perhaps the last bastion of professionalism for the fucktards (and I include the Tories in the appellation as well as Labour).

Still if representing yourself in a serious criminal matter is fine, how hard can it be to rely on Dr Google and a semi qualified tick box driven functionary?

My view remains the same, the NHS is a wonderful institution and certainly the least worst way of delivering healthcare, however it does need reform and it needs politicians to say it cannot grow in line with demand and it cannot do all things for all people all of the time (and quickly) for free at the point of service.
Title: Re: The end of the NHS.
Post by: GCW on August 24, 2014, 05:57:34 pm
Your last sentence is the key. It can't remain a free service with unlimited access.
Title: Re: The end of the NHS.
Post by: petejh on August 24, 2014, 10:39:25 pm
We say the introduction of PCSO's and the bollocks to count them as Police Officers, we've seen the assault on legal aid and the debauchment of the legal profession, medicine is perhaps the last bastion of professionalism for the fucktards (and I include the Tories in the appellation as well as Labour).

Still if representing yourself in a serious criminal matter is fine, how hard can it be to rely on Dr Google and a semi qualified tick box driven functionary?

Thing is, there are aspects of 'healthcare' that aren't dealt with very well by highly-qualified, expensively educated 'professionals'. Try going to your GP with non life-threatening but otherwise bloody disruptive musculoskeletal problems. Then go and see a semi-professional specialist. There's no doubting who's more useful, and there are plenty more examples in healthcare and other aspects of life where semi-professional people prove the most useful tool for the job. I honestly don't see a need for GP's in these cases, other than acting as continuity data filters. I do get the impression you're a little bit too far up your own arse regards the supposed worth of professionals in some areas of life.

Don't get me wrong, serious illness, disease, surgery etc. - I'd want the most highly-regarded professional there is. (edit) In your view do you regard nurses as professionals? Some of what they do makes what your colleagues in the legal profession get up to look like a load of trivial nonsense in comparison.

So if there are opportunities for semi-professionals to take the place of Doctors I'm not automatically against the idea. As always there'll be pitfalls and benefits. Avoid the former and milk the later.

Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 08:16:38 am
I agree with a lot of that. Things like MSK issues should never come to see me until physio has been trialled first. The whole system is arse about face.
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 10:11:24 am
Sure. I very rarely see a doctor. I'm never out of the physio's.

The rub for me isn't the principle of specialisation.

It's who wants to introduce it. And to what end.
Title: Re: The end of the NHS.
Post by: Sloper on August 25, 2014, 05:58:31 pm
I agree with a lot of that. Things like MSK issues should never come to see me until physio has been trialled first. The whole system is arse about face.

So as a doctor what % (roughly) of attendances on a doctor are a total waste of time?

MJR, you really need to grow up a bit if you think that Labour have an animus any different to the Tories in respect of the NHS, all recognise its flaws, everyone knows of the failures and there is a universal desire to make it work.
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 06:41:54 pm
At least half of GP visits?  Dunno. I'll audit it this week.....
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 07:04:41 pm

MJR, you really need to grow up a bit if you think that Labour have an animus any different to the Tories in respect of the NHS, all recognise its flaws, everyone knows of the failures and there is a universal desire to make it work.

 You assume without sound evidence.

 :wank:
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 08:58:32 pm
No evidence, but probably true. Unfortunately.
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 09:02:39 pm
You read that post as a defence of Labour? They have the same direction of travel, at a different pace.
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 09:14:27 pm
Nope, as I've said before there is an underlying agenda. Doesn't matter who is in power, saying you have to pay for health is political suicide. Hence the plans to cause failure.
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 09:19:52 pm
Nope....

I infer you think Labour would bring in private providers at exactly the same hurried pace as the current administration?
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 09:47:02 pm
Hurried? Political changes resulting in private providers have been slowly implemented over the last 15 plus years. True, the Tories have been more aggressive in the rape of primary care, but it couldn't have been done without the foundations laid over the last number of administration changes. Infer whatever you like, but there is an agenda that isn't seen from outside.

I'm getting rather close to jacking it in and looking at doing something else, and I know I'm not alone. Primary Care is going to go bang in the next few years; 2015 if you believe some of the leaks.
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 10:04:48 pm
I'm well aware that this has been slowly built up since at least 99 and probably back to the 80s if the information were there to corroborate it. Hurried refers to this administration. 

A shame you are feeling so disillusioned. if it were pay not principle you found inspiring, you'd be on the winning team, no?  Medicare is nearly here, surely?
Title: Re: The end of the NHS.
Post by: fatdoc on August 25, 2014, 10:08:38 pm
You are both indeed traveling in the same direction. Once primary care fails.. Secondary care inevitablly will fall.

All caused by some very clever peeps over at least 15 years, for the system to be seen to fail, and politicians walks away... Like what we discussed earlier on in this thread.

It's a perfect, unstoppable, storm.

Unfortunately my retirement date is 14 years and six months away... ( earliest option )

Darn it... Be full shifts 7/7 ( we cover 7/7 but not fully shifted at present) in my 50s to look forward to. Now, I'm reasonably fit for my age... But I doubt I'll be able to Manage that in 10 years time... That will finally nail the coffin of the DGH... No one will want to work there, and the aging workforce will either get out as soon as they can... Or keel over.

Happy days, finishing annual 2 weeks summer family holiday tonight... Into a full week, full weekend, then full week. Deep joy... A few hundred mainly useless emails await, to be read after the all day clinical work. No doubt detailing loss of acticvity, targets missed, lack of achievement in cost improvement and increase in overspend. Sooo relieved I stepped out of trust level medical management, nearly killed me. Unfortunately that experience has given me the insight to see a really rather good healthcare system been set to explode. Such a waste....
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 10:29:50 pm
A shame you are feeling so disillusioned. if it were pay not principle you found inspiring, you'd be on the winning team, no?  Medicare is nearly here, surely?

Pay not principle? You really have no idea, do you?

I'm sick of secondary care dumping on us. I get twenty letters a day from the hospital saying please give antibiotics for a sample I sent when I could do it myself, please repeat blood tests when I could do it myself, please refer to my colleague when I could do it myself etc. I'm sick of people coming in to get paracetamol on prescription just because they are on benefits and get free prescriptions. I'm sick of people coming in for a month's sick note because they hate their job/ life/ wife.

Don't start on the principle crap, I've worked my ass off in extra roles like the LMC and CCG just to get screwed over again and again, whilst the media pedals the rich GP shit you've clearly swallowed.

Yeah, I'll be far happier in France running a gite than earning whatever I am now and listening to people that have no clue (not aimed at you, just all the other parties that slag us off) moan about the crap service.

Last week I had someone that had gone book an appointment to get re-referred on the nhs because the cost of a hip replacement was "ridiculous". Err, that's how much it costs the nhs, it's just that you don't pay directly.

Go on, keep bashing us lot that do all the work until we all give up our shit salaries and worse pensions and you're left with nothing. Then there will be no way back and you'll have burned you're bridges for "pay not principle".
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 10:54:38 pm

Don't start on the principle crap, I've worked my ass off in extra roles like the LMC and CCG just to get screwed over again and again, whilst the media pedals the rich GP shit you've clearly swallowed.


Woah .......  Can you really not follow the meaning of the post...? You're misconstruing or misunderstanding  the meaning, that to be motivated primarily financially rather than for other sources of job satisfaction, would position you better to enjoy a career in an increasingly privatised system.


Go on, keep bashing us lot that do all the work until we all give up our shit salaries and worse pensions and you're left with nothing. Then there will be no way back and you'll have burned you're bridges for "pay not principle".

I said -and implied- nothing of the sort  :shrug: :shrug: 

You're criticising  the antithesis of what I wrote..... Why be hostile to a post which is sympathetic to your position?

(edit: last comment added)
Title: Re: The end of the NHS.
Post by: GCW on August 25, 2014, 11:15:16 pm
Ok, the pay not principle bit was evidently misinterpreted. I took it to mean that I valued pay over principle, based on
if it were pay not principle you found inspiring, you'd be on the winning team, no?
.

Anyway, it's all rather academic as it's gone too far now for any repair job.

I'm sorry if I'm hostile, but the perpetual negativity gets rather tiresome.  Last few weeks, we've had GPs are rubbish because they don't diagnose cancer and don't refer enough. Next day, GPs are rubbish because they refer too much to the hospital. I could carry on, but what's the point?
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 25, 2014, 11:28:00 pm
I'll take some blame for the wording...it's easy to misread..

Title: Re: The end of the NHS.
Post by: fatdoc on August 26, 2014, 12:12:10 pm
 :kiss2:

Nothing like aninternet forum to cause chaos.

I  read it you both were saying the same thing!!!!



Title: Re: The end of the NHS.
Post by: mrjonathanr on August 26, 2014, 04:42:10 pm
We were, smartypants  :wave:
Title: Re: The end of the NHS.
Post by: GCW on August 26, 2014, 04:52:33 pm
Maybe so, but I was right  :shrug:
Title: Re: The end of the NHS.
Post by: Sloper on August 26, 2014, 04:58:00 pm
Maybe so, but I was right  :shrug:

But if you don't quote latin it doesn't count, it's abit like no top no tick (mutatis mutandis)
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 26, 2014, 05:46:38 pm
Maybe so, but I was right  :shrug:

As we were saying the same thing, I think I'm right, ipse loquitur.
Title: Re: The end of the NHS.
Post by: GCW on August 26, 2014, 05:57:22 pm
Oh yea.  Coquus est in culina.
Title: Re: The end of the NHS.
Post by: tomtom on August 26, 2014, 05:57:52 pm
EGO innutum per asinus, ignis ad coques, dum fumigantium a clavus in polypus.
Title: Re: The end of the NHS.
Post by: petejh on August 26, 2014, 07:06:34 pm
Lorem ipsum, as they say in guidebook publishing..

How's your audit going GCW - any cases yet which could've been dealt with by a non-professional as effectively as by a professional?
Title: Re: The end of the NHS.
Post by: Sloper on August 26, 2014, 07:32:13 pm
Independent Sector Treatment sectors, initiated by Labour, the introduction of competition between NHS providers via 'choose & book' (and lets not even look at the IT systems) by Labour, the current government's reforms: all of which are which while open to criticism from some due to the 'market' aspects of the policy are all driven by a desire to make the NHS fit for the 21st century.

The NHS was designed for a different age, it cannot continue without an evolutionary event.

Fatdoc & GCW, at least you don't have your regulator imposing a requirement to conduct diversity surveys (or maybe you do) and then changing the reporting mechanism (without telling you of course) and then threatening disciplinary action because you can't complete the task, or imposing reporting criteria and then deciding at the last moment you don't need to report (meaning work over a year (which was always a waste of time) was then wasted) although things may be bad, I would suggest that they're not as bad as the legal profession which has suffered death by a thousand cuts from fucktard consultants.
Title: Re: The end of the NHS.
Post by: mrjonathanr on August 26, 2014, 08:20:21 pm
Fortunately education has been spared this sort of meddling :blink:
Title: Re: The end of the NHS.
Post by: Sloper on August 26, 2014, 08:42:25 pm
Indeed, our system of state education is entirely without critique and clearly in no need of reform .

http://www.bbc.co.uk/news/education-24433320 (http://www.bbc.co.uk/news/education-24433320) yep, in real terms we're they only country where the trend is going 'backwards'

4/5ths (i.e. nearly half  ::)) have poor levels of numeracy and that declined in the 8 years from 2003 http://www.nationalnumeracy.org.uk/what-the-research-says/index.html (http://www.nationalnumeracy.org.uk/what-the-research-says/index.html)

That Thatcher has a bloody lot to answer for. :spank:

Title: Re: The end of the NHS.
Post by: mrjonathanr on August 26, 2014, 10:10:00 pm
Indeed, our system of state education is entirely without critique and clearly in no need of reform .


Ah I see. Change in education is essential reform but in law it's distressing meddling.

 :lol: :lol:
Title: Re: The end of the NHS.
Post by: GCW on August 26, 2014, 11:16:39 pm
Lorem ipsum, as they say in guidebook publishing..

How's your audit going GCW - any cases yet which could've been dealt with by a non-professional as effectively as by a professional?

1. Kid with a sore mouth eating QuaversTM.
2. Woman with sore labia after shaving.
3. Bloke with sore arm after breaking it, and having fracture clinic follow up.
4. Man with poor memory
5. Woman with a cough for 3 days.
6. Guy that ran the C2C in 4 days, with an infected leg. Had a nice chat about the 3 rings of Shap. He kicked my ass. Dick.
7. Guy needing a sick note.
8. Man the hospital advised to see me for some medication.
9. Man with prepatellar bursitis that has settled but was told to see GP for follow up.
10. Man for BP check. It was ok.
11. Woman with strong urine for a day - no evidence of infection.
12. Boy with a wart.
13. Man that had some questions after his consultant appointment.
14. Woman with a red eye for a day, conjunctivitis that a pharmacy could treat.
15. Woman that wanted more tramadol than we were unhappy to give.
16. Guy on 1/4 of a mirtazepine per day for years came to ok it for the next year.
17. Man with a deaf ear, needed referring for a hearing test. Pardon?
18. Nursing home resident that hasn't eaten since admission, needs dietician input?!?!
19.Woman with indigestion for a few days.
20. Man with a headache for 5 days on and off.
21. Woman I saw 2 days ago feeling a bit viral, that seems to have a virus.
22. Man with a solar keratosis on his face that hasn't gone with dermatology treatment, so he comes to see me again.
23. Woman with bad OA knee that I'll aspirate and inject.
24. Elderly chap whose careers think has lost 500g despite their attempts to feed him.
25. Man that broke his shoulder, and is due to be seen in fracture clinic. It's sore.
26. Woman with a headache on and off for 3 weeks. Only when she's stressed.
27. Man with prostate issues that urology changed his meds. He needs a script.
28. Man with arm injury that needs a date changing on his sick note.
29. Elderly lady comes to check the dose of her medication.

That's 3 I would think needed to be seen, out of 29. And you wonder why I'm sick of it???? A monkey could do this. And possibly a Sloper, although I'm not convinced.....

 
Title: Re: The end of the NHS.
Post by: Sloper on August 27, 2014, 07:38:00 am
Indeed, our system of state education is entirely without critique and clearly in no need of reform .


Ah I see. Change in education is essential reform but in law it's distressing meddling.

 :lol: :lol:

There's been very little change in the law, or indeed in the practice of law, the regulation (and public funding of access to law) has changed massively but the law remains the same, outcomes remain broadly stable and in some areas including criminal law have improved massively (judged on the number of appeals and successful appeals falling).

But then you'd rather avoid the harsh reality that the standards of education are falling and therefore teachers (as a collective group)  are failing, (or do we blame the parents or society?) and instead play a bit of whabouttery.  How depressingly true to form.
Title: Re: The end of the NHS.
Post by: Sloper on August 27, 2014, 07:42:17 am
Lorem ipsum, as they say in guidebook publishing..

How's your audit going GCW - any cases yet which could've been dealt with by a non-professional as effectively as by a professional?

1. Kid with a sore mouth eating QuaversTM.
2. Woman with sore labia after shaving.
3. Bloke with sore arm after breaking it, and having fracture clinic follow up.
4. Man with poor memory
5. Woman with a cough for 3 days.
6. Guy that ran the C2C in 4 days, with an infected leg. Had a nice chat about the 3 rings of Shap. He kicked my ass. Dick.
7. Guy needing a sick note.
8. Man the hospital advised to see me for some medication.
9. Man with prepatellar bursitis that has settled but was told to see GP for follow up.
10. Man for BP check. It was ok.
11. Woman with strong urine for a day - no evidence of infection.
12. Boy with a wart.
13. Man that had some questions after his consultant appointment.
14. Woman with a red eye for a day, conjunctivitis that a pharmacy could treat.
15. Woman that wanted more tramadol than we were unhappy to give.
16. Guy on 1/4 of a mirtazepine per day for years came to ok it for the next year.
17. Man with a deaf ear, needed referring for a hearing test. Pardon?
18. Nursing home resident that hasn't eaten since admission, needs dietician input?!?!
19.Woman with indigestion for a few days.
20. Man with a headache for 5 days on and off.
21. Woman I saw 2 days ago feeling a bit viral, that seems to have a virus.
22. Man with a solar keratosis on his face that hasn't gone with dermatology treatment, so he comes to see me again.
23. Woman with bad OA knee that I'll aspirate and inject.
24. Elderly chap whose careers think has lost 500g despite their attempts to feed him.
25. Man that broke his shoulder, and is due to be seen in fracture clinic. It's sore.
26. Woman with a headache on and off for 3 weeks. Only when she's stressed.
27. Man with prostate issues that urology changed his meds. He needs a script.
28. Man with arm injury that needs a date changing on his sick note.
29. Elderly lady comes to check the dose of her medication.

That's 3 I would think needed to be seen, out of 29. And you wonder why I'm sick of it???? A monkey could do this. And possibly a Sloper, although I'm not convinced.....

The joke in insurance litigation is that you can train a monkey to do it in 8 weeks, two weeks of which is training in law and the other six is to get them to stop defecating on the floor and throwing it at colleagues. Obviously that's a joke, you can't train a monkey to stop defecating on the floor.
Title: Re: The end of the NHS.
Post by: Sloper on September 03, 2014, 08:36:18 pm
Here's the perfect exemplar of why the NHS needs radical surgery.

http://www.theguardian.com/society/2014/sep/03/four-heart-experts-jailed-fraud-nhs-trust-basildon-thurrock (http://www.theguardian.com/society/2014/sep/03/four-heart-experts-jailed-fraud-nhs-trust-basildon-thurrock)

They were only doing 55% of their hours and no one noticed for four years? FFS If you tried that in the private sector you wouldn't last 4 weeks (indeed 4 days would probably be pushing it)
Title: Re: The end of the NHS.
Post by: drdeath on September 04, 2014, 10:45:27 am
Here's the perfect exemplar of why the NHS needs radical surgery.

http://www.theguardian.com/society/2014/sep/03/four-heart-experts-jailed-fraud-nhs-trust-basildon-thurrock (http://www.theguardian.com/society/2014/sep/03/four-heart-experts-jailed-fraud-nhs-trust-basildon-thurrock)

They were only doing 55% of their hours and no one noticed for four years? FFS If you tried that in the private sector you wouldn't last 4 weeks (indeed 4 days would probably be pushing it)

Absolutely...I mean the idea that this could or would happen in the private sector is simply laughable...

Oh, wait a minute, that's utter bollocks...

http://www.economist.com/news/leaders/21603026-how-hand-over-272-billion-year-criminals-thats-where-money (http://www.economist.com/news/leaders/21603026-how-hand-over-272-billion-year-criminals-thats-where-money)

And if that's too much like standard America bashing for you, let's try Germany, land of ruthless efficiency...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1143614/ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1143614/)



Title: Re: The end of the NHS.
Post by: Jaspersharpe on September 04, 2014, 01:06:02 pm
(http://img3.wikia.nocookie.net/__cb20080310214948/uncyclopedia/images/3/3d/You_just_got_pwned.jpg)
Title: Re: The end of the NHS.
Post by: Sloper on September 05, 2014, 11:05:56 am
Absent the fact that I haven't got a clue what 'pwned' means (I imagine it's not complimentary) but Dr Death is talking through his arse, I would have thought a doctor would understand the flaw in comparing the equivalent of a broken leg and a viral infection. The two examples he cites are akin to supply chain fraud (although the economist link is paywalled).

There's also a fair amount of straight financial fraud in the NHS too, let's see the successful prosecutions this year shall we?

http://www.nhsbsa.nhs.uk/4635.aspx (http://www.nhsbsa.nhs.uk/4635.aspx)
http://www.nhsbsa.nhs.uk/4634.aspx (http://www.nhsbsa.nhs.uk/4634.aspx)
http://www.nhsbsa.nhs.uk/4472.aspx (http://www.nhsbsa.nhs.uk/4472.aspx)
http://www.nhsbsa.nhs.uk/4456.aspx (http://www.nhsbsa.nhs.uk/4456.aspx)


The point is, the culture in the NHS is/was so inefficient that for four years, that's almost 200 working weeks these four critical staff were not at work for >50% of the time and that that was not addressed.

Quite simply this is simply inconceivable in the private sector.
Title: Re: The end of the NHS.
Post by: GCW on September 30, 2014, 03:00:13 pm
Cameron tells GPs they must work weekends. (http://www.thetimes.co.uk/tto/news/politics/article4222020.ece)

Er, how is this even vaguely possible within five years?????
Title: Re: The end of the NHS.
Post by: Sloper on September 30, 2014, 03:11:19 pm
I've absolutely no idea how it can be made to work*, but as a policy objective it's a good one.

* Although I would say restructuring practices, recruitment of more allied health professionals and reducing attendanes of a routine nature would free up a significant amount of capacity.
Title: Re: The end of the NHS.
Post by: GCW on September 30, 2014, 03:38:30 pm
The KPMG survey just done suggests around 40% of GPs in this area plan to leave within 5 years. The current intake of trainers won't even cover the current needs, never mind to staff an extra 2 days each week. GP has been made such an unpopular specialty due to all these changes, the training posts aren't filled anyway. No amount of restructuring will provide the numbers needed. Unless it's all privatised.....
Title: Re: The end of the NHS.
Post by: Oldmanmatt on September 30, 2014, 03:46:27 pm

Cameron tells GPs they must work weekends. (http://www.thetimes.co.uk/tto/news/politics/article4222020.ece)

Er, how is this even vaguely possible within five years?????

Increasing the role of the Practice Nurse to include basic diagnosis?

As in "yes dear, you've got a cold dear" and " No dear, antibiotics won't help" or possibly even "No, dear, little Jaden won't have rabies because your Bull Terrier torn his face off"...
Title: Re: The end of the NHS.
Post by: Oldmanmatt on September 30, 2014, 03:56:57 pm
Seriously though...

Is there no scope for a mid tier with a GP practice?

As I recall, the first point of call in my military days was the MA or MedTech. They filtered out the "take two aspirin and call me in the morning" brigade and reduced the Duty Medical Officers work load dramatically.
Title: Re: The end of the NHS.
Post by: GCW on September 30, 2014, 04:11:56 pm
Yes, as I've said before a lot of stuff doesn't need to see a doctor. It needs a huge reeducation if patients and their expectation. And it needs more funding than £60 per patient got unlimited access.
Title: Re: The end of the NHS.
Post by: Sloper on September 30, 2014, 04:57:43 pm

Cameron tells GPs they must work weekends. (http://www.thetimes.co.uk/tto/news/politics/article4222020.ece)

Er, how is this even vaguely possible within five years?????

Increasing the role of the Practice Nurse to include basic diagnosis?

As in "yes dear, you've got a cold dear" and " No dear, antibiotics won't help" or possibly even "No, dear, little Jaden won't have rabies because your Bull Terrier torn his face off"...

 :agree: + a simple advice sheet 'you're fat beause you eat too much and don't exercise' should cover a significant proportion of patients.

Perhaps if we started charging people for frivolous attendances say £100 (no charge if there's a real need) we might start allowing GPs to actually practice medicine again?
Title: Re: The end of the NHS.
Post by: lagerstarfish on September 30, 2014, 06:11:51 pm
or see/speak to a triage nurse before being allowed near the GP to ask for some more benzos and a sick note?
Title: Re: The end of the NHS.
Post by: webbo on September 30, 2014, 07:34:38 pm
I'm not sure how introducing lower grade practioners would work in a complaint averse NHS.
The number of complaints where we get a request for a patient to have a different nurse/ social worker because they are the wrong gender,they where the wrong shoes or part their hair on the wrong side seems to take up half my working week.
Title: Re: The end of the NHS.
Post by: tomtom on September 30, 2014, 07:57:42 pm
Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...
Title: Re: The end of the NHS.
Post by: Sloper on September 30, 2014, 08:17:20 pm
Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...
Hmmm the cynic would say the change to the GP contract and structures introduced by Labour, or is it more complex than that? GCW, answers please.

Webbo, time the NHC stopped dealing with every complaint as if they have a currency just because they're made, cf whistleblowing.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on September 30, 2014, 08:28:54 pm

I'm not sure how introducing lower grade practioners would work in a complaint averse NHS.
The number of complaints where we get a request for a patient to have a different nurse/ social worker because they are the wrong gender,they where the wrong shoes or part their hair on the wrong side seems to take up half my working week.

I think " Suck it up Princess" as a standard reply should just about cover it...
Title: Re: The end of the NHS.
Post by: webbo on September 30, 2014, 08:37:41 pm
Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...
Hmmm the cynic would say the change to the GP contract and structures introduced by Labour, or is it more complex than that? GCW, answers please.

Webbo, time the NHC stopped dealing with every complaint as if they have a currency just because they're made, cf whistleblowing.
If what you are saying is the NHS should stop believing every compliant has validity. I would love someone to implement this.
I have a current situation with a client with an extensive forensic history including robbery with violence,kidnapping, wounding and so on. Who complained because he turned up for an appointment at the wrong time and date due the appointment letter having a date and time that didn't match. He didn't bother to ring to say the letter did not make sense, before that was delt with. He then complained because he had not been allocated a female nurse because he can not trust men.
All this rather gets in the way of providing care for other patients and people wonder why there are waiting lists.
Title: Re: The end of the NHS.
Post by: Sloper on September 30, 2014, 08:49:00 pm
Yes, that is exactly what I am saying, some complaints have inherent value, i.e. fluid balance charts not being completed, prescribed drugs not being administered, allegations of sexual misconduct, others as you say are horseshit and we should not spend millions investigating them as if they have some inherent currency.

When I was investigating allegations of serious misconduct against solicitors our fuckwit cvnt of a director decided that every lunatic who complained about a global masonic conspiracy and bent solicitors was to be taken as seriously as those cases where we had real concerns.  Of course dealing with the fucking twats (and I include senior Law Society managers here too) meant that you actually didn't have any time to deal with the cases which needed proper investigation.

It drove to to the very edge and beyond until I resigned.
Title: Re: The end of the NHS.
Post by: webbo on September 30, 2014, 09:05:02 pm
How I wish I was in a position to tell them to shove it.
Title: Re: The end of the NHS.
Post by: GCW on October 01, 2014, 07:55:06 am

Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...

The contract changed so that workload tripled. The financing dropped exponentially.
Title: Re: The end of the NHS.
Post by: Sloper on October 01, 2014, 08:08:08 am
When was this? The last significant change in GP contracts I can recall (from general reportage) was in 2004.
Title: Re: The end of the NHS.
Post by: GCW on October 01, 2014, 10:11:06 am
2004 and 2014.
Title: Re: The end of the NHS.
Post by: Sloper on October 01, 2014, 11:42:17 am
What's the deal with the 2014 contract?

<inference being that the inability to get an appointment <2014 is a consequence of the 2004 contract>
Title: Re: The end of the NHS.
Post by: rich d on October 01, 2014, 11:56:46 am
To get referred to a physio I had to go see my GP first. Total waste of an appointment as far as I could see.

[/quote]
The contract changed so that workload tripled. The financing dropped exponentially.
[/quote] why did the workload triple? Is it different Px expectations, more Pxs, more health issues etc or a reduction in number of GPs? 
Title: Re: The end of the NHS.
Post by: GCW on October 01, 2014, 03:13:22 pm
That was my point a while ago about it being back to front.

Yes, patient load and demand has increased significantly. But there has been an enormous increase in the non patient contact workload- hospitals asking us to do a lot of their work for them, paperwork etc etc.
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 03:07:02 pm
 Jeremy Hunt admits there is a lack of GPs to cover the current workload.
Trainee GPs are to be forced to stay in the uk once qualified.

Bound to help recruitment and allow 7 day cover, eh?
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 03:12:29 pm
Peverley sums up the general mood.  (http://www.pulsetoday.co.uk/views/blogs/peverley/)
Title: Re: The end of the NHS.
Post by: Jaspersharpe on October 02, 2014, 03:58:42 pm
Fucking unbelievable. The tax thing is presumably because the practice has to be run as a partnership which is the worst way to run a business (and one I always advise clients to avoid).

You're getting fucked from every side.
Title: Re: The end of the NHS.
Post by: Sloper on October 02, 2014, 04:08:42 pm
What's preventing them from being a LLP or even a Ltd Co?

As for requiring trainee GP's to stay in the country, not good, they should be free to leave, but if they want to leave they have to repay the costs of their training not met by tuition fees.

My view is that we're going to see fewer patients being seen by a real doctor, which from what GCW says as to the fuckwits he deals with, isn't actually a bad solution.
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 04:40:58 pm

Fucking unbelievable. The tax thing is presumably because the practice has to be run as a partnership which is the worst way to run a business.

Yes, but at present there isn't an alternative....  Unless a private company starts taking over practices and re employs us as salaried GPs who purely do the legwork.
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 04:43:49 pm

Quote from: Sloper
As for requiring trainee GP's to stay in the country, not good, they should be free to leave, but if they want to leave they have to repay the costs of their training not met by tuition fees.

UK doctors pretty much pay their fees, as far as I know. Plus they will have had to work for 6 years in the uk to finish GP training. Then they will be forced (not sure how??) to stay longer.

Everything is just making GP less attractive. It's all going to implode soon. Secondary care cannot work without GPs as gatekeepers. Maybe that's the plan?
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 04:52:22 pm
What's preventing them from being a LLP or even a Ltd Co?

There are quite strict rules on this. You'd need to get NHS England to agree a new contract. Effectively, you pretty much can't.
Title: Re: The end of the NHS.
Post by: tomtom on October 02, 2014, 06:28:21 pm

Thanks for the answers GCW. Sounds like you're getting shafted from all sides :(



Quote from: Sloper
As for requiring trainee GP's to stay in the country, not good, they should be free to leave, but if they want to leave they have to repay the costs of their training not met by tuition fees.

UK doctors pretty much pay their fees, as far as I know. Plus they will have had to work for 6 years in the uk to finish GP training. Then they will be forced (not sure how??) to stay longer.

Medical degrees cost c.25k per year per student to run... (According to the internal figures I've seen) The govt still pays the shortfall between their 9k contribution and the main cost...
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 06:57:44 pm
Fair enough. Although they will pay their tax.

The main thing is the fact it will put people off.
Title: Re: The end of the NHS.
Post by: Sloper on October 02, 2014, 07:55:50 pm
Not if they fuck off to Australia they won't.

How could the NHS stop a partnership assigning the rights under a contract to a LLP / Company? The contractual rights are property of the partnership and I would be surprised if they could not be transferred, after all a retiring / dead partner cannot be a new event.

Ohh and if salaried doctors earn more than partners then their salaries are too high, sorry but a partnership is a business and if it isn't worth the candle then it needs to change or close.

If that sounds brutal, that's the real world, sorry.
Title: Re: The end of the NHS.
Post by: Ru on October 02, 2014, 08:17:12 pm
How could the NHS stop a partnership assigning the rights under a contract to a LLP / Company? The contractual rights are property of the partnership and I would be surprised if they could not be transferred, after all a retiring / dead partner cannot be a new event.

I very briefly looked into this a year ago.

The contracts can be held by limited companies, with some caveats, but transferring a contract is probably not possible. There's a clause in the GMS contract that says that it's non assignable without consent of NHS England, but NHS England won't give consent. Instead they would be put the contract out to tender under the Public Contracts regs.

AFAIK, LLPs cannot hold a GMS contract under the GMS Regulations.
Title: Re: The end of the NHS.
Post by: Sloper on October 02, 2014, 08:29:08 pm
Nonsense on fucking stilts (not your explanation which I take as wholly accurate) but the bollocks rules structured by the DoH.

Maybe the Dr's need some wholly owned service companies and SPV to work around the regs? I'm sure you know a commercial devil to work around?
Title: Re: The end of the NHS.
Post by: Ru on October 02, 2014, 08:56:13 pm
Maybe the Dr's need some wholly owned service companies and SPV to work around the regs? I'm sure you know a commercial devil to work around?

Zero visibility. Not sure I'd want to invest in a business that might become completely unviable after the next election.
Title: Re: The end of the NHS.
Post by: a dense loner on October 02, 2014, 09:04:20 pm
Can I ask why this news would put people off being gp's? They have to do more work I understand that, they have to do more work for less money I understand that. Everybody has to do more work for less money it's a sign of the times, what else are the trainee gp's going to do? Become lawyers? That'll drive the price down for that. People of a certain intelligence are always going to be drawn to a particular vocation.
Title: Re: The end of the NHS.
Post by: Ru on October 02, 2014, 09:29:53 pm
There are lots of other sorts of doctors apart from GPs.
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 09:49:16 pm
Sorry Ru, I have clearly missed your point.
Title: Re: The end of the NHS.
Post by: a dense loner on October 02, 2014, 09:52:13 pm
Ok let's substitute gp for doctor. I also call a barrister a lawyer, a surgeon a doctor etc. my bad
Title: Re: The end of the NHS.
Post by: GCW on October 02, 2014, 09:59:05 pm
The difference is that as a GP we get £60 per patient per year for unlimited access. Secondary care gets multiples of that, but still expects GPs to do their work. So the consultant does less work, fewer hours and dumps work in the GP but we get called lazy  and overpaid?  It's far too complex to explain, but basically Lee all the GPs will fuck off and the NHS will die. 
Title: Re: The end of the NHS.
Post by: Ru on October 02, 2014, 10:26:54 pm
It was a reply to dense, but i didn't read back far enough in  the thread. Ignore my last post. Carry on.
Title: Re: The end of the NHS.
Post by: a dense loner on October 02, 2014, 10:49:53 pm
Gcw no it won't. I think people already in a decent position forget about the hard work it took them to get there and how people coming up through the ranks will take most hits going to get to such a decent position. I know a few gps who have entered the profession recently, they moan like everyone else and then take the job anyway. Which is what people do
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 06:39:39 am
That's fine Lee, but I think time will prove you wrong.
Title: Re: The end of the NHS.
Post by: a dense loner on October 03, 2014, 07:57:00 am
By there being less doctors? What utter rot. Don't get me wrong I'm not saying gps are lazy and overpaid I'm saying there'll always be someone to fill the gap, willing to do the same workload for less
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 08:50:21 am
That's exactly the point.
Title: Re: The end of the NHS.
Post by: a dense loner on October 03, 2014, 09:01:07 am
Eh? I was replying to you saying all the gps will fuck off and the nhs will die. I said no they won't there will always be someone wanting to be a gp even if it means a shitter workload and pay cuts. So the gps will always be there and the nhs won't die, well it will but not for a lack of gps. So what's exactly the point?
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 09:15:04 am
It's a shame you can't read the comments on the Peverley thread.  Doctors won't do this work if the pay is less and the work is more. That's a fact based on recent surveys. The point, therefore, is that someone else will do it ie nurses etc. It won't work.

Another announcement today that hospitals can open a GP surgery if the local GPs can't recruit. Eh? The reason they can't recruit is that there aren't enough GPs!

I won't be a GP on 10 years, unless things change significantly.
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 09:19:04 am
Just to be clear- it won't work as a free at the point of access system.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on October 03, 2014, 09:23:35 am

It's a shame you can't read the comments on the Peverley thread.  Doctors won't do this work if the pay is less and the work is more. That's a fact based on recent surveys. The point, therefore, is that someone else will do it ie nurses etc. It won't work.

Another announcement today that hospitals can open a GP surgery if the local GPs can't recruit. Eh? The reason they can't recruit is that there aren't enough GPs!

I won't be a GP on 10 years, unless things change significantly.


I think Lee has heard similar arguments in a different profession, as have I in a similar line to Lee.
In my industry, the overworked, highly trained professionals; when they began to protest, found themselves replaced by people with East European or Filipino  accents...

I'm not in any way saying it's right.
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 09:40:31 am
Yes, that's true. But the big difference is that they are employees. As a GP, I am the boss. I hold the contract. If you replace me with an Eastern European then they would need to be employed by someone ie Virgin healthcare.

Lee, I'll be frank here. I work in a decent practice, above average income. I work 11 hour days which are pretty high workload and even more responsibility. I read shit in the papers every day about how rubbish GPs are, which is increasingly the perception. In the last tax year after tax, employee pension, employer pension, indemnity cover, college membership, BMA membership etched etc etc, my net earnings were less than £40k.

Do you seriously think I'll carry on doing more work for less money?  Or do you think that with a degree and high level of education, I could do a less stressful job for not much less money?
Title: Re: The end of the NHS.
Post by: a dense loner on October 03, 2014, 10:34:59 am
First off it's not Sunday so why is everyone calling me Lee all of a sudden? I can see you're pissed off with the situation, it's shitty! It happens in every industry to some degree. That has not been my point, my point is not about you or your peers now. You're speaking from your situation "do you think I'll carry on doing more work for less money" no I don't think you will. You'll leave and someone else will replace you, you're not omnipotent you know  ;)

Obviously deals will be thrashed out around large walnut tables to see how much they can take off you but that's another story.
Title: Re: The end of the NHS.
Post by: rich d on October 03, 2014, 10:36:03 am
Yes, that's true. But the big difference is that they are employees. As a GP, I am the boss. I hold the contract. If you replace me with an Eastern European then they would need to be employed by someone ie Virgin healthcare.

Lee, I'll be frank here. I work in a decent practice, above average income. I work 11 hour days which are pretty high workload and even more responsibility. I read shit in the papers every day about how rubbish GPs are, which is increasingly the perception. In the last tax year after tax, employee pension, employer pension, indemnity cover, college membership, BMA membership etched etc etc, my net earnings were less than £40k.

Do you seriously think I'll carry on doing more work for less money?  Or do you think that with a degree and high level of education, I could do a less stressful job for not much less money?
Genuine question what are the other options for qualified doctors? Hospital doctors especially newly qualifying/qualified seem to work horrendous hours and shifts, or that's the perception that's given. Are there other opportunities for other areas?
The industry I work in hasn't seen a reduction in wages for qualified opticians, workload and expectation have increased but seeing as the colleges are not increasing the number of graduates coming through the wages are still high due to scarcity. In areas where younger graduates don't want to live (south west, East Anglia and other areas away from the large conurbations) the simple logistics of supply and demand create a gap and considerably higher salaries.
Most opticians work for private companies, with a reclaim for NHS work going to the private company and the optician taking a salary from the company so I understand there is a difference.

From the NHS website with some provisos GP salary "Salaried GPs who are part of a CCG earn between £54,863 to £82,789 dependent on, among other factors, length of service and experience" This doesn't seem like it'll put too many people off, especially as there is still a perception that GPs and doctors have a real status in a community and there may be other benefits

(http://s24.postimg.org/tej2kmgcl/Co_AD.jpg)
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 10:41:50 am
Dense, I know I will be replaced. But it won't be as an independent contractor, which is the difference. I'm sure you could run things on salaried doctors, but who would do the other work that makes up the unseen half of the work?
It will have to be done on a larger scale by a company that can run matters and tender for the service. There is likely to be a fee attached to this...
Title: Re: The end of the NHS.
Post by: Ru on October 03, 2014, 11:23:50 am
Actually, having read the rest of the thread, my post did make sense. The point was that medical students will opt not to become GPs and become other sorts of doctor instead. This will lead to a recruitment issue at the bottom end. At the top end partners will retire early or jump ship to become locums or salaried. This is happening. No one will want the financial risk, added stress and increased workload of becoming a partner when often they earn less than locums. Partnerships will fold (short term). This is happening. There is currently nothing to replace the patnerships. Result, GP shortage.
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 11:25:17 am
Decent summary there, Ru.
Title: Re: The end of the NHS.
Post by: tomtom on October 03, 2014, 11:36:54 am
Is it me or does this sound awfully like what happened to the teaching profession during the 80/early 90's...?

Devaluing of the career, erosion of pay and benefits? Leading to a crisis in the profession and the Blair govt having to spend millions on training & sweeteners to get people to join/train?
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 11:43:34 am
Except I think this is intentional and a one way ticket.
Title: Re: The end of the NHS.
Post by: Ru on October 03, 2014, 01:42:41 pm
It seems to happen cyclicly. I thought that the infamous 'botched' contract negotiation in 2004 or whenever it was that removed out of hours and increased pay was done on purpose to entice people to join or stay in the profession. The difference between then and now is that theres no money to do that again. Ultimately however some sort of sweetner might be needed, hopfully before systemic collapse. The general public however currently prefer the "whippings will continue until morale improves" approach which makes it difficult for politicians to engage brain.
Title: Re: The end of the NHS.
Post by: GCW on October 03, 2014, 01:56:10 pm
2004 cut pay, but there was an option to do out of hours in addition. The income for out of hours was relatively tiny, so predictably nobody opted in!!
Title: Re: The end of the NHS.
Post by: GCW on October 04, 2014, 11:14:06 pm
NHS chief suggests GPs should 'reflect' on damage caused by raising alarm over state of profession. (http://www.pulsetoday.co.uk/your-practice/practice-topics/employment/nhs-chief-suggests-gps-should-reflect-on-damage-caused-by-raising-alarm-over-state-of-profession/20008115.article#.VDBvct14WrU)

Drum? I's a bangin'.
Title: Re: The end of the NHS.
Post by: Sloper on October 10, 2014, 08:10:14 pm
What's the score with the MDU & etc? I'm going to be doing some due diligence on the acquisition of a book of clinical negligence work and an early indication is that if the claim is against Dr Death etc then the chances of success are very real, does in your view the NHS actually manage out dysfunctional practitioners or just try and keep it quiet.

The costs of claims against the NHS is going up and going up steeply, this may be the equivalent of a serious internal bleed but there seems to be no proper response, perhaps this is the only real threat to the existence of the NHS.

PS I fucking hate doing due diligence, so as from next Monday please expect a bellicose Sloper.
Title: Re: The end of the NHS.
Post by: Jaspersharpe on October 10, 2014, 09:48:59 pm
It's try to keep it quiet not try and. FFS.
Title: Re: The end of the NHS.
Post by: fatdoc on October 10, 2014, 09:50:17 pm
I kinda just understood that...

2penneth....

Post Francis, game changer. Not just in consolidating validation... But on the  shop floor change of attitude. Remember staffs was not dr lead, but dr accepted. This no longer happens.

There is no ongoing bleed. I suspect you are dealing with the non healing scabs from such in times gone past.

Foundation trusts get rid of of the failing ( in the eyes of the waiting list exec)  permanent member of medical staff like a shot.. Like you should...??  Worryingly perhaps just coz they don't tow the line..

There is not cohorts of hospital consultants being cuckholded by their peers, nor known poor performance being covered up..

Yes, the dysfunctional, in terms of corporation, are moved out. Yes in terms of revalidation, the poor performers are also pushed.


Title: Re: The end of the NHS.
Post by: Jaspersharpe on October 10, 2014, 11:24:05 pm
Jon.

Could you please write that in English so I can actually get your view on this.

I'm not being a cunt, I have no idea what you just said.
Title: Re: The end of the NHS.
Post by: GCW on October 11, 2014, 08:56:21 am
The MDU et al are just insurance companies, like any other insurance company. If it will cost more to defend a claim than to settle, then they will settle even if it's a stupid claim as it'll cost them less.

As for bullying, protecting incompetence, in my opinion it goes on a lot less than it potentially did.   There's no way of collecting actual data on it so we don't really know.

Reading Pulse this week, it seems that in the last 3-4 years over 500 GP surgeries have had to close. No new practices have been opened.
Title: Re: The end of the NHS.
Post by: Sloper on October 11, 2014, 10:12:40 am
That's not true, the MDU will defend cases which they will clearly lose, often to the door of the Court when costs are eye watering and most categorically they do not settle cases based on economics. 

As for the bullying of staff, particularly whistleblowers this seems to be a fairly common themein The Eye

Jon, good to know that the known dysfunctional clinicians are pushed out the door, to become locums one expects which is an even greater concern no?
Title: Re: The end of the NHS.
Post by: GCW on October 11, 2014, 11:44:30 am
I didn't say they wouldn't defend cases them may lose. That's a different matter.
Title: Re: The end of the NHS.
Post by: Sloper on October 11, 2014, 02:31:28 pm
My experience is that they don't settle cases for say £10k when it will cost £100k to defend, there's a point in defending cases when there's a defence, but the MDU & etc defend cases when there's no realistic prospect of a successful defence keeping the claimant out of their damages for longer and massively increasing the costs.

Good insurers admit liability when there's no defence and deny when there is a good defence, the MDU does neither.
Title: Re: The end of the NHS.
Post by: tomtom on October 11, 2014, 09:12:18 pm
(http://tapatalk.imageshack.com/v2/14/10/11/2bf96db7002b85bf1d76f8f57835472f.jpg)
Title: Re: The end of the NHS.
Post by: Sloper on October 12, 2014, 10:49:52 am
The NHS will always be 'failing' as demand is in essence infinite and resources finite, the world in which the NHS operates has changed beyond recognition since the NHS was incepted, and I would be surprised if the pace of change does not increase.

The NHS will change radicall over the next 10 years as it has changed over the last 60 years, but to decry the change is like harking back to a golden age that never was, old maids cycling to evensong, toasted crumpets with honey and the Dr as god.
Title: Re: The end of the NHS.
Post by: GCW on October 12, 2014, 01:41:38 pm
Prediction: in five or so years GPs will be employees and work shift patterns. Although, that will cause a huge exodus from the profession. You'll never get to see the same doctor twice, referrals to secondary care will increase and the cost of the NHS will rocket.
Title: Re: The end of the NHS.
Post by: a dense loner on October 12, 2014, 02:29:13 pm
I agree with that gcw. To be fair I've not seen the same doctor twice since I was about 17. Not that I go to the docs much after they botched my penis reduction
Title: Re: The end of the NHS.
Post by: GCW on October 12, 2014, 02:33:12 pm
Microsurgery can be pretty tricky.
Title: Re: The end of the NHS.
Post by: GCW on October 13, 2014, 01:50:42 pm
NHS reforms our worst mistake. (http://www.thetimes.co.uk/tto/news/politics/article4234883.ece)


Quote
.....charges to see a GP......


Get that seed firmly planted.....
Title: Re: The end of the NHS.
Post by: tomtom on October 13, 2014, 01:54:16 pm
Quote
.....charges to see a GP......


Get that seed firmly planted.....

I think that'll be a nightmare...

Hey - I've paid my £10 to see you - I want some pills!!!
Title: Re: The end of the NHS.
Post by: GCW on October 13, 2014, 01:56:32 pm
Oh, it would be awful. But is it avoidable now?
Title: Re: The end of the NHS.
Post by: Sloper on October 13, 2014, 02:47:25 pm
I see that there are a number of problems with this,

1. An increase in entitlement culture, as Jasper says, I've paid my money and want to see a quack (even when there's no clinical need)

2. Dissuading people who need to see a Dr but don't want to spend the £££ resulting in later diagnosis, increased exposure to transmission and so on, my view is that there needs to be a presumtpion that if the attendance was reasonable / necessary the charge be waived.

3. It's not enough to dissaude the middle class worried well from attending with stained urine (conveniently forgetting the borscht at the country supper the day before)
Title: Re: The end of the NHS.
Post by: fatdoc on October 15, 2014, 02:00:55 pm
I wrote that sober ( in on the wagon health kick mode..) , but in rapid short hand mode I'd use in preparing to write a paper... As in flight of ideas, sorry.. If Japser can't follow it.. No one can!!


I kinda just understood that...

2penneth....

Post Francis, game changer. Not just in consolidating validation... But on the  shop floor change of attitude. Remember staffs was not dr lead, but dr accepted. This no longer happens. 

=POST Francis the duty of candour is a very real daily presence in the shop flower

There is no ongoing bleed. I suspect you are dealing with the non healing scabs from such in times gone past.

= the failing service is not left to potentially harm patients. But the services are now failing for ressons what GCW has expelained in primary care and my concerns re centralisation in secondary care..



Foundation trusts get rid of of the failing ( in the eyes of the waiting list exec)  permanent member of medical staff like a shot.. Like you should...??  Worryingly perhaps just coz they don't tow the line..

= the if your face doesn't fit you are out culture is as stowing as its ever been, at senior nurse, senior manager and consultant level



There is not cohorts of hospital consultants being cuckholded by their peers, nor known poor performance being covered up..

= I'm convinced of this, in my organisation at least

Yes, the dysfunctional, in terms of corporation, are moved out. Yes in terms of revalidation, the poor performers are also pushed.

= you have to way below the bar that foundation hospitals set for annual appraisal to not get revalidated..

In the next 2 years... So all drs revalidated by then... They won't get Locums work if not revalidated. That is a real improvement... But by no means a perfect solution...


Title: Re: The end of the NHS.
Post by: Sloper on October 16, 2014, 08:16:03 pm
The reaction in the Guardian to the announcement that malpractice and negligence is the biggest threat to the NHS shows how just how polarised (politically) and removed from rationale debate discussion of the NHS has become.

I actually see this knee jerk reaction and blind, Pavlovian response to proposed reform is the biggest threat to the NHS.
Title: Re: The end of the NHS.
Post by: Ru on October 23, 2014, 02:09:48 pm
NHS reforms our worst mistake. (http://www.thetimes.co.uk/tto/news/politics/article4234883.ece)

Interesting that they see the reforms as their worst mistake. In fact their mistake is ongoing and involves entrusting broad sweeping changes to ministers that have no idea what they're doing while simultaneously plugging their ears when the professions involved point out what stupid ideas they are.

It's not one bad decision it's a broken decision making process.
Title: Re: The end of the NHS.
Post by: Sloper on October 23, 2014, 02:11:51 pm
Don't worry it will all be so much better after the election  :shrug:

I see you're back on line or are you working from home.
Title: Re: The end of the NHS.
Post by: mrjonathanr on October 23, 2014, 08:25:25 pm

Interesting that they see the reforms as their worst mistake. In fact their mistake is ongoing and involves entrusting broad sweeping changes to ministers that have no idea what they're doing while simultaneously plugging their ears when the professions involved point out what stupid ideas they are.

It's not one bad decision it's a broken decision making process.

Interesting that you see these ("no top down reform of the NHS") politicians as speaking in good faith here. I saw it as politics as usual, dealing with the fall-out, objectives unchanged.
Title: Re: The end of the NHS.
Post by: GCW on October 23, 2014, 09:50:59 pm
I want to write a column based on Catch 22.
Title: Re: The end of the NHS.
Post by: tomtom on October 23, 2014, 10:16:46 pm

I want to write a column based on Catch 22.

Take a leaf out of Major Major Major Majors book and hop out of your window whenever a patient is due... :)
Title: Re: The end of the NHS.
Post by: Ru on October 23, 2014, 11:16:27 pm
Interesting that you see these ("no top down reform of the NHS") politicians as speaking in good faith here. I saw it as politics as usual, dealing with the fall-out, objectives unchanged.

I don't really know TBH. From the outside idiocy and conspiracy look quite similar.
Title: Re: The end of the NHS.
Post by: GCW on October 25, 2014, 12:32:55 am
Ward 22 Episode 1

Knock. Knock. "Come in".
Dr White sits down. Regular exercise, good food and fresh air could keep him healthy. Unfortunately in general practice we all work long hours and have little time for relaxation.
"It's my heart, Doc" Dr White says. "I keep getting this crushing central chest pain radiating to my left arm whenever I think about QoF or enhanced services. The last time was just now and it lasted for 24 hours."
I thought long and hard. "It could be your heart" I said "we need a specialist opinion".
"OK" said Dr White, going a little blue.

"Med Reg".
"Err, hello. I have a 56 year old smoker, stressed to the eyeballs, strong family history with cardiac sounding chest pain."
"Yeah?  What's the ECG show?"
"I can't get one immediately. Can you not see him without?"
"Well, we need to rule out a cardiac cause."
"That's why I've called you. If the ECG is abnormal, what will you do?"
"Ah, we will see him on MAU."
"OK, and if the ECG is normal?"
"Ah, we will see him on MAU."
"Pardon?"
"Don't be so naive, a normal ECG doesn't exclude ischaemia."
"So if I get an ECG, whatever the result, you'll see him on MAU?"
"Yeah. Unless he's acutely unwell, in which case he needs a 999 ambulance to A&E."
After thirty minutes on the 'phone, I called 999 and sent him to A and E.

The next day I received a snotty A&E letter. "Serial ECGs normal, CK normal, troponin I, troponin T normal, CTPA normal. Poor GP referral with obvious musculoskeletal pain".
Title: Re: The end of the NHS.
Post by: a dense loner on October 25, 2014, 02:09:46 pm
Shouldn't that have been in the "only joking" thread  ;)
Title: Re: The end of the NHS.
Post by: GCW on October 25, 2014, 05:39:41 pm
It isn't a joke, Dense.   :boohoo:
Title: Re: The end of the NHS.
Post by: tomtom on October 25, 2014, 05:55:36 pm
I now see where your catch22 thoughts come from... bonkers.
Title: Re: The end of the NHS.
Post by: Sloper on October 29, 2014, 03:09:59 pm
http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677 (http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677)

It seems as if some Doctors are changing they way they practice.

Perhaps the real issue is poor management in the NHS?
Title: Re: The end of the NHS.
Post by: webbo on October 29, 2014, 07:46:12 pm
http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677 (http://www.bbc.co.uk/news/uk-england-hereford-worcester-29815677)

It seems as if some Doctors are changing they way they practice.

Perhaps the real issue is poor management in the NHS?
Poor management in the NHS. Well I never, next you will be suggesting in order to meet performance targets. Clinicians should stop seeing patients so they can spend time checking figures.
Last year the local acute trust in order to meet a performance target for staff having flu jabs, offered staff an extra days leave if they had one.
So they made more money paying the staff not to be at work.
Title: Re: The end of the NHS.
Post by: Sloper on October 29, 2014, 07:59:19 pm
NO, I do not support the idea of performance targets, performance should be about clinical outcomes, not 4 hour waits, not referral time targets, not fuckwitted 'diagnosis' targets.

Clinicians should be free to be clinicians and exercise their professional judgment.

The management of the NHS is, in my view a part of the problem not the likely source of the solution secondary cause of difficulties is the the political ineptitude and cowardice exhibited by all leading politicians.  The NHS simply cannot deliver everything, for everybody, all time time, free at the point of service.  Until politicians accept this then we're doomed to the failure of mediocre management.

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.
Title: Re: The end of the NHS.
Post by: fatdoc on October 29, 2014, 08:16:24 pm
Shouldn't that have been in the "only joking" thread  ;)

See this every 3 hours at work... As in.. This PISS poor ability for allegedly well educatated professionals seriously fucks it up. All the fucking time... Why?? Well these people don't go to work to do a shit effort.. The whole system breeds decay, rot and failure. This is a classic example..
Title: Re: The end of the NHS.
Post by: Sloper on October 29, 2014, 08:25:48 pm
Think of your BP, and relax.

On a more serious note, how would it improve your practice if you were able to tell people to fuck off, lose some weight, stop smoking, do some exercise and so on without the fear of 100s of complaints and so on?
Title: Re: The end of the NHS.
Post by: fatdoc on October 29, 2014, 09:17:55 pm
Im currently in a personal BP management programe. You are right, this sort of out of work reflection is not good for my health.

If I could tell people that is costs £10 per visit to ED, and that I could tell them, to f3ck off even so... My life would be much less stressful.
Title: Re: The end of the NHS.
Post by: GCW on October 29, 2014, 10:35:58 pm
Try getting £55 per head per annum for unlimited access. That'll get your BP up......
Title: Re: The end of the NHS.
Post by: a dense loner on October 30, 2014, 02:09:03 am
What was that the other day about some gp's getting 6 figures for only working wknds? How not true is that?
Title: Re: The end of the NHS.
Post by: chris j on October 30, 2014, 05:29:44 am

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?
Title: Re: The end of the NHS.
Post by: drdeath on October 30, 2014, 07:58:31 am

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

The legal system implicated?! The very idea...

Seeing as we usually quote to the Guardian around here, I might as well redress the balance...and I know Sloper likes cherry-picked examples as indicative of broad practice (as shown by earlier posts to this thread...)


http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html (http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html)

There have been reforms to the legal-aid/no win no fee arrangements since this was written, but a bulk of the claims still being processed date from before that time...

Declaration of interest - I work for solicitors writing reports on various clinical/medico-legal issues...it's paid pretty well so far and I say yes to every offer that comes across my desk...money for old rope.
Title: Re: The end of the NHS.
Post by: GCW on October 30, 2014, 08:10:12 am
What was that the other day about some gp's getting 6 figures for only working wknds? How not true is that?

Average partner earnings are consistently dropping and are around £103,000 Gross. Knock off 24% pension, high rate tax, £10,000 compulsory fees etc and the take home ain't a lot for the job.
Title: Re: The end of the NHS.
Post by: fatdoc on October 30, 2014, 09:56:49 am
I have to agree with that. It's sounds a lot of cash... But these days with the accrued debts of educatin in what is a high school achieving cohort... Well, I'm sure moat student drs are a lot brighter than me... And could earn a truck load more cash doing something else.

I lecture / inform 6th form students about the career paths medicine offers. Every time I get directly questioned on income. Ive done this for about 8 years, the income drop is now very clear in that time frame.

I realise, all to well, medicine is a vocation. But to attract the bright, motivated and eager I'm afraid the income isn't worth it these days. Don't get me wrong, real time salaries have fallen for decades, and in past generations the income from th state was preposterously high.... But now.... Put it this way..... I've made it very clear to my kids not to consider medicine...

There are easier ways to bring home a good wage.

Personally, despite rants and BP surges... I love my job. As I age I have learnt to let the ridiculous in house and national political meddling pass me by a whole lot more.... Well, to a degree. Best decision I ever made was to leave medical management. I feel for this in primary care, they cannot do that.

The stats say it all, no one wants to be a GP!!!!

This will give us a different point of access to free medical cre very soon.

Super sized impersonal primary care health factories with a huge onus on desperate to achieve ever changing national targets are inevitable.

Title: Re: The end of the NHS.
Post by: GCW on October 30, 2014, 10:18:16 am
Glad you do. I'm sick of all the crap, constant negative portrayal and blame by the media, and to be honest listening to the problems of 120 people each week is mostly pretty boring and mentally not stimulating. 
Title: Re: The end of the NHS.
Post by: lagerstarfish on October 30, 2014, 01:15:54 pm
PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

the cost of everything has been rising steadily since 1999/2000

also; the population has increased

also; as new types of case go through the courts, the gates are opened for easier claims for similar cases innit? as time increases, total cost of claims must increase
Title: Re: The end of the NHS.
Post by: lagerstarfish on October 30, 2014, 01:22:58 pm
as an aside; if any of you GPs fancy setting up a private alcohol rehab/detox facility, I'd be up for helping you print money
Title: Re: The end of the NHS.
Post by: drdeath on October 30, 2014, 01:33:16 pm
The richest colleague I ever had was contracted to one of those places...

I should have learned from him...

D
Title: Re: The end of the NHS.
Post by: Sloper on October 30, 2014, 01:49:00 pm

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

Not true.

Payouts in terms of the damages to the injured party a. only occur when there's negligence and b. have not kept pace with inflation.

Costs for claimant's are higher because of the 100% uplift which was introduced in 1997 by yes, you know who, to allow 'no win no fee'.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123761/ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123761/)

1999

Year           Damages             Defence Costs Claimant costs    Total
1999          £386,000,000      u/k                   £62,000,000 (legal aid)
2005-2006 £412,245,050     £53,894,083    £91,252,864       £557,391,997
2006-2007  £332,786,934    £49,808,394    £83,830,905       £466,426,233
2007-2008 £384,841,737     £56,848,517    £108,921,201     £550,611,455

This graph shows the numbers of claims going up c.40%

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/246509/0527.pdf (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/246509/0527.pdf)

I understand that payments for 2013 qill be about £1.25Bn

Yes, patients may be more willing to bring proceedings now than say in 1950, but I would suggest that this social change has not been a factor certainly in the last 4 years, so what cause could there be for an increasing number of claims, succesful claims and value of the claims?
Title: Re: The end of the NHS.
Post by: Sloper on October 30, 2014, 02:03:45 pm

PS I'm still waiting for anyone to come up with an answer as to why the cost of successful claims for clinical/medical negligence has been rising steadily since 1999/2000.

Because punters are more litigious than they used to be and less likely to accept an error as 'mistakes happen sometimes' and rapacious lawyers are demanding higher pay-outs?

The legal system implicated?! The very idea...

Seeing as we usually quote to the Guardian around here, I might as well redress the balance...and I know Sloper likes cherry-picked examples as indicative of broad practice (as shown by earlier posts to this thread...)


http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html (http://www.telegraph.co.uk/health/healthnews/9352397/Lawyers-seizing-lions-share-of-payouts-in-NHS-negligence-cases.html)

There have been reforms to the legal-aid/no win no fee arrangements since this was written, but a bulk of the claims still being processed date from before that time...

Declaration of interest - I work for solicitors writing reports on various clinical/medico-legal issues...it's paid pretty well so far and I say yes to every offer that comes across my desk...money for old rope.

I can't connect to the Torygraph, but will asssume that they don't realise that the costs claimants earn are a. generally limited by the Courts, b. assessed for reasonableness and c. are paid by the compensating party only if the claimant wins.

Legal Aid was withdrawn by Labour and to maintain 'access to justice' firms were allowed to act on no win no fee and chagre a 'success fee' of up to 100% of base costs to the defendant provided there was a settlement.  The rate of successful clin neg claims is actually quite low and such you need to 'win big' to subsidise the cases which don't settle.

That said most cases are kicked out by claimant lawyers before the letter of claim is sent, so there's not a lot of defence costs incurred on those matters.

Lagers, the point is the claims vs the NHS were steady until about 2008 and then there's been significant and unexpected growth, so there's been something that underpins that, in respect of inflation generally, yes, I'm aware that it's been going up (as has the population) but I don't think we've seen a 40% inflation in population or a 300% rise in general inflation since 2008, so the natural rise theory doesn't look too attractive.

The most logical suggestion I've heard is that the underlying case is the WTD and the changes to hospital doctors' training, i.e. Drs are now less experienced than before and consequently make more and more serious errors.
Title: Re: The end of the NHS.
Post by: jfw on October 30, 2014, 02:09:37 pm
could the propensity for error also be linked to the paucity of funding

i.e. stretch resources too thinly and cock ups happen
Title: Re: The end of the NHS.
Post by: lagerstarfish on October 30, 2014, 02:17:36 pm
I can't be expected to formulate theories that are consistent with actual data. I'm not a scientist

Title: Re: The end of the NHS.
Post by: Sloper on October 30, 2014, 04:43:25 pm
could the propensity for error also be linked to the paucity of funding

i.e. stretch resources too thinly and cock ups happen

It absolutely could, and this is not to be dimissed, but clin neg claims usually have a lag time of three / four years between the index event and settlement (and about two years from index event to proceedings) so I don't think we'll see whether there has been any effect until say 2017/18 9as the spending rate for the NHS until about 2012 was I think steady with the previous government's settlements.

What is however clear is that the graph, in terms of claims was going up even when money was, if you accept that it was and that is open for debate, pouring into the NHS, so that funding didn't depress the claims.
Title: Re: The end of the NHS.
Post by: drdeath on October 30, 2014, 04:50:24 pm

The most logical suggestion I've heard is that the underlying case is the WTD and the changes to hospital doctors' training, i.e. Drs are now less experienced than before and consequently make more and more serious errors.


Hmm....I am no sure that's the case for a few reasons...

1 -
I worked both before the EWTD and after and in my experience people are far more aware of patient safety/the  possibility of negligence than they used to be, and practice accordingly...but that's just anecdotal, so not worth much...on the flipside I saw people get away with offering scandalously dangerous/poor treatment in the late 90's that I wouldn't expect to be tolerated now...maybe I'm just a starry-eyed optimist...

2 -
EWDT and changes to training were identical across both Scotland and England, and Scotland has seen nowhere near the level of payouts that England has...the budget for clinical negligence claims in Scotland is around £24 million. a year. If multiplied by 10 to get the UK estimate that would be £240 million - nowhere near the 1.25 Billion predicted for the UK.

I can't explain that disparity  -  and I have seen no reasonable explanation offered elsewhere.



Title: Re: The end of the NHS.
Post by: Sloper on October 30, 2014, 05:23:19 pm
While the costs are different apparently the upwards trend is very similar dor the year 2010/11 i.e. before there were any 'savage cuts'  ::) to the NHS (18% Scotland) (20% England) http://www.smj.org.uk/tag/negligence/ (http://www.smj.org.uk/tag/negligence/)  and the suggested cause, at least superficially is that such claims are harder to pursue in Scotland.
Title: Re: The end of the NHS.
Post by: drdeath on October 30, 2014, 05:42:47 pm
They're not just 'different', they would be predicted to be around £125 million...they're 20% of that...

And I don't believe the rise is due to savage cuts...

But I do agree with you that the likely biggest factor (in any increase/difference) is the access to/usage of the legal system as a means of redress...for better or worse...

D

Title: Re: The end of the NHS.
Post by: Sloper on October 30, 2014, 05:51:37 pm
Sorry, I think we're broadly ad idem, the costs and n of claims are probably due to the different legal systems (I don't even know how the assess damages in Scotland): however my point was that while the costs of the claims is much lower the trend line is pretty consistent and as such given the disparity between the systems the cause of the rise in England and Scotland is likely to be broadly similar.

Since the systems are so different (and the barriers to making a claim so significant) it is reasonable to suggest that the rise is not due to increased ease of access in England & Wales (as this has remained constant since 1997 and yet in 2007/8 we've seen a significant increase in claims (i.e. for events that probably occurred in 2004-5.

My point about cuts was slightly disingenuous. 
Title: Re: The end of the NHS.
Post by: GCW on October 30, 2014, 10:47:21 pm
The number of claims is difficult to quantify, Tom. The reasons for the increase in claims are mulifactorial. Media crap plays a huge part. Look at all the bollocks about GPs not referring cancers soon enough. Really? I respectfully suggest that we follow NICE guidance and the specific 2 week referral pathways. Oh hang on, that's what we are doing. And the hospitals are now complaining that we refer too much as potential cancer and they can't cope unless their funding increases. Ha ha.

Anyway, claims go up because every other advert is about how shit your NHS care is, it's cheap,to have a go (no win no fee). My most recent complaint was a guy that lives in southport that we took off the list because he lives over 20 miles outside our boundary.  I'd love to repeat the personal abuse, but that wouldn't be professional. PS thanks for wishing the deaths of my children, but you still need to register with a new GP.

I'm almost looking forward to the day that the government makes primary care collapse, and then privatise it. Let's see how the general public react when they realise what they've thrown away.
Title: Re: The end of the NHS.
Post by: Sloper on October 31, 2014, 10:39:01 am
The claims numbers come from the NHSLA so I think they're pretty accurate.

Should we allow for the solicitors to provide incentives for people to claim e.g. have a free ipad when your claim is accepted? Absolutely not and why it isn't banned escapes me entirely. (note we don't offer incentives)

Should we allow advertising, that's a more difficult one to address.

I'm sure the rise of the number of claims is complex and don't suggest that I have an answer or indeed can suggest the leading causes: however it is clear from the data that funding is not the prime cause i.e. funding goes up, the number of claims is at least flat / rising.
Title: Re: The end of the NHS.
Post by: GCW on November 05, 2014, 11:50:30 am
Quote from: GP Online
An unprecedented third round of GP trainee recruitment by Health Education England (HEE) cost £113,000 and filled just 72 out of 451 posts that remained vacant after the first two rounds, official data show.

Quote from: GP Online
GP workforce crisis could force 600 practices to close, warns RCGP

What was that the parties said about increasing numbers?   :lol:
Title: Re: The end of the NHS.
Post by: Sloper on November 05, 2014, 12:49:24 pm
One of the benefits of the market is if you can't recruit at £x + benefits you'll have to offer more £ or better terms,

Since you're here Doc, I've got a cold, can I have some antibiotics  :tease: (actually I've also now got a cough and green snot but I expect that too is viral and will pass)
Title: Re: The end of the NHS.
Post by: GCW on November 05, 2014, 01:09:56 pm
One of the benefits of the market is if you can't recruit at £x + benefits you'll have to offer more £ or better terms

Yeah, or get bailed out by someone on enough better terms than that!
Title: Re: The end of the NHS.
Post by: Sloper on November 05, 2014, 04:10:54 pm
Well if the desire is to have the state 100% i/c of the NHS and they say GP's should work 7 days a week for £40k surely those who rail against the 'privatisation' of the NHS should applaud this and encourage the GPs to 'suck it up', after all we can't "stuff Doctors mouths with gold" forever can we?

Or is it the case that Dr's want the benefits of a free market aspect within the NHS when it suits them? :-\

Title: Re: The end of the NHS.
Post by: GCW on November 14, 2014, 05:25:05 pm
To the anonymous person who wrote in to complain that I shouldn't be wearing a watch whilst seeing patients: balls to you. How do you want me to check your pulse?  FFS.
Title: Re: The end of the NHS.
Post by: tomtom on November 14, 2014, 05:34:28 pm
Get a fuck off big hourglass (set to 5 min of sand) and make a big point of turning it over when a patient comes in
Title: Re: The end of the NHS.
Post by: Sloper on November 14, 2014, 08:15:10 pm
To the anonymous person who wrote in to complain that I shouldn't be wearing a watch whilst seeing patients: balls to you. How do you want me to check your pulse?  FFS.

Isn't there a machine that does that?  PS the patient is obviously a cock.  I hope their complaint received the response 'thank you for your letter. We have considered the same.  We will take no further action. Yours Sincerely'
Title: Re: The end of the NHS.
Post by: webbo on November 14, 2014, 08:37:20 pm
More likely it will be " we accept that Dr Lanky Punter was not following infection control procedures to letter. In that although he followed correct hand washing procedure and had bare arms to the elbow, he was wearing a wrist watch. Therefore we accept your claim that you have been extremely traumatised by this and willing to offer you £1,000,000 for your troubles"
Title: Re: The end of the NHS.
Post by: Sloper on November 14, 2014, 08:51:01 pm
Sadly you're probably closer to the truth than I am.

When dealing with client complaints (about 1 or 2 a week) when we've screwed up we accept it and look to resolve things sensibly and move on, if we're in the clear I won't sell our staff short.

We had a cvnt complaining that 'a fucking school child could do that, you're shit' and some other less coherent nonsense (and stuff that I have to maintain confidentiality on), I asked him to apologise, he said no, so I told him we were terminating the retainer and even though it was 'no win, no fee' we could send him a bill and we would, and if he didn't pay we'd sue him.

The twat phone me and started having a go, and I offered to reduce our bill by £5 (to £1195) and if he didn't like it he could go to the Ombudsman,

If the NHS can't deal with twats properly then its a lack of political will within the trusts.
Title: Re: The end of the NHS.
Post by: petejh on November 14, 2014, 09:04:09 pm
The NHS could contract special lawyers as consultants to help them deal with these sort of issues... in fact outsourcing all complaints to a specialist team of case handlers would perhaps free up blah blah blah...
Title: Re: The end of the NHS.
Post by: Sloper on November 14, 2014, 09:10:16 pm
Yes they could and it would cost a fair bit, whether it would cost less than their in house fucktards is another question entirely.

If it was truly independent then the scandals would be laid bare (here's an example that pretty much all concerned must have been aware of http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis (http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis) and it would be significantly more likely than not that there would have been complaints that would have been "investigated" and "not substantiated")and dealt with and the frivolous fuckwits would be told go fuck off, a win win situation if there ever was one: however wouldn't this be creeping privatisation and therefore bad?

Having a complaints system that backs the clincians would I imagine result in a massive boost of confidence in the staff in the system and a real help with morale.
Title: Re: The end of the NHS.
Post by: webbo on November 14, 2014, 09:30:00 pm
The NHS works on the premiss that if it's cheaper to settle out of court even if we are in the right then fuck backing the Clinician.
Title: Re: The end of the NHS.
Post by: petejh on November 14, 2014, 09:55:55 pm
Yes they could and it would cost a fair bit, whether it would cost less than their in house fucktards is another question entirely.

If it was truly independent then the scandals would be laid bare (here's an example that pretty much all concerned must have been aware of http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis (http://www.theguardian.com/society/2014/nov/14/colchester-hospital-sedation-restraint-cqc-nhs-crisis) and it would be significantly more likely than not that there would have been complaints that would have been "investigated" and "not substantiated")and dealt with and the frivolous fuckwits would be told go fuck off, a win win situation if there ever was one: however wouldn't this be creeping privatisation and therefore bad?

Having a complaints system that backs the clincians would I imagine result in a massive boost of confidence in the staff in the system and a real help with morale.
I don't have a view either way other than: either way could work perfectly well or perfectly poorly dependent on the leadership and other qualities of the individuals that comprise the institution. After all an institution/system/whatever comprises individuals who possess independent minds, and consciences, morals and integrity that sit somewhere on a spectrum of psychopath to saint. What doesn't seem acceptable to me is any institution whether private, pseudo-private (state-funded contractors) or fully state-funded, working poorly/lazily/inefficiently.
Seems a key question is what drives people - patients and the institutions that serve them - to behave in the ways described in this thread? Jon Alexander's '4 thought' Killing the Consumer' offers one explanation.
Title: Re: The end of the NHS.
Post by: Sloper on November 14, 2014, 10:00:46 pm
The NHS works on the premiss that if it's cheaper to settle out of court even if we are in the right then fuck backing the Clinician.

Sorry simply not true.

THE NHSLA spends untold millions defending cases that are always
Title: Re: The end of the NHS.
Post by: webbo on November 14, 2014, 10:12:18 pm
Can someone explain in one reasonable length paragraph why 10 years ago I could see a GP within a couple of days (and I knew who they were) and now I get an appointment with 'my GP' (the new one allocated to me after the other one and the one before left) two weeks after calling? I'm not blaming anyone (especially Gp's) - it just seems like something that worked in fashion is now ferked...
Hmmm the cynic would say the change to the GP contract and structures introduced by Labour, or is it more complex than that? GCW, answers please.

Webbo, time the NHC stopped dealing with every complaint as if they have a currency just because they're made, cf whistleblowing.
If what you are saying is the NHS should stop believing every compliant has validity. I would love someone to implement this.
I have a current situation with a client with an extensive forensic history including robbery with violence,kidnapping, wounding and so on. Who complained because he turned up for an appointment at the wrong time and date due the appointment letter having a date and time that didn't match. He didn't bother to ring to say the letter did not make sense, before that was delt with. He then complained because he had not been allocated a female nurse because he can not trust men.
All this rather gets in the way of providing care for other patients and people wonder why there are waiting lists.
I posted this a couple of weeks ago. We are now being threatened with legal action for not responding to this "service users" needs and it seems in order avoid a court case the trust it's bending over backwards to avoid this.
Rather than actually challenging anything.
Title: Re: The end of the NHS.
Post by: petejh on November 14, 2014, 10:43:28 pm
Well, someone did fuck up the appointment letter did they not, causing this patient <consumer of medical product> to waste/rearrange a few hours of his existence.

But seriously, a court case for what? What could he claim for?
Title: Re: The end of the NHS.
Post by: GCW on November 15, 2014, 08:03:22 am
In some respects it is irrelevant. Technically, I'm supposed to acknowledge my "complaint", then investigate and respond within a certain timescale. This is obviously a fair bit of time and effort in what are usually stupid cases. In this one, I don't know who it is so I can't respond. We will have to look at it internally. :yawn:
Title: Re: The end of the NHS.
Post by: webbo on November 15, 2014, 10:01:00 am
They are claiming they are not receiving appropriate treatment and are requesting that they are given therapy 3 times a week home visits by a female nurse.
This is someone that the risk indicators strongly suggest should not be visited at home and if there is no way a home visit can be avoided then it would be a two person visit one of whom should be a male(large size).
They will not accept any clinical opinions that this is not viable.
Chances are they will reoffend blame their" Illness" and lack of treatment and sue.
Title: Re: The end of the NHS.
Post by: Sloper on November 15, 2014, 12:10:22 pm
That's shit management. There's no loss and therefore no basis for a claim in law.

We're dealing with a case of negligent dental treatment, where the patient did not consent to the procedure, the evidence from the expert (joint) witness is overwhelmingly in favour of the claimant and yet the matter had been running on for 2.5 years with no admission then 16 months after the joint expert report said the defendant was liable there was an admission but no offer.

We had to issue proceedings to obtain an interim payment to fund remedial treatment.

The interim payment was £8500 and the costs of the application for the interim payment were about £2k for us (and a similar amount for the defendant) still there's no offer to settle.

The costs at the moment will already exceed the value of the claim, the defendant's actions are not in their own interests as this case will end up with £35k for damages and costs globally will be at least double that.  While it's better for us to have a £20k bill, this really isn't in the interests of the patient/client or indeed the NHS.

This is not the defendant solicitors fault it is the NHSLA not giving reasonable instructions.

The above is not an outlier, rather a common occurrence.
Title: Re: The end of the NHS.
Post by: Offwidth on January 06, 2015, 01:06:14 pm
A classic Roy Lilley Xmas post:

   
Merry Xmas, again!
News and Comment from Roy Lilley

Yes, it's me again. I'm sorry but I just couldn't let this go. Something dropped into my inbox that made me soooo cross, I put it on Twitter and Twitter exploded; now a lot more people are angry. https://twitter.com/RoyLilley/status/547137950581288960/photo/1
 
This is not the time of the year to be annoyed. This is about good cheer, mince pies, sprouts and peace but I'll have to get this off my chest before I can settle down to my slice of Norfolk.
 
It's a letter sent to medical directors from the three blind mice; the Carbuncle, the Totally Dismal Army the TDA and over-paid Monitor (The boss costs us, in total, probably close on a quarter of a million a year), the purpose is to remind medical directors that the NHS is busy and there are targets to be met.
 
It is signed by two people I doubt you would know if they popped out of your Christmas cracker and the third, unbelievably, Uncle Bruce. I think Bruce Keogh is the most trusted man in the NHS and why he has put his name to this I cannot imagine.
 
This letter epitomises what is wrong with today's NHS. First, it is signed by three people. Who runs the NHS? If I want tickets for the Cup Final I could ring up Greg Dyke, the chairman of the FA. If I have a complaint about a dress I bought in Top Shop I could ring Phil Green. I know who runs these organisations. Who runs the NHS? Who do I ring? If Martians land in the back garden and demand 'take me to your leader' where do you go? Train to Leeds, Tube to Elephant&Castle or cab to Whitehall?
 
The second irritating, exasperating, infuriating thing is the tone of the letter. 'There should be zero tolerance of over 12 hours waits for admission'. YES, WE ALL KNOW THAT! And, eleven hours and 10, 9, 8, 7 and even half an hour. That is why the NHS is straining everything it's got, to work in this silted up, fragmented, short of people system.
 
When social services can't get people home safely, patients are two in a bed and there are six ambulances parked outside, should we show this letter to the patients and say; 'Please go home, we have no hope in seeing you in the target time and we will get into trouble if you stay'.
 
This letter is simply backside covering; when the inevitable headline appears in the Daily Mail and LaLite goes off on one, these two and god knows why, Uncle Bruce, can say, 'We wrote a letter, Minister'.
 
Does it say 'if you have a problem ring me'? No. Does it say here are ten really good ideas that might give you some help. No. Does it say we have a plan, a brainwave, anything helpful, useful, assistive? No.
 
So, when the anonymous ones are feet up, snoozing after their Xmas lunch they can dose-off in the knowledge that whilst the rest of the NHS is busting a gut, heaving, sweating, pushing, shoving, straining and working 'till they drop... they have written a billet-doux. They've done their bit.
 
And their 'bit' is? Point out that the NHS is busy and if you foul up send in a root-cause analysis, in triplicate, by Monday.
 
This letter says it all about the NHS; poor leadership, clunky communications, dysfunctional triplicated, distributed leadership model, buck-passing, annoying, petty, unhelpful people looking busy. It says 'I'm covering my back by loading stuff onto your back'.
 
This has to stop. The pointless TDA have to be scaled back, rolled into a slimmed down Monitor. NHS leaders have to behave like leaders.  If things can't be done they have to say so, figure out why and fix it if it can be fixed.  We need 2015 to be the year of stripped-pine honesty.
 
If the service is going to get through the next few months threatening letters disguised as seasonal greetings won't help. They fool no one and are at the heart of the other corrosive NHS malaise; bullying, whistleblowing and getting to the truth. You can bet your life Medical Directors will be shoving this letter down the pipeline and down the throats of the front line; heaping more pressure onto people who dare not complain or question because they see whistle-blowers lose their jobs. 
 
Bullying starts at the top and this letter is testament to that.
 
Leaders must learn, when targets are failed only one word matters; 'why'. Serious incident reports will never discover more than reflective management. Leaders must celebrate success and share best practice, give time and space for good people to do great things.
 
Merry Xmas, again...
------------------------
What's the future for primary care?
If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of
 The Big Conversation about Primary Care.
  Details here.
--------------
  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.
Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.

Title: Re: The end of the NHS.
Post by: Will Hunt on January 06, 2015, 10:03:15 pm
I do not work in the NHS but my partner is a sister. We often liftshare and even I can see that leadership in the NHS from the management side is totally fucking non-existent. In fact, it's less than that.

As in the post above, these people are faceless and anonymous. Nobody on what you could call the 'operational' side of the NHS - the part that matters to the people who pay for it - knows who is running the show behind the scenes. Just before Christmas a few of the directors did the rounds of the hospital to spread the festive spirit. Nobody knew who any of them were. They turned up with faces like slapped arses and NOBODY FUCKING SAID MERRY CHRISTMAS! In fact on of them followed it up with a totally fictitious complaint that the ward smelled funny (elderly ward. Not uncommon to have UTIs, incontinence etc. Hardly a fucking surprise if there is occasionally a little whiff that is later dispelled).
Title: Re: The end of the NHS.
Post by: Will Hunt on January 06, 2015, 10:22:11 pm
And then of course its possible to go too far the other way - though this is the lesser of the two evils. A CEO of the Dudley Trust was on the radio this evening and was very eager to tell the pundit how she and her management team had been "rolling up their sleeves" to "pitch in" during this "difficult time" and had been pushing patients on trolleys up and down the corridor.

Now on one side I can see how this is a great thing to "lead from the front" and show the troops that we're all in this together etc etc etc  :sick:
But stop, let's think a minute. The CEO of the Dudley Group is paid £175k - 180k. And you're telling me that they spent half a day doing portering work? How is that an effective use of their time? Why not engage in positive, sensible leadership all year round rather than having an epi when winter hits and getting under everybody's feet trying to do a job that you have no fucking idea how to do.
Oh take this one to Ward K3 and give them to Nurse Stressed-to-Fuck? Could I just clarify where that is and who they are, please?
Title: Re: The end of the NHS.
Post by: GCW on January 06, 2015, 10:43:33 pm
The media over the past 48 hours has been mental.

A&E has been super stretched since the start of December because GPs are closed over Christmas. Errr, what????

Make GPs do 5 A&E sessions a month. Errr, yeah but who covers my 5 sessions a month and who pays??

There aren't enough GP trainees to fill the posts. Oh, well all GP trainees should take a 31% cut in pay.

It's all about to fall over and become privatised.............


Quote from: GP Trainee
As a GP in training, I read with interest the recent articles detailing the return of ‘golden hellos’ to certain practices that can’t seem to recruit partners. These incentives are anything from £5,000-£20,000, should the partner remain for a requisite time period. Will anyone really be won over by an extra £1,250 approximately a year after tax? Ultimately, it’s going to be less of a bind, doing a couple of locum shifts. I’d see it as a nice bonus at best, but it’s hardly a golden ticket.

There is a shortage of GPs, which means there is always going to be some sort of work available. As more senior GPs take their retirement early in wake of the changes to our pension scheme (among other things), the number of vacancies will only increase and so there will be that much more choice for those left. That, in turn, means that those looking to recruit must compete against one another, and we’ll see more cases of golden handshakes, golden handcuffs and the like.

I don’t plan on applying for a partnership when I complete my training. There are several reasons for this. Firstly, I’d like to try working for different practices. This seems to be what the majority of newlyqualified GPs do. It makes good sense to know that the practice you’re committing to is where you want to remain. Secondly, there is more scope for working part-time, or to a particular working pattern which lets me put the children to bed at least a few nights a week. Thirdly, and this is true for a lot of doctors, my partner is also a doctor, albeit a hospital doctor. We must both fit our careers in, and as there are that many more jobs in primary than secondary care, we will be more governed geographically by her place of work than by mine. Fourthly, from what I gather there is almost no benefit, financially at least, in becoming a partner. Coupled with the additional pressures and workload this brings, it’s easy to see why most people aren’t jumping in with both feet.  And finally, there is the consideration of relocating overseas. Many of my friends have done this; most go for the experience but end up staying as they have found so much more job satisfaction and work-life balance. There was a time when talking about relocating overseas would give me a pang of guilt; the National Health Service is very close to my heart, and I think we should all be proud to work for the values it embodies.

Unfortunately, the NHS is no longer an ideal employer, and thinking of it in purely careerist terms, , that pang of guilt I feel about emigrating goes away quite quickly. When I substitute ‘NHS’ for, to pick a random example, Tesco, things start to sound pretty unappealing. For example, ’Tesco staff told no pay rise for three years’ sounds entirely unacceptable. Why, then, would people still work for such a company? Increasingly they are not. Doctors are leaving the NHS for greener pastures at all stages of their careers. A significant number of the people I qualified with have left medicine altogether, and not for glamorous careers elsewhere. I know of consultants leaving to become photographers, or personal trainers. And now, of course, there are a lot of doctors preparing to take early retirement.  Clearly, the NHS is no longer an attractive employer.

I’m not sure I know how to fix the situation. Recruit more doctors? Retain the ones we’ve got?

Certainly, any form of golden handshake would probably need to start on the first day of medical school to have any meaningful sort of effect. The military use it as a recruitment tool - perhaps the NHS needs to as well. Only when there are enough people staying in the NHS will there be enough people to recruit from. But only by changing the way the NHS treats its staff will people stay in the long term. Doctors are not volunteers and the NHS is no charity - most obviously, charities still provide their employees with pay rises.

If nothing happens to improve things then the situation will continue its downward spiral. Shortfalls will put more stress on those in post, who will in turn look to get out for their own sake, be it by going abroad, switching careers or retiring. With such uncertainty, it is not surprising that few people want to commit to partnerships.

Ultimately there may be few things that can be done to attract new partners, but I think any prospective surgery would need to be supportive and caring. It may sound twee, but getting on with the people you work with and the culture at your surgery make a big difference to any GP’s morale. People don’t mind hard work, provided that they feel valued. (That, and a big fat cash incentive.)

Dr Tim Cassford is a GPST1 in Chichester.

We are a high flying, well respected practice- forward thinking, on th LMC and CCG. One of our partners is going- can we recruit a new partner?  Can we f**k!  So where does that leave us?  Having to put masses of our own cash into the business?  No siree in this climate!  Sell out and move on?  Hmmmm.  Speak to me in a few weeks......
Title: Re: The end of the NHS.
Post by: GCW on January 06, 2015, 11:10:10 pm
PS. 93% of GPs can't be wrong, eh?  Eh?   Eh?         Eh?                  Eh?

(http://i280.photobucket.com/albums/kk163/CyLwiki/imagejpg1.jpg)
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 07:34:42 am
GCW, hmm 'no one wants to put money into the business'? Sounds like private enterprise to me, I thought that privatisation was a bad thing? :greed: ::)

So if it's already 'private', maybe it needs nationalisation, salaried GPs without the partners taking out the profit?

Ohh and as for a 31% cut? Luxury, for most of the work we do the amount we can recover has fallen >60% by government fiat.
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 08:11:24 am
That's the issue. It's a bizarre blend of small business that isn't private, can only work within tightly set criteria and struggles to move on. It's a model that won't work in five years.

But, that's the system as is. So unless it entirely collapses (banging that drum again) it's nigh on impossible to reform.

No one gets how cost efficient general practice is. To run it privately as is will cost five times as much (at least).  Go for it. I think you'll struggle.

As for pay, partners often don't earn more than salaried but may well have £100k liability in the ownership. Trainees don't earn what "qualified" GPs do. Do to recruit yo primary care in crisis, the best thing is to pay 2/3 of a hospital job.

Even you can see your point is illogical.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 09:32:00 am
I have no doubt that the system is facing very real challenges and that as a system it will change radically over the next 10 - 20 years.

What makes this necessary change more difficult is the childish and ignorant political response as demonstrated by too many who comment on the subject (see this thread for legion examples).

For example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.

You say to run general practice privately will cost more but it IS run privately, as you yourself say partners put money into the business and will get a return on that investment*: how would stripping out partner equity and return on equity make the system more expensive?

The issue seems to be one of relatively fixed supply with demand increasing in an unfixed manner.  That in any circumstances will lead to fracture and failure. 

What we need to do is restrict demand to those with a genuine need: you yourself recognise that many attendances are unnecessary, the only means of achieving this is to start charging for unnecessary attendances in both primary care and A&E.  The money raised will be marginal but it will drive a degree of change as to social mores re use of the system.

* even if not in direct earnings.
Title: Re: The end of the NHS.
Post by: slackline on January 07, 2015, 09:42:46 am
For example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.

And what was it under the Tory government that preceeded Labour?  If it was 4.9% when Labour took over then such representations are perfectly justified.  If you could cite your sources I'll go and look this up.

(I don't really care who is responsible for the greatest amount of privatisation, its petty tit-for-tat bickering since both parties are as bad as each other, but I do think that its bad practice to cherry pick statistics and ignore others in order to support ones point of view).
Title: Re: The end of the NHS.
Post by: tomtom on January 07, 2015, 09:59:32 am
The issue with privatisation and the NHS is that the 'system' needs to be integrated. For example, A&E crisis partly due to elderly patients not being able to be released due to reduced council care budgets, therefore no beds, therefore A&E clogged, therefore people waiting in ambulances, therefore ambulances in use so hour plus waits for 999's etc...

The £££ for treatment needs to go with the person not the facility... (almost like an insurance policy... more later..). if GP, Hospital, Social care/Rehab are all funded separately then there is little or no incentive for any integration between the various organisations. Another example, GP's under strain (financially or other), so people bumped onto A&E... many of GCW's examples (in previous posts) show the lack of integration. Even at a higher level, examples on C4 news last night where trust execs saying how in the past other hospitals would pitch in and help those in trouble - now there is less/no incentive for those from another trust to help..

This is my biggest beef with the privatisation - its fucking cack handed.... It needs a way to ensure that the transition between the various parts of the service are good and smooth. If you had one (decent) company running everything - overseeing stuff from top to bottom (an insurance company for example??) then I can see that working to a degree - but at the moment it appears to be all over the shop... Oh - is that what NHS trusts are supposed to be?

I dunno. Its depressing stuff... listening to R5 this morning and a A&E consultant saying how he saw a stroke victim who put off coming until 12 hours after his symptoms came on to try and save A&E pressure - and in the docs words "missed his window for recovery"... I've a wonky back and in an ideal world would like to get a proper scan and diagnosis - but no point even bothering my GP about this ~ 2 week appointment time at the moment. Yet MrsTT (Different city, different surgery) has just completed a 6 week hydrotherapy course for her (very much less) wonky back referred from her GP.. My parents both suffer from AMD and fortunately (postcode lottery) get the £££ jabs in the eye every month or two to treat it. Yet disabled brother in law is withering away (sadly literally) waiting for a delayed op to drain fluid on the brain... Sorry the last bit was a bit of a rant rather than anything constructive - I guess my point is that there seems no logic or consistency in what happens...
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 10:34:15 am
For example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.

And what was it under the Tory government that preceeded Labour?  If it was 4.9% when Labour took over then such representations are perfectly justified.  If you could cite your sources I'll go and look this up.

(I don't really care who is responsible for the greatest amount of privatisation, its petty tit-for-tat bickering since both parties are as bad as each other, but I do think that its bad practice to cherry pick statistics and ignore others in order to support ones point of view).

From memory the 'siphoning off' was about 0% of the NHS budget under the Tories (yes there was contracting out of non care services, cleaning IT and the like) but the use of NHS buget for what would previously have been w/in the NHS care started following (from memory) the 2003 Act and increased after the 2007 Act.

I'm sure the Kings Fund did a paper on the Independent Sector Treatment Centres in 2006/7 showing the inefficiency resulting from the poor contracting process.

Fatdoc is probably well placed to comment on the transfer of elective surgery >2003
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 10:41:31 am
The issue with privatisation and the NHS is that the 'system' needs to be integrated. For example, A&E crisis partly due to elderly patients not being able to be released due to reduced council care budgets, therefore no beds, therefore A&E clogged, therefore people waiting in ambulances, therefore ambulances in use so hour plus waits for 999's etc...

The £££ for treatment needs to go with the person not the facility... (almost like an insurance policy... more later..). if GP, Hospital, Social care/Rehab are all funded separately then there is little or no incentive for any integration between the various organisations. Another example, GP's under strain (financially or other), so people bumped onto A&E... many of GCW's examples (in previous posts) show the lack of integration. Even at a higher level, examples on C4 news last night where trust execs saying how in the past other hospitals would pitch in and help those in trouble - now there is less/no incentive for those from another trust to help..

This is my biggest beef with the privatisation - its fucking cack handed.... It needs a way to ensure that the transition between the various parts of the service are good and smooth. If you had one (decent) company running everything - overseeing stuff from top to bottom (an insurance company for example??) then I can see that working to a degree - but at the moment it appears to be all over the shop... Oh - is that what NHS trusts are supposed to be?

I dunno. Its depressing stuff... listening to R5 this morning and a A&E consultant saying how he saw a stroke victim who put off coming until 12 hours after his symptoms came on to try and save A&E pressure - and in the docs words "missed his window for recovery"... I've a wonky back and in an ideal world would like to get a proper scan and diagnosis - but no point even bothering my GP about this ~ 2 week appointment time at the moment. Yet MrsTT (Different city, different surgery) has just completed a 6 week hydrotherapy course for her (very much less) wonky back referred from her GP.. My parents both suffer from AMD and fortunately (postcode lottery) get the £££ jabs in the eye every month or two to treat it. Yet disabled brother in law is withering away (sadly literally) waiting for a delayed op to drain fluid on the brain... Sorry the last bit was a bit of a rant rather than anything constructive - I guess my point is that there seems no logic or consistency in what happens...

In respect of integretation (which is imissible with fragmented privatisation) I entirely agree: generally I am against the widespread use of private services within the NHS as generally the NHS can do things better and more efficiently as part of larger organisation not driven by profit.  The most obvious area where this fails is the GP sector. 

Large GP practices in towns and citys are probably quite profirable if well run but smaller practices in rural areas will be probably on the margins of profitability if care is to be adequate. 

As such if there's a 'non profit distributing group' of practices the large profitable urban centre can cross subsidise the unprofitable rural centre and provide better services, greater penetration and more robust resilience.

Although I can imagine that nationalisation of GOP care might not go down too well with the well off GPs (I accept some might not fall into this description).

Of course we need to look at social care and 'pathways' but these are incredibly complex and difficult relationships~; what is not complex or difficult is to say to twats who turn up to A&E without any good cause is 'that'll be £150.00 please' (not the NHS recovers almost <£600 from the liable insurer if someone turns up in A&E following a road traffic collision).
Title: Re: The end of the NHS.
Post by: slackline on January 07, 2015, 11:00:11 am
For example 'privatisation' of the NHS was something like 4.9% under Labour and has increased to 6.1% under this government, but the representation of the 'privatisation' is very, very different i.e 'it's the Tories wot done it'.

And what was it under the Tory government that preceeded Labour?  If it was 4.9% when Labour took over then such representations are perfectly justified.  If you could cite your sources I'll go and look this up.

(I don't really care who is responsible for the greatest amount of privatisation, its petty tit-for-tat bickering since both parties are as bad as each other, but I do think that its bad practice to cherry pick statistics and ignore others in order to support ones point of view).

From memory the 'siphoning off' was about 0% of the NHS budget under the Tories (yes there was contracting out of non care services, cleaning IT and the like) but the use of NHS buget for what would previously have been w/in the NHS care started following (from memory) the 2003 Act and increased after the 2007 Act.

I'm sure the Kings Fund did a paper on the Independent Sector Treatment Centres in 2006/7 showing the inefficiency resulting from the poor contracting process.

Fatdoc is probably well placed to comment on the transfer of elective surgery >2003

I'm expected to trust your alcohol abused memory!   :slap:


Only joking, but it would be interesting, some might say vital, to know these figures and even more importantly how they are derived (i.e. are they directly comparable) in order to understand the broader picture of which party is responsible for what that is being insinuated.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 11:14:15 am
My memory for politics and other random stuff is frighteningly good, it's stuff like who people are or what I did when that's awful and has nothing to do with  :alky:

I would imagine there would be so much variation in the collection of stats and the protocols re aggregation & etc that precise comparison would be impossible (whether by design or otherwise).

http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/health-privatisation (http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/health-privatisation)
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 11:52:37 am
You say to run general practice privately will cost more but it IS run privately, as you yourself say partners put money into the business and will get a return on that investment*: how would stripping out partner equity and return on equity make the system more expensive?

The current system costs £50 odd quid per patient per year for core work, for infinite access to a GP.  It's a flat rate, plus bits of performance related pay on top.  A single private GP appointment at our local private provider is £80, and that doesn't include tests or prescription.  If a private provider ran the system, there is no way they could maintain this service (which is what is happening in the current system) and make a profit.

Large GP practices in towns and citys are probably quite profirable if well run but smaller practices in rural areas will be probably on the margins of profitability if care is to be adequate. 

We are talking about an average sized practice having a turnover of £1.5 million if that - it's small fry stuff.  A lot of rural practices receive an addition funding to support them - this is now being pulled and a LOT of these guys will make a loss very soon and thus close.  Virgin won't touch these with a stick.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 11:59:54 am
You say to run general practice privately will cost more but it IS run privately, as you yourself say partners put money into the business and will get a return on that investment*: how would stripping out partner equity and return on equity make the system more expensive?

The current system costs £50 odd quid per patient per year for core work, for infinite access to a GP.  It's a flat rate, plus bits of performance related pay on top.  A single private GP appointment at our local private provider is £80, and that doesn't include tests or prescription.  If a private provider ran the system, there is no way they could maintain this service (which is what is happening in the current system) and make a profit.

Large GP practices in towns and citys are probably quite profirable if well run but smaller practices in rural areas will be probably on the margins of profitability if care is to be adequate. 

We are talking about an average sized practice having a turnover of £1.5 million if that - it's small fry stuff.  A lot of rural practices receive an addition funding to support them - this is now being pulled and a LOT of these guys will make a loss very soon and thus close.  Virgin won't touch these with a stick.

You seem to be missing the point, your practice is a private practice: just a practice which doesn't charge the patients for routine work (I am sure your practice charges for lots of other things, letters to lawyers, reports for employers and the like).

BTW I'm not arguing that there should be wholesale or widespread privatisation of the NHS or in healthcare, merely pointing out that the hysteria on this subject (i.e. privatisation rather than the wider problems within the NHS, re-organisation and so on) is ignorant at best or malign at worst.

The reason why Virgin / Bupa won't touch small rural practices is that they're loss making, hence the need for either significant subsidy or group cross subsidy from more profitable practices which would require the current private GP practices to be brought within the ownership of the state.

Nye talked of 'stuffing the doctors mouths with gold' perhaps those on the left would like to see the GP practices owned by the partners acuired by the state with no compensation to the partners?
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 12:09:36 pm
This comes down to what I've been saying for years - the whole idea is to stop doctors being independent contractors, and to make everyone a salaried employee by forcing the system to fail.  Then it can be taken over by private providers - but it will mean we all have to pay for the care in one way or another (not via NI) in addition to what we now pay, and the cost to the government to run it will skyrocket.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 12:46:39 pm
This comes down to what I've been saying for years - the whole idea is to stop doctors being independent contractors, and to make everyone a salaried employee by forcing the system to fail.  Then it can be taken over by private providers - but it will mean we all have to pay for the care in one way or another (not via NI) in addition to what we now pay, and the cost to the government to run it will skyrocket.

Sorry but that's tin foil hat style crap.

Why would the NHS having driven all GP's to be centrally contracted on say a scale of £80-100k (insert more realistic numbers I'm just guessing) and owning the estate, having centralised HR & IT systems then pay more for a profit making (if not distributing provider) provider?

Title: Re: The end of the NHS.
Post by: lagerstarfish on January 07, 2015, 01:12:25 pm
because they only commit to paying the provider for the length and targets of the contract, with the provider then being responsible for sorting out redundancies which result from reductions in funding?

there must be some reason
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 01:14:43 pm
Because I don't think they realise how much more it will cost.

The bottom line is this:  The NHS cannot remain free at the point of access in the current world of demand.  To continue, it will have to be paid for like other countries, insurance or whatever.  It is political suicide to privatise the whole thing, so the only way forward is to have a reason to do it - ie the system fails.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 01:24:00 pm
because they only commit to paying the provider for the length and targets of the contract, with the provider then being responsible for sorting out redundancies which result from reductions in funding?

there must be some reason

Hmm, let me put my business hat on . . . no that doesn't make sense businesses, let me try myu business hat . . . no still no.

Redundancies don't arise due to a lack of funding they arise when the job function is no longer required.

The reason why GCW's suggestion doesn't make sense is that it's bollocks.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 07, 2015, 01:29:06 pm

Redundancies don't arise due to a lack of funding they arise when the job function is no longer required.


lol
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 01:29:36 pm
Because I don't think they realise how much more it will cost.

The bottom line is this:  The NHS cannot remain free at the point of access in the current world of demand.  To continue, it will have to be paid for like other countries, insurance or whatever.  It is political suicide to privatise the whole thing, so the only way forward is to have a reason to do it - ie the system fails.

At last we agree, the NHS cannot remain FATPOU, all the time, for everything, for everybody.

As such we need to either

1. pour untold billions in (which is impossible given the present position)
2. restrict acces.

2. Is possible but politically risky: as such there needs to be a politically acceptable solution and charging (generally) drunken twats for atending A&E and using the ambulance service to ge there would be I think acceptable to virtually all the mainstream.  Of course it would be the thin end of the wedge and I ahve no doubt that a charge for GP appointments would follow with the 'safety net' that if you needed the appointment the charge would be waived which is slightly more problematic i.e. increasing the risk of late presentation it would do something to control demand.

Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 01:32:02 pm

Redundancies don't arise due to a lack of funding they arise when the job function is no longer required.


lol

https://www.gov.uk/staff-redundant/overview (https://www.gov.uk/staff-redundant/overview)

So unless they business went 'bust' and was not bought as a going concern with TUPE your 'model' is about as helpful as a matchbox car is to get you to work.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 07, 2015, 02:41:41 pm
that's what I thought

the norm in subs misuse is to TUPE staff across to the winning organisation and then make redundancies
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 02:56:12 pm
Sorry, that doesn't make sense from the NHS's perspective and politically it would be suicide.

So about as sound a plan as my scheme to sell body part options (inter vivos and post mortem)
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 03:17:46 pm
At last we agree, the NHS cannot remain FATPOU, all the time, for everything, for everybody.

Eh?  I've said that for ages! (http://ukbouldering.com/board/index.php/topic,21748.msg451687.html#msg451687)
Title: Re: The end of the NHS.
Post by: webbo on January 07, 2015, 03:26:35 pm
that's what I thought

the norm in subs misuse is to TUPE staff across to the winning organisation and then make redundancies
Sorry, that doesn't make sense from the NHS's perspective and politically it would be suicide.

So about as sound a plan as my scheme to sell body part options (inter vivos and post mortem)
However lacking in sense it has been a model in substance misuse since private providers have been allowed to bid for NHS contracts.
You put in a lower bid get the contract, TUPE the NHS staff across. Get rid of the expensive qualified ones, recruit lots of unqualified cheaper staff. Your outcomes(deaths) might be worse but who cares its only Alkies or Junkies.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 03:28:44 pm
At last we agree, the NHS cannot remain FATPOU, all the time, for everything, for everybody.

Eh?  I've said that for ages! (http://ukbouldering.com/board/index.php/topic,21748.msg451687.html#msg451687)

And I don't think I've ever disagreed with you.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 03:31:28 pm
that's what I thought

the norm in subs misuse is to TUPE staff across to the winning organisation and then make redundancies
Sorry, that doesn't make sense from the NHS's perspective and politically it would be suicide.

So about as sound a plan as my scheme to sell body part options (inter vivos and post mortem)
However lacking in sense it has been a model in substance misuse since private providers have been allowed to bid for NHS contracts.
You put in a lower bid get the contract, TUPE the NHS staff across. Get rid of the expensive qualified ones, recruit lots of unqualified cheaper staff. Your outcomes(deaths) might be worse but who cares its only Alkies or Junkies.

I'm not an employment lawyer but that sounds like a flagrant breach of TUPE to me!

Further as for the politics, pleasant or not people regard the treatment of substance misuse as categorically different to GPs.  I would imagine that if you conducted a survey 995 would say that GP services should be publically funded and I would not be suprprised if a majority said that addiction services should not be publically funded.
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 03:38:59 pm
At last we agree

 :-\
Title: Re: The end of the NHS.
Post by: webbo on January 07, 2015, 03:45:53 pm
I'm not sure about employment law either but in the NHS if your job is put at risk, you can be offered a post at a grade lower with 18 months protected pay. Then you go down to the lower pay scale. I think its the same for local goverment staff.
The young peoples substance misuse service here in Dull was run by the city council with addtional seconded NHS staff. In the cuts they down graded all the Social workers who then left, the NHS were put at risk and moved to other posts. It is now staffed by unqualified care workers.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 07, 2015, 03:51:31 pm
staffed by unqualified care workers.

 :wave:

they're even training us triage monkeys to take bloods
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 07, 2015, 03:53:01 pm
I wonder whether those NHS redundancy/redeployment rights go with you if you get TUPEd into a non-NHS organisation?
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 03:55:44 pm
At last we agree

 :-\

Once you get used to it, you'll feel a lot better  :smart: although there are side effects.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 03:58:15 pm
I'm not sure about employment law either but in the NHS if your job is put at risk, you can be offered a post at a grade lower with 18 months protected pay. Then you go down to the lower pay scale. I think its the same for local goverment staff.
The young peoples substance misuse service here in Dull was run by the city council with addtional seconded NHS staff. In the cuts they down graded all the Social workers who then left, the NHS were put at risk and moved to other posts. It is now staffed by unqualified care workers.

that's called suitable alternative employment as an alternative to redundancy, but again not an employment lawyer and the question would be politics rather than law.
Title: Re: The end of the NHS.
Post by: webbo on January 07, 2015, 07:47:27 pm
It may be alternative employment as alternative to redundancy but it's a real pisser when you actually wish for redundancy.
Title: Re: The end of the NHS.
Post by: Sloper on January 07, 2015, 07:50:03 pm
Yep, I was talking to someone at **** bank before Christmas and he was fuming that he wasn't being offered redundancy as he was already planning to leave and be a consultant, hard to feel sorry for a banker though :coffee:
Title: Re: The end of the NHS.
Post by: GCW on January 07, 2015, 10:31:26 pm
There's an election looming. Labour will make me work 7 days. Tories are already screwing me over. Lib Dems plans are just as bad. Who can I vote for? (http://www.pulsetoday.co.uk/news/political-news/ukip-calls-for-revalidation-and-cqc-inspections-to-be-halted/20008866.article).

You gotta give it to them, they know a target market  :-\
Title: Re: The end of the NHS.
Post by: Sloper on January 08, 2015, 08:02:39 am
The Tories, because they won't fuck up the economy and without a strong economy the NHS will always suffer.



Title: Re: The end of the NHS.
Post by: GCW on January 08, 2015, 08:30:59 am
(http://mydavidcameron.com/images/cam-nhs1.jpg)
Title: Re: The end of the NHS.
Post by: Offwidth on January 08, 2015, 03:05:01 pm
that's what I thought

the norm in subs misuse is to TUPE staff across to the winning organisation and then make redundancies

One of the very very important but very understated aims of this govenment is to move activities from the public to private sectors arrangements . 'TUPE and forget' is much much cheaper than redundancy and ongoing expensive pension liabilities. Slope's argument about voting tory is bollocks as there will be nothing left to save in the NHS with the OK economy if this keeps going for much longer. I'm not even convinced their economics is so hot from a capitalist perspective as they seem to rely too much on a limited subset of ideology. Plus of course the right wing govenments got as royally screwed as the left wing governments in the worldwide crash which was triggered under the republicans in the US (labour must be too blame (as maybe Gordon Brown international super hero rescued them all wrong).
Title: Re: The end of the NHS.
Post by: Sloper on January 08, 2015, 04:17:50 pm
Steve, did you read the Kings Fund debunking the myth of privatisation & etc? They're hardly Monday Club nutters are they?

http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/health-privatisation (http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/health-privatisation)
http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/evolutionary-reforms (http://www.kingsfund.org.uk/topics/nhs-reform/mythbusters/evolutionary-reforms)

There is no credible basis for saying that a Conservative government will lead to significant damage to the NHS let alone its wholesale destruction, privatisation or the like.

Why do you continue to peddle such dishonest and moronic nonsense?

As for the implication in your post, viz. that Gordon Brown had nothing to do with the crash, that's simply a moronic lie.  Gordon brown instituted the failed regulatory regime overnight and ran a deficit in the boom years.  As such not only was he partially responsible for the bust he was wholly responsible for having nothing to hand to deal with the bust when it occured. 
Title: Re: The end of the NHS.
Post by: GCW on January 09, 2015, 08:58:07 am
Why would the NHS having driven all GP's to be centrally contracted on say a scale of £80-100k (insert more realistic numbers I'm just guessing) and owning the estate, having centralised HR & IT systems then pay more for a profit making (if not distributing provider) provider?

Slightly different, but look at Circle (http://www.theguardian.com/society/2015/jan/09/circle-exit-private-contract-hinchingbrooke-nhs).  Private provider takes on running the trust.  Once demand increases and income falls a bit, it's not a viable business.  The rest of the system is running under the same increase load and reduced income.

"Its franchise to operate the trust was not sustainable" - I think that's quite a damning statement for the whole system as is.
Title: Re: The end of the NHS.
Post by: tomtom on January 09, 2015, 09:05:17 am
Why would the NHS having driven all GP's to be centrally contracted on say a scale of £80-100k (insert more realistic numbers I'm just guessing) and owning the estate, having centralised HR & IT systems then pay more for a profit making (if not distributing provider) provider?

Slightly different, but look at Circle (http://www.theguardian.com/society/2015/jan/09/circle-exit-private-contract-hinchingbrooke-nhs).  Private provider takes on running the trust.  Once demand increases and income falls a bit, it's not a viable business.  The rest of the system is running under the same increase load and reduced income.

"Its franchise to operate the trust was not sustainable - I think that's quite a damning statement for the whole system as is.

Was listening about this on the radio this morning. The MD (or whoever) of Circle said demand for A&E had gone up 30% since they took over - hence not viable under the payment system they had. So the company can just walk away eh..
Title: Re: The end of the NHS.
Post by: GCW on January 09, 2015, 09:06:22 am
Yeah, but if you aren't a private company you don't have that luxury......
Title: Re: The end of the NHS.
Post by: tomtom on January 09, 2015, 09:37:25 am
Yeah, but if you aren't a private company you don't have that luxury......

Indeed.. (sorry my 'eh' was meant to convey that)...
Title: Re: The end of the NHS.
Post by: Sloper on January 09, 2015, 10:12:14 am
Why would the NHS having driven all GP's to be centrally contracted on say a scale of £80-100k (insert more realistic numbers I'm just guessing) and owning the estate, having centralised HR & IT systems then pay more for a profit making (if not distributing provider) provider?

Slightly different, but look at Circle (http://www.theguardian.com/society/2015/jan/09/circle-exit-private-contract-hinchingbrooke-nhs).  Private provider takes on running the trust.  Once demand increases and income falls a bit, it's not a viable business.  The rest of the system is running under the same increase load and reduced income.

"Its franchise to operate the trust was not sustainable" - I think that's quite a damning statement for the whole system as is.

Exactly and that's why the system is just not suitable (as I said many posts ago) for privatisation and why there are no plans for privatisation & etc

That the Blair & Brown PFI project has been such a disaster is surely reason enough not to trust Labour with the NHS.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 09, 2015, 10:24:58 am
is the plan to make the NHS function at such a low level that more people will begin to take out private health insurance?
Title: Re: The end of the NHS.
Post by: Sloper on January 09, 2015, 11:03:50 am
is the plan to make the NHS function at such a low level that more people will begin to take out private health insurance?

BUPA & etc have been around since er when exactly, let me fire up google.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 09, 2015, 11:59:10 am
yes, they already existed, but I'm sure they would be happy to increase their customer base if they were to become become the only percieved safe option for people who are scared of their families suffering ill health and related death stuff
Title: Re: The end of the NHS.
Post by: petejh on January 09, 2015, 12:55:13 pm
With zero stats to back up my claim I'm certain that private healthcare is becoming increasingly common in the uk. I've gone through 10 years of on-off treatment for lower back problems and virtually all of it has been self-funded - MRI's, various consultants, physio, chiro, and eventually an operation. All private. I had one injection on the NHS - and even for that I jumped the queue by seeing the consultant privately, who then offered me the injection on NHS (against the rules). I felt at the time that this was morally questionable. My back hurt so I did it anyway.
My clear impression of the health care system in the UK - at least for muscular-skeletal treatment - is that there exists a large well-established 'grey market' of consultants and scanning technologies, and that there are loads of people 'topping-up' and accelerating their treatment by having scans, consultations and other such treatments privately - which then gets you further along in the system - while trying to keep the really expensive stuff -operations - on the nhs.
Waiting to have all treatment on the nhs is akin to sitting in the left-hand lane, as a two-lane road 'merges-in' approaching roadworks, and watching every sharp elbowed twat move past you on the right-hand lane - thus making your journey slower. The advertising backs this up. Various companies now overtly offering 'jump the nhs queues'. Another symptom of the have/have-not society (below the super rich) in this country
Title: Re: The end of the NHS.
Post by: Sloper on January 09, 2015, 01:24:01 pm
yes, they already existed, but I'm sure they would be happy to increase their customer base if they were to become become the only percieved safe option for people who are scared of their families suffering ill health and related death stuff

Actually I'm not sure that they would want to increase their number of members (across the board) as their own capacity is probably less flexible than the potential increase.

Peter, you're absolutely right abou the grey market, when I needed my knee surgery (waiting time 2 years in 2004/5) I paid for a private consultation c£250 and the magically foundmyself on the NHS waiting list in 3 months  :sorry:
Title: Re: The end of the NHS.
Post by: tomtom on January 09, 2015, 01:51:36 pm
Yup - I've not even bothered my GP regarding my back problems... all ££ from my own pocket. Still I can afford it at the moment, so...
Title: Re: The end of the NHS.
Post by: petejh on January 09, 2015, 02:05:19 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
Title: Re: The end of the NHS.
Post by: GCW on January 09, 2015, 02:07:03 pm
Part of the issue is the unfair two tier system of NHS and Private medicine where going down the PP route queue jumps NHS care, and any f**k ups done in private care get dumped on the NHS to sort out.
Title: Re: The end of the NHS.
Post by: webbo on January 09, 2015, 02:32:38 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.
Title: Re: The end of the NHS.
Post by: petejh on January 09, 2015, 02:48:22 pm
That's why I didn't type 'nurses'.
Title: Re: The end of the NHS.
Post by: webbo on January 09, 2015, 02:57:59 pm
That's why I didn't type 'nurses'.
As you state Doctors, consultants and other healthcare professionals who else do you mean other than Nurses. Occupational Therapists?
Title: Re: The end of the NHS.
Post by: tomtom on January 09, 2015, 02:59:45 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses? ;)
Title: Re: The end of the NHS.
Post by: petejh on January 09, 2015, 03:05:12 pm
That's why I didn't type 'nurses'.
As you state Doctors, consultants and other healthcare professionals who else do you mean other than Nurses. Occupational Therapists?

You're the medical guy - suggest someone with a similar power to mould their environment as 'Doctor' and 'Consultant'. If there is no-one then take my 'other' to mean 'no-one'.  You might have figured that was my intent though.
Title: Re: The end of the NHS.
Post by: petejh on January 09, 2015, 03:07:29 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses? ;)

As well as for Judges, Police and Nazi Party members..
Title: Re: The end of the NHS.
Post by: webbo on January 09, 2015, 03:09:16 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses? ;)
You promised to keep that quiet.
Title: Re: The end of the NHS.
Post by: lagerstarfish on January 09, 2015, 03:09:51 pm
Actually I'm not sure that they would want to increase their number of members (across the board) as their own capacity is probably less flexible than the potential increase.

easily solved by buying up unused industrial units and vacant city centre shops and offering enough money (and free health care) to existing NHS staff to move across to working only with people who are stable enough to earn money
Title: Re: The end of the NHS.
Post by: tomtom on January 09, 2015, 03:16:05 pm
...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.
I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses? ;)
You promised to keep that quiet.

I've still got your number.... ;)
Title: Re: The end of the NHS.
Post by: webbo on January 09, 2015, 03:44:27 pm
You think you have but as I have recently flitted back across the Rio Humber, you may struggle to track me down :dance1:
Title: Re: The end of the NHS.
Post by: slackline on January 11, 2015, 09:52:17 am
(https://pbs.twimg.com/media/B65TGsCCUAEgg-t.jpg:large) (http://www.theguardian.com/society/2015/jan/09/hinchingbrooke-hospital-special-measures-cqc-report)
Title: Re: The end of the NHS.
Post by: Offwidth on January 13, 2015, 02:41:53 pm
Steve, did you read the Kings Fund debunking the myth of privatisation & etc? They're hardly Monday Club nutters are they?

There is no credible basis for saying that a Conservative government will lead to significant damage to the NHS let alone its wholesale destruction, privatisation or the like.

As for the implication in your post, viz. that Gordon Brown had nothing to do with the crash, that's simply a moronic lie.  Gordon brown instituted the failed regulatory regime overnight and ran a deficit in the boom years.  As such not only was he partially responsible for the bust he was wholly responsible for having nothing to hand to deal with the bust when it occured.

Sorry been away. The posts I linked were from Roy Lilley who is an ex trust CEO and one time advisor to Maggie: hardly a trot, to follow your theme. Lets have less of the moron stuff please. I thought you were the one who flitted in and out of cartoon character online, is this calm uncle with an occasional potty voice approach the new more acceptable persona?

Oh and on Gordon and Blair, you know me so you know I'm no fan (certainly not of the PFI blight which like student fees is another stunt to raise money they dont have without it going on the defecit), but to be fair to them Will Keenan in the Observer on Sunday reminded us that the tory boys reluctantly backed labour spending plans in the run up to the crash so all this blame either goes both ways or is especially dishonest hot air. I favour a mixture with more of the latter as there must be a chance that Keynes had something with his stimulus ideas in recession and even if he didnt Osbourne is just doing the stimulus bit more inefficiently through QE.

The present government IMHO has done more damage to the NHS than any other with its failed reorganisation burning money, destroying functioning (if inefficient) management structures and wasting so much time and energy of health workers and failing to almost entirely to work properly with their representatives. With the links of Osbourne and co  to those with pretty hard core small state beliefs its hard to beleive they are just being stupid... the small state bunch almost need the NHS on its knees whilst professing their undying love and regret that more reform is now the only way. Being public about despising the NHS is electoral suicide. Labour (and or others) would certainly fuck some things up but not on this scale and only out of well intentioned error, as they believe in the NHS and don't despise the status and organisations of most of it's employees. Hence vote anything but Tory (or further right) for the moment remains my view.
Title: Re: The end of the NHS.
Post by: Offwidth on January 13, 2015, 02:48:02 pm
The latest from Roy:


Diogenes   News and Comment from Roy Lilley

Ok, I accept, it might be me. On the cusp of losing my first flush of youthful optimism.  I might be entering a pessimistic, sceptical phase.
 
I could be heading towards misanthropic? Noooo! I could accept sardonic; only because there is no point in denying it. If you are feeling generous, I would prefer wry. But, I am a realist. The bright polish of my boyish hopefulness has journeyed through the sanguine and been corroded by experiences that have pushed me into being a touch, a tiny bit, a soupçon, well... cynical.
 
There; I've said it. In a circle of complete strangers I have joined the group, stood up and said; 'My name is Roy Lilley and I am a cynic'. A small ripple of applause might warm the cockles of my hard heart.
 
I'm working my way towards contemptuous, derisive and scoffing. Why? Because I have had my fingers burned. I made the catastrophic error of trusting David Cameron.
 
I'm old enough to be his father and feel licensed to give him a bit of a Dutch-Uncle; David, either you are a fool or a liar and I can't figure out which. Either way, you need to sort this out before the election.
 
David is privileged and all the rest but you can't choose where you are born or who your parents are. As a young family man he suffered the agonies of a profoundly disabled child who was not to reach manhood. An experience that would leave a fingerprint on a soul made of Teflon.
 
When he said there would be no more top-down reorganisation of the NHS I believed him. I thought his personal experiences would have cemented his commitment to the men and women who create and run the health services. When Andrew Lansley's madness was unveiled as the Health and Social Care Bill, I never thought for one moment Cameron would see it through. I really did believe the 'pause' was designed to find a graceful way out of an ugly cul-de-sac.
 
I followed Lansley around the pre-election conference circuit and heard him, time after time, talk of reducing bureaucracy, putting Doc's in the driving seat and introducing a management cost cap. He never mentioned the wholesale destruction of all the instruments of management and replacing them with a cat's cradle of unworkable bureaucracy and beadledom.
 
The key question is this; just who knew what and when? Did Lansley tell bare faced lies? Did he know exactly what he wanted to do? Did he share his dark secret with Cameron or did he lie to him, as well.
 
The Prime Minister is in a difficult position. Either he too is a liar and knew exactly what Lansley's plans involved or he is a fool, naïve and his judgement in doubt. Was he duped by the man who was once his boss?
 
There is a third explanation. During the frenzied negotiations, the weekend after the election, Tory Oliver Letwin, privatiser and market maniac and LibDem David Laws, who has written of his preference for a social insurance model for the NHS, were in charge of creating a coalition health policy.  The result took everyone by surprise. Lansley included.
 
I think herein the truth is to be found. With trade-offs, deals and the Bond Markets breathing down his neck, Cameron was powerless to stop it.  He needed a cabinet, agreement and a government by Monday morning.
 
So, here we are again. An election in the offing. Cameron says there will be more money for health. Of course there will, everyone knows that. It is not a policy it is a necessity.
 
'Health' does not feature in Cameron's 2015 list of key election themes; the deficit, jobs, tax, home ownership, education and retirement.
 
How are we to interpret this silence.  Is it sinister?  Should we be worried?  The NHS is facing unprecedented pressures and the PM doesn't have the NHS on his list?  Is the answer:
 
I'm letting Simon Stevens crack on with the 5YFV, we'll fund what the economy allows and try to distance politicians from the NHS as much as possible.
 
Or, we have no policy; steady as she goes and fingers crossed.
 
Or, I've learned my lesson from last time and sacked Lansley.
 
Or, I got away with it last time and you won't believe what I have up my sleeve this time.
 
Prime Minister you have to persuade me and 1.4 million NHS workers, we have no cause to turn into a latter day Diogenes. 
------------------------
  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Title: Re: The end of the NHS.
Post by: Sloper on January 13, 2015, 05:34:03 pm
Steve,

Can you just post a link?

As for your comments about the economy.  Quantitative easing ended in 2010, the current government has not applied QE, but hey what are facts between mates :-[

http://www.bankofengland.co.uk/publications/Documents/quarterlybulletin/qb110301.pdf (http://www.bankofengland.co.uk/publications/Documents/quarterlybulletin/qb110301.pdf)

My point was have you read the Kings Fund debunking the myth about privatisation?

What I am saying is that this bollox that the tories are planning to 'end the NHS' & etc is just risible and you should know better.

I'm not saying that the NHS isn't facing a period of profound change or that it is, has been and always will be substantially dysfunctional.

As for the current government 'burning money' @ etc, while the merit of their proposals or otherwise (and whether it is a top down re-organisation) can only be something to be assessed in perhaps 10-15 years time: however to compare this government with the waste of the last and describe it as 'having done more damage than any other' is risible to the point of dishonesty, again, shall we brings some evidence to the discussion? 

Here's a precis of the Labour reforms to the NHS

1999 NHS reorganisation: GP fundholding is abolished; new primary care groups (PCGs) are established
2000 NHS Executive abolished
2002 District Health Authorities are abolished and we get Primary Care trusts and Strategic Health Authorities
2002 Regional Health Authoriy Powers are transfered to Strategic health Authorities.
2003 Community Health Councils abolished; NHS Modernisation Agency;Regional Directorates of Health and Social Care abolished
2004 Foundation Trusts
2004 The Healthcare Commission takes over from the Commission for Healthcare Improvement
2005 Modernisation Agency replaced by NHS Institute for Improvement and Innovation
2006 Strategic health authorities reduced from 28 to 10, Primary Care Trusts from 303 to 152
2008 Abolition of Community Health Councils
2009 The Health Care Commission abolished and replaced by the Care Quality Commission (CQC)

Let's now focus on the burning of money, NHS IT system and projects were a byword for overspend and failure with the well known one costing £10bn before it was scrapped,

PFI, hmm well covered elsewhere we can move on,

Private Sector treatment sectors hmm a monstrous inefficiency and overspend (and badly managed at that)

Management inefficiency, at the highpoint they were employing > 3000 consultants (note not doctors but management consultants) at day rates up to £1000 and so on etc. 

Let's not forget Stafford and the other scandals.

I don't think that it would be possible to replicate their level of fuckwittery if one tried.

So I don't think we've seen anything like the degree of fuck ups (although to be fair Labour did have longer and who knows what could happen in the future) but as for intenion, you have noticed the number of former Labour Ministers (and yes Tories) who are now on the Boards of private health providers.

So in short, other than a cut and paste and a heap of factual errors beyond some froth we haven't actually got much of substance from you have we?


Title: Re: The end of the NHS.
Post by: Offwidth on January 14, 2015, 10:14:18 am
Wish I could link Roy Lilley's stuff but its a posted blog so unless someone can come up with an alternative its cut and paste (which loses many of the evidence links). I dont agree with everything he says but he does cut through much of the crap and I do agree with the seriousness of the situation the NHS is in and he's one of the few from the management end pushing the vital importance of the proper treatment of front line staff in any solution and real ideas on such solutions.

The Kings Fund posts are problematic for all sorts of reasons which I'll come back to this if I have time. My main gripe is their key conclusion that the tories will not 'privatise the NHS' is stupidly simplistic (but I guess its easy to slip into this when responding to some of the hyperbole out there) but overall is correct in as much as it can be (the situation is, very complex but privatisation is growing and some areas the conservative part of the government tried on would have been very damaging and  hard to reverse). However that was not my point. If something is spinning out of control what does it matter who might run it in a decade. This government is responsible for what happens now and next. They took a limping system and hobbled it and now seem stuck like rabbits in approaching headlights.

Despite that list of Labour faults (most of which I'd agree with) there was no large scale crisis, just the odd local crisis and way too much waste (mitigated by generous funding). Its possible to list equally mad and bad stuff other governemts have done and lots of good stuff too, but whats the point? Governments fuck up stuff in the NHS but so far they bumble through to avert major system crisis.

Title: Re: The end of the NHS.
Post by: slackline on January 14, 2015, 10:22:22 am
Wish I could link Roy Lilley's stuff but its a posted blog so unless someone can come up with an alternative its cut and paste (which loses many of the evidence links).
Quote

What is a 'posted blog'?  Blogs (a portmanteau of 'web log') are hosted on web-pages, all of which have URLs which can be copy and pasted, this would then make all links contained within available to others.

Perhaps you mean its text from an email you have received, which isn't a blog (because by definition blogs are posted on the web), but a distribution list?  If so these often have a link to "Read in browser" which might be useful?




I dont agree with everything he says but he does cut through much of the crap and I do agree with the seriousness of the situation the NHS is in and he's one of the few from the management end pushing the vital importance of the proper treatment of front line staff in any solution and real ideas on such solutions.


The Kings Fund posts are problematic for all sorts of reasons which I'll come back to this if I have time.

Kings Fund Whos Who : Roy Lilley (http://www.kingsfund.org.uk/about-us/whos-who/roy-lilley)

Title: Re: The end of the NHS.
Post by: Offwidth on January 14, 2015, 10:57:38 am
Its an emailed commentary that you subscribe to free and are encouraged to forward as an email. I'm aware of his work with Kings Fund but it didn't seem to link to his regular postings.
Title: Re: The end of the NHS.
Post by: Sloper on January 14, 2015, 11:21:47 am
Steve, how would you feel if the Kings Fund dismissed your research and so on as 'stupidly simplistic'?

As for the Government being i/c and therefore responsible for what happens now, do you think the SoS can just push a button on his desk in Whitehall and magic up 1000 A&E consultants, 5000 A&E doctors and 10000 A&E nurses, if so you're delusional.

There's probably at least a 5 year lead in / lag for policy to take effect in the NHS, some systems i.e. policing will have a much shorter lag between policy change and practical change.

Finally, your point about there being no wide spread crisis, I can't remember the stat but something like <5% of hospitals have delcared major events or what ever they're called.

there was a 'winter crisis' in the NHS pretty muh every year under Labour and this will probably be repeated under this and the next government: it's to do with a massive spike in demand.

The system now is under more pressure than before, the population has increased and the number of older people has increased.

Here's a good paper on the NHS under Labour, I think it's far too soon for a comparable retrospective on this government.  http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf (http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf)

Now any chance of you admitting that your comments about QE were total bollox?


Title: Re: The end of the NHS.
Post by: petekitso on January 14, 2015, 12:42:48 pm
I really don't know why I am getting involved in this but . . .

If you cite a paper published in 2011 it is clearly not going to cover activity after that date. I think that QE - in terms of the ongoing purchase of assets - has increased by £175bn since then. The most recent large purchase was in July 2012. I am basing this on the Bank of England's own figures.

http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx (http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx)

You will note that the ongoing reinvestment of maturing assets - and potentially the maintenance of a £375bn portfolio - amounts to an ongoing policy of QE.
Title: Re: The end of the NHS.
Post by: Offwidth on January 14, 2015, 01:33:42 pm

Steve, how would you feel if the Kings Fund dismissed your research and so on as 'stupidly simplistic'?


etc...

The research is mostly fine what is wrong is a "myth" / "no myth" black and white answer, thats just journalistic junk. Same nonsense Ch4 news have a habit of using to ruin the possibility of perfectly good nuanced reporting. The main issue as I've said is as a source its not answerring my question (nor yours, even though you pretend it is) as I've expressed no beleif the NHS is going to be fully privatised in the near term by the conservatives.

You clearly wont agree this is the most serious crisis the NHS has yet faced... its not just declarations from trusts (a symptom) its the biggest ever gap between funding and needs, the complete mess in council led social care due to the cuts (and the feedthrough into hospital beds etc), the views of the vast majority of staff I know who work in various parts of the sector. Prove me wrong on that.

The idea nothing can be done in  a term is nonsense and yes Im aware of feed through issues.
Title: Re: The end of the NHS.
Post by: Offwidth on January 14, 2015, 01:43:06 pm

Here's a good paper on the NHS under Labour, http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf (http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf)



Indeed, pretty fair I'd say, and it paints a very different picture to the very biased one you do.
Title: Re: The end of the NHS.
Post by: Sloper on January 14, 2015, 02:05:31 pm
I really don't know why I am getting involved in this but . . .

If you cite a paper published in 2011 it is clearly not going to cover activity after that date. I think that QE - in terms of the ongoing purchase of assets - has increased by £175bn since then. The most recent large purchase was in July 2012. I am basing this on the Bank of England's own figures.

http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx (http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx)

You will note that the ongoing reinvestment of maturing assets - and potentially the maintenance of a £375bn portfolio - amounts to an ongoing policy of QE.

A large slice of humbe pie barman  :-[ tis a fiar cop guvnor,
Title: Re: The end of the NHS.
Post by: Offwidth on January 18, 2015, 11:00:27 am
Latest:

http://www.theguardian.com/society/2015/jan/17/nurses-nhs-stress-leave-staff-breaking-point (http://www.theguardian.com/society/2015/jan/17/nurses-nhs-stress-leave-staff-breaking-point)

Title: Re: The end of the NHS.
Post by: Sloper on January 18, 2015, 02:16:49 pm
Isn't it odd when the tories make reference to problems in the NHS they're 'doing it down' 'damaging it' 'causing a crisis in moral'?

Or are we now saying it's fare game for naked political point scoring?
Title: Re: The end of the NHS.
Post by: Offwidth on January 19, 2015, 08:59:45 am
Human frailty eh? Management over-defend their structures by understating problems, unions when presented  with real stress evidence use this too much as a weapon. Political parties use rhetoric to try to defeat their opponents. Naked point scoring applies to so many people, including a poster above who picks all the bad bits from a paper and none of the good to encourage us to vote their way and along the path accuses those of us with different view of moronic acts and factual error (even in the face of their own failings). In the meantime another aspect of the NHS is headline news, which was the point of providing the link.
Title: Re: The end of the NHS.
Post by: Sloper on January 19, 2015, 11:38:07 am
Incoherent gibberish
Title: Re: The end of the NHS.
Post by: mrjonathanr on January 19, 2015, 12:58:32 pm
Don't be so hard on yourself Sloper. Some of your posts do actually cohere.
Title: Re: The end of the NHS.
Post by: Sloper on January 19, 2015, 02:00:18 pm
Don't be so hard on yourself Sloper. Some of your posts do actually cohere.

The law of probability in action.

Title: Re: The end of the NHS.
Post by: tomtom on January 19, 2015, 02:15:21 pm
Don't be so hard on yourself Sloper. Some of your posts do actually cohere.

The law of probability in action.

http://youtu.be/no_elVGGgW8 (http://youtu.be/no_elVGGgW8)
Title: Re: The end of the NHS.
Post by: Sloper on January 20, 2015, 12:09:23 pm
The NHS cannot continue in its present form.

http://www.theguardian.com/society/2015/jan/19/nhs-we-have-not-fit-for-future-warns-top-doctor-bruce-keogh (http://www.theguardian.com/society/2015/jan/19/nhs-we-have-not-fit-for-future-warns-top-doctor-bruce-keogh)
Title: Re: The end of the NHS.
Post by: GCW on January 20, 2015, 12:13:38 pm
And only one party leader (http://www.bbc.co.uk/news/uk-politics-30877758) agrees with that.....
Title: Re: The end of the NHS.
Post by: Sloper on January 20, 2015, 01:04:40 pm
 he's liberated by the fact he won't be in number 10; further that basically everything other than immigration / the EU is a 'whoosh' issue for most Kippers.
Title: Re: The end of the NHS.
Post by: GCW on January 20, 2015, 04:57:09 pm
Yeah, the other leaders are well aware of the agenda to bring in privatisation but still refuse to acknowledge it.
Title: Re: The end of the NHS.
Post by: tomtom on January 20, 2015, 05:15:44 pm
From my limited understanding (that should send warning bells ringing about the upcoming content)...

Is one of the problems of revising/changing/updating the NHS a mixture of legacy systems/operation and the 'turning the supertanker' analogy.. to explain what I mean...

1. Because everyone is used to how it operates, bringing in a completely different system (ie some form of state/private insurance and private/non profit providers) would probably make the system different for people to use and thus prove befuddling to the masses..
2. Its so big you cannot just switch from the old system to the new system overnight... meaning some sort of slow transition (probably painful due to 1) would occur...
Title: Re: The end of the NHS.
Post by: Offwidth on January 21, 2015, 03:22:08 pm
From that guardian article with Uncle Bruce (after denying there is a crisis):

"Keogh said that the NHS would have to undertake a “complete transformation” of the way it operates over the next few years in order to keep itself sustainable. That would require hospital consultants to visit patients in their GP surgery and the sickest patients being given much more time to discuss their health than the usual 10-minute appointment with a family doctor.

In future, many patients will be able to get much of their care, including diagnostic tests and an expanded range of treatments, at their GP surgery to save them having to go to their local hospital.

Providing many more services under one roof would, Keogh said, reduce patients’ frustration at having to undertake appointments in different places. “Too many patients find the NHS fragmented [and] confusing. They find that they get pushed from pillar to post; they feel like a ball in a pinball machine at times.”

But he added that NHS England was confident that the major changes outlined in October in its Five Year Forward View blueprint for the service’s future, including an unprecedented build up of services delivered outside of hospitals, would help the NHS remain viable. The main priority in future would be to keep as many patients as possible out of hospital “dormitories” where they do not want to be and could catch an infection.

Keogh pinpointed the lack of local services such as district nurses, beds in community hospitals and mental health support as a key cause of the ever-rising demand for care from A&E units and for hospitals running out of beds. All those services are “very, very busy” because of the rising number of older people with complex medical needs and therefore have waiting lists."


I hope he is being misquoted as one asks: has he not seen from past changes what complete transformations of the NHS will require? As an example on his detail how on earth do you get expensive consultants efficiently to GP surgeries to see patients: is Scotty gonna knock him up some matter transporters (alongside magical contract changes). Also, are not the sickest patients the very ones who need sending straight to hospital where better diagnosis and response are available.

The pillar to post argument is completely missing the main point. Its not about GP surgeries (where tweaking will only help a bit and only then if they can get most GPs back onside), it happens because there is no proper linkage with social care and because primary and secondary care don't link as well as they should. In fact secondary care doesnt even always link internally (anyone who has had an operation unexpectedly delayed or witnessed two consultants fighting a turf war over a patient with complex problems will know that).

Towards the end he starts to rhetorically hit one obvious nail on the head but this was all known years ago and so why are they still talking about it instead of doing it. Social workers dealing with community care packages are stretched to breaking point, most council run care homes have closed and the private sector replacements are struggling, district nurse numbers have halved in recent years: just as a few examples. What is Bruce doing to ensure the government protect (and start to reverse damage in) social care in hard pressed councils: standing by while they are planning to make even more cuts with no workable ringfencing in place? When will he admit choice will be affected if budgets dont increase?

Crisis, what crisis? 5 year plans will weather the storms and bring summer to january. Yeah, right.
Title: Re: The end of the NHS.
Post by: Sloper on January 21, 2015, 03:29:15 pm
Tub thumping electronic engineer academic vs person i/c of the NHS, now call me a cynic but I'd say he was slightly better placed to comment on the subject than you.

As for the rest, you'd be better of standing by the Lions and selling the Socialist Worker.
Title: Re: The end of the NHS.
Post by: Offwidth on January 21, 2015, 06:07:03 pm
Childish and dishonest ad hominen distractions aside, I had high hopes for Bruce, but that article is depressing. Are we as citizens to bow down to a Bruce Almighty without challenge? I thought 5 year near impossible transformations were the realm of communist, regimes. Back on the detail does anyone seriously think moving consultants to see patients in GP surgeries is a good idea at the huge cost per hour we pay them and the time wasted in travel that cuts their ability to see others?
Title: Re: The end of the NHS.
Post by: a dense loner on January 21, 2015, 06:46:56 pm
No and I've never heard anything as ridiculous
Title: Re: The end of the NHS.
Post by: Sloper on January 21, 2015, 06:58:51 pm
Childish and dishonest ad hominen distractions aside, I had high hopes for Bruce, but that article is depressing. Are we as citizens to bow down to a Bruce Almighty without challenge? I thought 5 year near impossible transformations were the realm of communist, regimes. Back on the detail does anyone seriously think moving consultants to see patients in GP surgeries is a good idea at the huge cost per hour we pay them and the time wasted in travel that cuts their ability to see others?

So, the Kings Fund say that the 'privatisation agenda is a myth' and you call that stupidly simplistic (in summary) and Sir Bruce Keogh writes a considered piece and you in effect dismiss it and blame him for not challenging the government for something that is outside his remit.

The NHS is facing grave challenges and the sort of childish, tribal party political drivel you post makes sensible discussion of his and therefore necessary reform more difficult.
Title: Re: The end of the NHS.
Post by: Duma on January 22, 2015, 12:17:19 am
.... the sort of childish, tribal party political drivel you post makes sensible discussion .... more difficult.


 :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol:
Title: Re: The end of the NHS.
Post by: Offwidth on January 22, 2015, 08:48:46 am
I'm sure he's delighting in the wind-up and irony. He must remember I'm a bit too indepedant minded to have joined any political party, am very middle ground politically and have devoted a good amount of time opposing SWP idiocy in my academic union.  I have also never been an Electrical Engineer (but have worked with them).

He is right I was ranting a little bit but that article did annoy me. Its like nearly all promising cheif execs turn into cloned political mice whilst their pay spirals up to encourage reward for (unapparent) leadership. In my area of course its increasingly grey vice-chancellors who's pay is the highest its ever been relative to the average...and before the tory troll pops up again  its not a jealousy or structural thing for me as I dont mind higher pay if it delivers clear success. It looks like a giant con to me that such roles are almost defined as having superior leadership because of the money and when the con merchants say and do stupid stuff of course anger is all too easliy a result.
Title: Re: The end of the NHS.
Post by: tomtom on January 22, 2015, 08:53:31 am
I'd say that pretty much sums up our VC Offwidth...
Title: Re: The end of the NHS.
Post by: Sloper on January 22, 2015, 10:23:23 am
I'm sure he's delighting in the wind-up and irony. He must remember I'm a bit too indepedant minded to have joined any political party, am very middle ground politically and have devoted a good amount of time opposing SWP idiocy in my academic union.  I have also never been an Electrical Engineer (but have worked with them).

He is right I was ranting a little bit but that article did annoy me. Its like nearly all promising cheif execs turn into cloned political mice whilst their pay spirals up to encourage reward for (unapparent) leadership. In my area of course its increasingly grey vice-chancellors who's pay is the highest its ever been relative to the average...and before the tory troll pops up again  its not a jealousy or structural thing for me as I dont mind higher pay if it delivers clear success. It looks like a giant con to me that such roles are almost defined as having superior leadership because of the money and when the con merchants say and do stupid stuff of course anger is all too easliy a result.

Nothing wrong with a good rant though is there?  ;)

Whether 'chief executives' and senior managers (particularly in the non profit / public sector) are properly and fairly remunerated is an interesting and valid debtate: what is interesting about what lies at the heart of your rant is what you posit about people, once they reach a certain level, becoming political mice.

There may be something in this, but also it may be that as one rises higher one's vista expands and one can see more: hence the view becoming more consistent with the politicians (as opposed to those at the coal face) is a conseuqence of more and better information and a wider and deeper understanding.

Of course, the counter position is that they're utter cocks cannot be ruled out either.

So are we now agreed, the NHS is not liable for imminent substantial privatisation and that the rate of privatisation has slowed during the course of this government?
Title: Re: The end of the NHS.
Post by: Offwidth on January 23, 2015, 01:01:40 pm
No we are nothing like in agreement other than on the benefits of a rant. Kings Fund shows government has carried on with the incremental privatisation in the NHS where labour left off and if elected with a majority rather than being held back in coalition,  would have done much more damage, hence my advice don't vote tory. Other reasons (electoral suicide still being the main one) privatisation hasn't gone further include the inability of the private sector to compete that well (look at Circle) and issues around pensions if they want to hive sections off (but how long before they try and do a Royal Mail). On the social care and public health tender side (poor cousins that should have been NHS family) underfunding and privatisation continues apace.
Title: Re: The end of the NHS.
Post by: tomtom on January 23, 2015, 01:11:19 pm
(Probation service...)
Title: Re: The end of the NHS.
Post by: Sloper on January 23, 2015, 03:16:52 pm
No we are nothing like in agreement other than on the benefits of a rant. Kings Fund shows government has carried on with the incremental privatisation in the NHS where labour left off and if elected with a majority rather than being held back in coalition,  would have done much more damage, hence my advice don't vote tory. Other reasons (electoral suicide still being the main one) privatisation hasn't gone further include the inability of the private sector to compete that well (look at Circle) and issues around pensions if they want to hive sections off (but how long before they try and do a Royal Mail). On the social care and public health tender side (poor cousins that should have been NHS family) underfunding and privatisation continues apace.

Steve, let's look at the facts:

Privatisation under labour 4.9%
Privatisation under this government 1.2%

Circle failed because of the PFI costs (agreed by Labour) and that icnome is relatively fixed and limtied when demand is fluid and unlimited.

Royal mail is a discretionary service which charges customers directly.  The NHS? hmm can you see the difference?

Social care, I'm note sure about and the reform of the probation service is nonsense on stilts, but none of this has owt to do with the NHS.
Title: Re: The end of the NHS.
Post by: GCW on January 23, 2015, 03:18:13 pm
What does "privatisation" actually mean with regards to those figures?
Title: Re: The end of the NHS.
Post by: Sloper on January 23, 2015, 03:32:55 pm
What does "privatisation" actually mean with regards to those figures?

From memory it's payments from central NHS funds to private suppliers of treatment services (as opposed to IT outsourcing, locum staff, drugs, GPs and so on)

Title: Re: The end of the NHS.
Post by: webbo on January 23, 2015, 04:16:27 pm
 How far does that drill down. As one of the NHS providers in my area is a social enterprise but they commission lots of private providers to deliver their services. What I see on the ground here in the East Riding and Dull is a massive increase in private providers providing Mental Health care. Also if you go to the local Spire hospital (private) it's always overrun with NHS patients as they have referred there in order to meet waiting times.
I am not saying I have any figures to back this up but what I see seems different to those figures you quoted.
Also my own NHS trust has lost its Drug and Alcohol services, Improved access to Psychological therapies services and some of its prison health care services to the private sector under this Goverment.
Title: Re: The end of the NHS.
Post by: GCW on January 23, 2015, 04:34:18 pm
I would be very surprised if those figures reflect work done by private providers on the behalf of the NHS.
Title: Re: The end of the NHS.
Post by: Offwidth on January 23, 2015, 05:22:05 pm
Tom,

Those Labour changes happened over 3 terms and not from a zero start position. Also are you 100% sure if you dig down it will pick up all the subcontracted work (eg temp staff agencies, consultancies (esp IT and management), cleaning companiess) or indirect spend commisioned (through Public Health or other such sources). Its all smoke and mirrors hiding more private provision. The conservatives were only stopped from accelerating by the liberals who are liable to be almost invisble after the next election. So I stand by my arguments and genuinely think people should not vote tory if they care about the NHS ....but maybe, given your reputation, I do think you should keep telling people to.

Do you think an old confused person knows which bits of their health care are NHS or not? Having helped with Moff's dad's outcomes after a stroke its been a bloody nightmare getting the various organisations to link even with as knowledgable and tenacious a person as Moff (who is a trained nurse, trained social worker, public health manager with numerous doctor friends).. Its dumb not to coordinate these NHS and social care commissioned services better. A positive aspect is being oh so impressed how, despite all the pressures, the front line NHS staff and carers (on minimum wage) have been largely wonderful.
Title: Re: The end of the NHS.
Post by: Sloper on January 23, 2015, 09:33:13 pm
Nope, the vast majority happened 2005 - 2010.

GWC, those are the official stats, surprising or not, accurate or not that's what they are.
Title: Re: The end of the NHS.
Post by: slackline on January 29, 2015, 10:54:21 am
The truth about cash for referrals. BMJ 2015;350:h396  (http://www.bmj.com/content/350/bmj.h396)
Title: Re: The end of the NHS.
Post by: drdeath on January 29, 2015, 08:10:43 pm
The behaviour described in that article is disgraceful...and in my personal experience far more typical of the American or European model...but it's coming here slowly but surely.


D
Title: Re: The end of the NHS.
Post by: mrjonathanr on January 29, 2015, 08:48:49 pm
I'm a bit too indepedant

Love this. You don't have to go it alone-

Pedants of the world unite!
Title: Re: The end of the NHS.
Post by: GCW on January 29, 2015, 10:09:24 pm
GWC, those are the official stats, surprising or not, accuurate or not that's what they are.

Blimey Slopper, it's only three letters.
I don't belive the figures. I'm on the inside, and I know they are wrong
Title: Re: The end of the NHS.
Post by: Sloper on January 30, 2015, 07:00:08 pm
GCW, so you know the figures are wrong but the ONS & etc couldn't possibly be slightly better informed?

Anyway, so what is the current spend in % terms, is it 6.2% or 16%, 33% or what   
Title: Re: The end of the NHS.
Post by: webbo on January 30, 2015, 07:28:51 pm
My trust used to provide this areas Improved access to Psychological therapies. However under the new contract the provider/ managers of this service had to offer 80% of the service to any qualified provider. So in essence they had to 80% of the contract to the private sector. So an 100% NHS service becomes 80% private.
I suppose an even greater worry is that these services were only really created to get people of benefits and back to work. I guess they could all train to be therapists.
Title: Re: The end of the NHS.
Post by: Sloper on January 30, 2015, 07:39:49 pm
While I don't know the details of your trust, opening the NHS to non NHS providers doesn't mean that the private tender succeeds.

I'm sure that doctors wouldn't rely on a patient saying 'trust me, I know homeopathy works' or 'I know you tell me I need antibiotics but my priest says they're the devil's work and prayer is far more effective' and I think it's valid to consider the 'I know these stats are wrong' style of comments in the same way.
Title: Re: The end of the NHS.
Post by: webbo on January 30, 2015, 09:34:32 pm
Having done audits and complied stats. The odd decimal point or nought in the wrong or right place will give you what people want to see. ;) Also why would anyone trust figures trotted out by politicians, that statistical programme on radio 4 has proved that in Parliament when either side quotes figures to prove a point they tend to use different sources so as not to be proved wrong. It's all smoke and mirrors.
Title: Re: The end of the NHS.
Post by: Sloper on January 31, 2015, 10:24:48 am
The ONS are independent and reliable.

It's a typical type of bollocks along the lines, stats show what I want = you see I'm right: when the stats show something else and the stats are wrong, made up, manipulated etc 
Title: Re: The end of the NHS.
Post by: Offwidth on February 03, 2015, 10:34:46 am
The latest from Roy (evdidence links missing):


No one is asking
News and Comment from Roy Lilley
 
 
We'll call him Bill; tall thin. Widowed. Once in business, now retired. Can't shake off the habit of wearing a pinstriped suit and a military tie.
 
Bill is now one of the 'usual suspects'. On the committee of the CAB, Tory councillor, fundraiser for the hospice, volunteer driver at the Trust and with an interest in anything that will fill the empty days between a game of golf and a hand of bridge. Local charities and local politics are the beneficiaries of the Bills of this world.
 
We had an earnest conversation about the future of the NHS. Bill is numerate and understands the big-blue-bit-of-death. He gets the fact that the party he canvasses for, drops leaflets for and defends until death have made a mess of the NHS. His community involvement lays bare a picture of health and social services, confusion and pressures that his neighbours and friends don't see. He is not keen to amplify.
 
In the middle of a conversation about NHS funding Bill said something that sounded odd... scripted. Like he had learned it. It came out by rote but I got the impression he was uncomfortable saying it.
 
'... we have to deal with the deficit first, a strong economy underpins everything...'
 
On the way home I thought about Bill and what he'd said. It is hard to argue with. Nevertheless, I was cross with myself; I should have challenged him. He was trotting out lines from a Tory Central Office briefing that will be used a million times on the doorstep, up and down the country over the next 90-odd days before the election.
 
Electors will be carpet-bombed with that phrase. Indefatigable, solid, around the kitchen-table logic.  Really?
 
Bill's been conned. He's been brainwashed. There is a world of difference between debt and deficit. At its most basic, debt is how much the government owes. Deficit the difference between what the government takes in in taxes and what it spends. Get it right and there is a surplus; wrong and the government has to borrow to make up the difference and that adds to debt. The rest of us might call it an overdraft.
 
There are three ways to cut the overdraft. Screw government expenditure right down and don't add to the problem. Go hell-for-leather for growth and hope to harvest more taxes and pay it off, or the third; do both.
 
Here are a few random factoids:
Before the financial crisis Labour was borrowing less than the Major government in 1997
The world-wide recession, in 38 countries, was not caused because Labour spent too much on schools and hospitals.
The present government, in the last 5 years, is responsible for £517bn of the trillion+ accumulated public debt compared to the £472bn accrued during 33 years of a Labour led Britain.
There were two years of budget surplus under Mrs T and four under Mr Blair.
UK debt grows at £5,170 per second.
Both debt and borrowing are up.
It is not correct for the Prime Minister to say we are paying down Britain's debt.
The economy was growing at 2.6%pa. The latest figures reveal 0.5%.
The turbulence in the Eurozone and elsewhere may make our goods more expensive and potential customers may have less money to buy from us.
These facts (and I have no doubt you could find facts to challenge the facts and facts to challenge them) are not recited merely to underline the economy still stands in jeopardy.  They are more to demonstrate there is not much happening to sort it out. If austerity is supposed to be fixing the economy, it isn't.
 
The NHS commands about 9.3% of GDP and the EU-15 average is 9.9%. An average that includes countries facing austerity, just like us and some places worse. To ease the pressures Tarzan wants a gargantuan step change in NHS productivity to 3%.  Historically we've managed 1.5%.
 
My guess is, if asked, even people like Bill would pay a bit more in taxes, hypothecated for use by the NHS exclusively, to give it some headroom; but not to pay down debt.
 
The problem is; no one is asking.

------------------------
  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.
Title: Re: The end of the NHS.
Post by: Sloper on February 03, 2015, 10:49:33 am
The usual economic garbage.

Labour ran a defecit in the good times: remember Fast Eddie's NICE decade? This is to be distinuished from the defecit in the Major recession and that this was on the down slope to surplus. As such the relativity of the deficit is irrelevant: a basic summary of Keynesian economics is defecit in recession : surplus in times of good growth.

The recession of course was not caused by a single policy area: what was caused by Labour's policies was that there was so little ammunition available to fight the effects of recession.

The twat doesn't get the accumulation of debt due to deficit.

The muppet doesn't understand that unlike the US who present annualised figures for growth quarterly we present 1/4ly figures 1/4ly.

Hypothecation is generally regarded as being a very bad idea which is why basically no one does it.

So basically a lower VIth examination of the economy and a delta at that.

Why is it I'm not surprised you think it is some revelatory insight? :shrug:
Title: Re: The end of the NHS.
Post by: Offwidth on February 03, 2015, 12:48:57 pm
I never said I even agree with what he said, let alone see it as a revelation; its just his latest comment piece with clear relevance to this thread. Maybe its enough that an ex advisor of Maggie and a commentator way more knowledgable than you on the NHS (and linked strongly with the Kings Fund) can think the NHS is as much in trouble as a soft leftie does and that the vote tory line to save the NHS  (you are another Bill) is bunk. Maybe its good enough just that it makes you rant and rave here ...that's entertainment in itself.

PS Stephen Dorrel in the Observer this week was the latest saying the government's health reforms were a major mistake; alongside beds crisis for mentally ill children.

PPS still intending to get round to listing all the money going to non public sector areas that is not included in Kings Fund paper percentages, due to the limitations of what they define as spending in the NHS, but its a big job. I agree the tories didn't and won't likely soon privatise the NHS (as most people understand that) but plenty of extra money not included in those headline percentages goes to private and other non public sources than what did under Labour.This is another recent example of public sector NHS spending in those Kings fund numbers that in is in reality really private.

http://www.theguardian.com/society/2015/feb/03/nhs-doctors-staff-shortages-hospital (http://www.theguardian.com/society/2015/feb/03/nhs-doctors-staff-shortages-hospital)
Title: Re: The end of the NHS.
Post by: slackline on February 03, 2015, 01:02:02 pm
rant and rave here ...that's entertainment in itself.


No its not, its tedious, rude and lacks facts to substantiate anything (no not everyone remembers, so post some fucking links to substantiate).  Its rather like the noisy kids I remember from school who made a nuisance of themselves, shouting louder than everyone else for so long that everyone tires of hearing them and ends up ignoring them.  Thankfully this forum has an "Ignore user" feature to facilitate dealing with such nuisances.
Title: Re: The end of the NHS.
Post by: Offwidth on February 03, 2015, 01:05:58 pm
 I guess not all entertainment meets universal approval. It must entertain Tom as it makes no sense otherwise: he is much more normal and sensible and funny in the flesh. I should be clear I'd much prefer it if he drops this new schizoid cartoon character he hides behind: the wise great uncle with occasional tory torrettes. He was celebrating the fact that wonderful sentences like " fucking fucker's fucking fucked, fuck! " can be said here (and not on UKC) just days ago, without any apparent irony of missing the real differences between the sites. I'm not saying folk shouldn't have fun or be silly or be controversial but manufactured alternate personalities are a bit odd.

Apologies again for no link to Lilly's stuff... maybe someone more literate in these areas can find them somewhere I missed.
Title: Re: The end of the NHS.
Post by: slackline on February 03, 2015, 01:16:21 pm
Then I wonder why he acts out the part of trolling cunt here then?

Maybe he hates himself (http://www.theguardian.com/society/2015/feb/02/what-happened-confronted-cruellest-troll-lindy-west).
Title: Re: The end of the NHS.
Post by: Sloper on February 03, 2015, 04:57:38 pm
When I recently stomped on a moron who was  :worms: re creationism I received plaudits for the abrupt/abrasive nature of the response.

The problem with this debate is that I have provided links to the Kings Fund 'myth busters' and from memory the official stats that show that Labour engaged in a greater degree of privatisation of the NHS than the current government have.  The response? The stats are wrong / made up / I don't agree and some fairly tangential waffle.

the NHS is facing a good number of serious challenges and the continual cant of 'the tories are going to sell off our NHS' is not only jejune and facille but also limits proper debate of what reforms are needed to maintain the system that probably delivers more for less, for more people, more often and more fairly than any other comparable system.

As for trolling on this site, I would sugegst that I've never done so (my late career change was as close as it gets and that was intoxication rather than intentional trolling) the problem is that the group think is so pervasive that it takes a bit of an effort to cut through the mire of ignorant consensus.

Ohh and we're without consultants for A&E now, could this possibly be due to the choices of doctors who started training in 2001/2 etc?

The fantastically hypocrital Marget Hodge was on R4 this morning castigating A&E consultants who decided it was better to locum @£1760 per day (of course the agency would take some) and have a family life & etc then get arse fucked as a permanent staff member. WTF is it that surprising?  :o
Title: Re: The end of the NHS.
Post by: Offwidth on February 03, 2015, 06:07:45 pm
I think you're too often plain rude for the sake of it (we are not all religious nutcases) and you seem to me to often make stuff up as you spout rhetoric like its the truth, rather than opinion: that's not a trolling, if anything its an indication you need to grow the fuck up  online as you are just not like this in real life.

You are like a dog with a rag with these Kings Fund papers. Yet they only show things like directly contracted out health care to private providers from NHS budgets. I've said before, numerous areas of in house NHS spend goes to things like private management consultants, agency staff, contracted out work, PFI payments, etc; irrespective of the long standing private business grey areas of the NHS, like consultant contracted out time, GP surgeries, dentists practices, opticians etc. This is also before the huge changes in private provision in health ares not strictly in the NHS but intimately linked, like Social Care, Public Health Commisioning etc. Then we have the hundreds of millions wasted (and the huge distraction and all that energy that should have been constructively focussed elsewhere) on uneeded and unsuccessful change. I, like anyone, dont have the numbers to hand on the full scope of privatisation as they exist in numerous non-aligned reports most of which require an FOI. In fact its so bloody hard to find how much money is being directed to private companies through various parts of the public sector its arguably a national scandal....with the ideology present in some quarters its all the more reason to suspect stuff is being hidden.

Yours, a 'moron' (at a guess)
Title: Re: The end of the NHS.
Post by: Sloper on February 03, 2015, 07:33:48 pm
Calm down dear.  I can be just as obnoxious and rude in real life and generally will if the chance presents itself.

But moving on.

The reasons I keep referring to the Kings Fund is that they're independent and highly regarded: if I were to refer to Tory Party material I would rightly get a pasting, but it's nice to see that you've moved on from saying that the KF is wrong to something approximating the 'no true Scotsman' position, give it a few more years and we'll be having a real debate. :-*

Ohh and top marks for brass neck for the 'I don't have the numbers to hand but' yeah 'stands to reason eh g'vnor, ere I had that Oswold Mosely in the back of my cab the other day, 'e 'ad a point eh'.

Yes, your guess is spot on, on this subject you're being a prime moron, I'll remind you of it when I next have the chance to buy you a pint. (if the pub hasn't been nationalised by those filthy reds)
Title: Re: The end of the NHS.
Post by: drdeath on February 03, 2015, 08:22:19 pm


Ohh and we're without consultants for A&E now, could this possibly be due to the choices of doctors who started training in 2001/2 etc?

The fantastically hypocrital Marget Hodge was on R4 this morning castigating A&E consultants who decided it was better to locum @£1760 per day (of course the agency would take some) and have a family life & etc then get arse fucked as a permanent staff member. WTF is it that surprising?  :o

On this point - it is worth noting that the figures are, as ever, slightly misleading if not downright mendacious...

That 1760 a day was for a 16 hour shift.

Now, they could have just quoted 880 a day for the normal 8hrs that everyone would obviously expect that they were referring to, but that wouldn't have sounded quite so sensational...

Particularly, as you say, if they included the cut for the locum agency.

And they are talking about A&E Consultants...literal life and death, sharp end, RTA, major trauma, blood and guts decision making. How much do you expect to get that for, out of contract...

To compare apples and oranges - How much per hour would a similarly experienced corporate lawyer run you?  Or a lobbyist for that matter....

Do I think they should be having to spend such vast sums on locums - nope! Do I see how it gets to that - yup!

(Disclaimer, I do a wee bit of private medical work, usually from behind a desk, nice and comfy with coffee and biscuits, and charge £115-125 an hour...legal reports etc...)
Title: Re: The end of the NHS.
Post by: Sloper on February 03, 2015, 08:45:00 pm
Let me make this absolutely clear I do not criticise people deciding to o locum work rather than be a full time employee: nor do I (other than as a sophistic point) refer to 'fat cat doctors', nor do I think that the hourly rate is excessive, it's below what I charge out at* below what I pay counsel for serious work (i.e. when not on fixed fee which most is) [Ru, of course when I'm in the shit I'll pay what needs to be paid and there's a brief for you on the way].

My point was it was a bit fucking rich for Ms Hodge to seek to blame the doctors for the consequences of their policies for the NHS (and of course the policies of this government too) we're desperately short of A&E bods, perhas we could try and address the causes rather than creating a straw man to then burn as an effigy? 

*And by god I'm no high flying corporate lawyer.

Title: Re: The end of the NHS.
Post by: drdeath on February 03, 2015, 09:21:32 pm
Oh, I think this is one area that we are close to agreement on Sloper...just sick of hearing this crap on the radio today...

I mean...a 16hr shift for fuck sake...if it wasn't so blatant it would be funny.

Title: Re: The end of the NHS.
Post by: Offwidth on February 03, 2015, 11:22:08 pm
Calm down dear.  I can be just as obnoxious and rude in real life and generally will if the chance presents itself.

But moving on.

The reasons I keep referring to the Kings Fund is that they're independent and highly regarded: if I were to refer to Tory Party material I would rightly get a pasting, but it's nice to see that you've moved on from saying that the KF is wrong to something approximating the 'no true Scotsman' position, give it a few more years and we'll be having a real debate. :-*

Ohh and top marks for brass neck for the 'I don't have the numbers to hand but' yeah 'stands to reason eh g'vnor, ere I had that Oswold Mosely in the back of my cab the other day, 'e 'ad a point eh'.

Yes, your guess is spot on, on this subject you're being a prime moron, I'll remind you of it when I next have the chance to buy you a pint. (if the pub hasn't been nationalised by those filthy reds)
Title: Re: The end of the NHS.
Post by: slackline on February 04, 2015, 09:27:21 am
As for trolling on this site, I would sugegst that I've never done so

Utter fucking bullshit....

I am interested in debate, but have to confess that a lot of the time it's merely the prospect of a 5 minute argument rather than the former that attracts.

 :wank:
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 09:34:21 am
Having an argument is not trolling.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 09:34:46 am
yes it is you twat.
Title: Re: The end of the NHS.
Post by: petejh on February 04, 2015, 09:47:55 am
Fuck you Sloper  :tease:

... Genuine question - seeing how lots of NHS money is spent on expensive British (I assume?) locums, is there an opportunity here for highly qualified consultants from eastern euro/rest of the world to come and do the work for half the cost to the NHS. Or is there protectionism over and above professional qualifications?
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 10:53:30 am
Fuck you Sloper  :tease:

... Genuine question - seeing how lots of NHS money is spent on expensive British (I assume?) locums, is there an opportunity here for highly qualified consultants from eastern euro/rest of the world to come and do the work for half the cost to the NHS. Or is there protectionism over and above professional qualifications?

Yes there is an opportunity, but there was a very high profile case of a German Dr who flew over when knackered and administered a leathal dose of diamorpheine so i can imagine there being a real problem with public perception and politics.

In fact it could make Farage explode!
Title: Re: The end of the NHS.
Post by: slackline on February 04, 2015, 11:24:55 am
Having an argument is not trolling.

You are wrong...

In Internet slang, a troll (/ˈtroʊl/, /ˈtrɒl/) is a person who sows discord on the Internet by starting arguments or upsetting people, by posting inflammatory, extraneous, or off-topic messages in an online community (such as a newsgroup, forum, chat room, or blog) with the deliberate intent of provoking readers into an emotional response or of otherwise disrupting normal on-topic discussion. (https://en.wikipedia.org/wiki/Troll_%28Internet%29)

In your own words you are only looking for an argument, not a debate....

I am interested in debate, but have to confess that a lot of the time it's merely the prospect of a 5 minute argument rather than the former that attracts.

...ergo...

(http://cdn.arstechnica.net/wp-content/uploads/2011/09/bridge-troll-4e7123d-intro.jpg)

 :icon_321:
Title: Re: The end of the NHS.
Post by: petejh on February 04, 2015, 12:15:32 pm
Fuck you Sloper  :tease:

... Genuine question - seeing how lots of NHS money is spent on expensive British (I assume?) locums, is there an opportunity here for highly qualified consultants from eastern euro/rest of the world to come and do the work for half the cost to the NHS. Or is there protectionism over and above professional qualifications?

Yes there is an opportunity, but there was a very high profile case of a German Dr who flew over when knackered and administered a leathal dose of diamorpheine so i can imagine there being a real problem with public perception and politics.

In fact it could make Farage explode!

I don't think anyone cares one jot where their trauma specialists come from when they're on the operating table following a traumatic event, I'm sure even Farage would find his ideals dropped away the instant one of his family required specialist emergency care.

E.g the MSF model, applied to a first world healthcare system?

If the British healthcare system is facing a staffing/budget crisis as bad as it's described in the media, then this seems like an obvious partial solution to me - as a know-fuck-all-about-it observer.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 12:21:47 pm
That's not my definition  :P and besides I've lost a lot of weight since that photo' was taken.

besides what was the strap line for UKB?
Title: Re: The end of the NHS.
Post by: webbo on February 04, 2015, 12:27:15 pm
What does "privatisation" actually mean with regards to those figures?

From memory it's payments from central NHS funds to private suppliers of treatment services (as opposed to IT outsourcing, locum staff, drugs, GPs and so on)
I think this is where the myth lies as if its funds from the central NHS pot. Then it will not show local privatisation i.e offering services to any qualified provider which uses local budgets. Also they class this as outsourcing which is again a way of hiding it.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 02:38:02 pm
These tender exercises weren't within the figures for Labour and they're not within the figures fro the present government: that said this has been going on for some time: I wonder if the Kings Fund have any reliable data?
Title: Re: The end of the NHS.
Post by: Offwidth on February 04, 2015, 03:00:36 pm
These tender exercises weren't within the figures for Labour and they're not within the figures fro the present government: that said this has been going on for some time: I wonder if the Kings Fund have any reliable data?

Thats part of the the point I was trying to make which you seemingly regard as brass necking: the recent data is often not yet collected, partly collected or is as yet uncollated. All that King's Fund data (that only deals with outsourced health work and not the other areas I list) is at least a year old so is only looking at the first half of this goverment. In contrast the people I know who work in or around NHS commissioning, public health commissioning, social care commisioning, mental health commisioning all report noticable increases in non public sector provision (as do many similar positioned posters here). Labour started this off but the data you use tiodefend the condems seriously underestimates current scale and we wont know exactly how much until it is too late.

The locum/agency issues often have hidden causes like suppressed core staff levels to keep balance sheets suitable for trust status and work related stress due to overwork.

On the personnal point you really need to go back and look just how many of your posts involve non-climbing related 5 minute arguments and other assorted rudeness... get your wife to come on here and say she is happy that you are not wasting your life as an argumentaive actor and I'll beleive you (Moff advises me to cut down and calm down and I'm a cute puppy that nips occasionally compared to you).
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 04:05:00 pm
1. The first half of the government was 2010-2012.

2. The propotion of the NHS budget that you're talking about i.e. public health, social care, mental health is de minimis when taken agains the whole NHS budget: as such even if the ratio was 1:10 (Labour/Coalition) this would not change the overall ratio of Labour Privatisation to that under this government 4:1.

3. The data referred to in the stats published does not include the sort of outsourcing etc that you're referring to: as such the core charge that the NHS is being privatised simply fails.

Locum use will have a massive range of causes.

As for my posting, yes I do like a scrap, nothing wrong with that and I am sure Mrs Sloper prefers me to vent spleen and decompress on here then be a stroppy bastard at home.
Title: Re: The end of the NHS.
Post by: Offwidth on February 04, 2015, 05:28:02 pm
Privatisation increased 1% in the first half of this government compared to 4% in all the previous labour terms. Sure they are just as much to blame on volume (I always agreed that) but this goverment isnt tory, its a coalition.  In some areas there is way more non-public than public provision and the budget levels are not so different in scale: so your maths are far from certain (it could add a few more percent quite easily).

Most reasons for Locums are due to under-resourcing somewhere and any planned savings are easily lost, usually leading to a more expensive service provision.

I'm guessing Mrs Sloper would think different if she knew the scale of your venting. You're acting like an addict and your level of venting isnt healthy.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 07:28:50 pm
I doubt it, Mrs Sloper has heard/seen me at work, and much of the language I use on here is also used at work.
Title: Re: The end of the NHS.
Post by: webbo on February 04, 2015, 07:42:41 pm
I doubt it, Mrs Sloper has heard/seen me at work, and much of the language I use on here is also used at work.
I hope your employees are not taping things or you might a lawyer.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 08:09:50 pm
If calling a client / expert / opponent / counsel / instructing solicitor or Judge a moron / fucking twat or similar was a striking off / disbarring offence there would be no one in practice.
Title: Re: The end of the NHS.
Post by: webbo on February 04, 2015, 08:25:06 pm
No I sure it isn't a striking off offence but swearing and ranting in front of employees who may at some point decide you are no longer the boss of their dreams. Tape you and play it a tribunal and suddenly you are paying for the equivalent for months of locus consultants 16 hour days.
Title: Re: The end of the NHS.
Post by: Sloper on February 04, 2015, 08:57:59 pm
I usually close my office door and besides we're excellent employers.
Title: Re: The end of the NHS.
Post by: webbo on February 04, 2015, 09:04:48 pm
I usually close my office door and besides we're excellent employers.
:-\
Title: Re: The end of the NHS.
Post by: Offwidth on February 05, 2015, 08:59:17 am
End of the line
News and Comment from Roy Lilley
 
I've done the joke but in case you missed it; A Martian lands and says 'We'd like to copy your NHS, take me to the leader....' The little green man gives up and goes home. No one has any idea who the leader is.
 
The DH used to be in charge. The Carbuncle tries to make out it is in charge. Monitor can't figure out how much to charge, the CQC charge around like a bull in a china shop and the TDA... forget them.
 
I thought about the joke as I was reading about the Public Accounts Committee latest NHS bash. Margaret Hodge, the chair, says her biggest worry (really?) is NHS finances and points out; the proportion of NHS trusts and foundation trusts in deficit increased from 10% in 2012-13 to 26% in 2013-14. Her calculations are probably behind the curve; I reckon if the NHS had to balance its books tonight 2/3rds couldn't do it.
 
We are in a Kafka world.
There is not enough money in the system and Trusts are punished if they overspend.
They have to overspend to get staffing levels up to new 'safe' standards.
As there are not enough staff in the system they have to go to agencies to buy-in the same staff they once employed in the NHS, now at twice the price.
Many Docs and nurses don't want to work in the system because being an agency staffer creates flexibility and freedom not found in the consolidated ranks who are pressured, shoved around and the butt of everyone's ire.
Hospitals can't find enough staff and the CQC spend a fortune (that could be used on patient care), turn up with 80 people (who could be working in the NHS providing care) and say; 'You don't have enough staff, therefore this place is dangerous and we want new leadership'.
 
New leaders are found who hire more staff and overspend. Monitor (who spend a fortune that could be spent on patient care) turn up with an army (who should be working in the NHS) and say you have overspent and we want new leadership.
 
New leaders are found who balance the books by cutting the staffing levels and the CQC turn up and say; 'You don't have enough staff, we want new leadership'. The old leader gets the sack and .... around we go again.
 
If someone was I charge, would this happen? Would we continue to play this mad game of pass the parcel of responsibility? I don't think so.
 
The Carbuncle has to find efficiency, Monitor has to find a way to spread cash around the system and the CQC has to find fault. The DH has to find ways of pretending this isn't happening. None of them has to find a system wide solution. They exist to make life difficult for each other so they can say they are doing their bit.
 
I was thinking about all this when I bumped into Jane. I know her Mum; runs a scout group. I met Jane on the train into London. She lives in my neck of the woods but works in a London hospital because she gets paid more. She is a nurse; followed her Mum into a profession she loved.   Her Gran was a nurse, too.
 
'How you doing?'
 
I'm leaving...
 
A story of pressure, travel, anxiety, worry, exhaustion and rush unravelled.
 
'There is not enough money, they are cutting everything they can... not enough staff on the wards... unless the CQC turn up... then agency people come in and the managers come on the wards... give out the tea. I hate it. They all run around like headless chickens.  No one is in charge. There's no time to do anything properly.'
 
'What are you going to do?'
 
'I've got a job at the Meadows'.
 
...a huge shopping centre. Jane, will earn more, with family friendly hours and a discount on food and clothes. M&S is her new employer.
 
I looked at the pale, exhausted youngster in front of me. Her blue eyes welled; 'I don't want to but... we want to get our own place and start a family... and... I don't know how I'm going to tell Mum...' Her voice tailed off and she sunk into her brown scarf and puffa-jacket.
 
The train pulled into Waterloo. The end of the line. 

------------------------
  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.
Leaving the NHS, changing jobs - you don't have to say goodbye to us! You can update your Email Address from the link you'll find right at the bottom of the page, and we'll keep mailing.
Title: Re: The end of the NHS.
Post by: Offwidth on February 06, 2015, 07:37:10 am
Look what the fuckwit left-wing morons in this so called thinktank have come up with now  :slap:

http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund (http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund)
Title: Re: The end of the NHS.
Post by: GCW on February 06, 2015, 08:08:37 am
"Led by GPs" is a bit misleading too......
Title: Re: The end of the NHS.
Post by: Offwidth on February 06, 2015, 10:28:02 am
Found this TED talk as well

https://m.youtube.com/watch?v=Cz5dl9fhj7o
Title: Re: The end of the NHS.
Post by: slackline on February 06, 2015, 10:47:07 am
I am sure Mrs Sloper prefers me to vent spleen and decompress on here then be a stroppy bastard at home.

And I'm pretty sure that the majority of UKBs regular denizens would rather you are a stroppy bastard at home than ranting on here.

If you want kill five minutes venting/ranting/arguing/"bantz" you'd fit right in to /r/ukpolitics (http://www.reddit.com/r/ukpolitics).
Title: Re: The end of the NHS.
Post by: Sloper on February 06, 2015, 11:02:37 am
Look what the fuckwit left-wing morons in this so called thinktank have come up with now  :slap:

http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund (http://www.theguardian.com/society/2015/feb/06/nhs-reforms-tories-damaging-thinktank-kings-fund)

When have I ever called the Kings Fund that?  I'm more than happy to accept their critique and conclusions here just as I am happy to accept their views elsewhere. 

No face slap required, just a little maturity and consideration.
Title: Re: The end of the NHS.
Post by: webbo on February 06, 2015, 12:23:21 pm
Looks like someones hacked slopers account.
Title: Re: The end of the NHS.
Post by: Sloper on February 06, 2015, 12:33:10 pm
Oi Florence, back on the ward.

There normal service has been resumed.

I've also just finished the big matter I've been working on so happy days.

by the way COME ON YOU TAFFS
Title: Re: The end of the NHS.
Post by: slackline on February 07, 2015, 09:16:48 am
The Kings Fund may now be critical of the changes that have been made to the NHS, but Clive Peedell (https://twitter.com/cpeedell) highlights this from the report suggesting they helped the bill get through (https://twitter.com/cpeedell/status/563982127919017984)...

(https://pbs.twimg.com/media/B9Or3fJIYAAsviC.jpg:large)
Title: Re: The end of the NHS.
Post by: lagerstarfish on February 07, 2015, 09:26:12 am
Turns out I'll be meeting that Dixon later this year

I'll have a word

I'll try to drop something in about Sasquatch doing Mandala
Title: Re: The end of the NHS.
Post by: Offwidth on February 07, 2015, 01:26:16 pm
The Kings Fund may now be critical of the changes that have been made to the NHS, but Clive Peedell (https://twitter.com/cpeedell) highlights this from the report suggesting they helped the bill get through (https://twitter.com/cpeedell/status/563982127919017984)...

(https://pbs.twimg.com/media/B9Or3fJIYAAsviC.jpg:large)

I think the critics of the Kings Fund  often have their own axe to grind but they are worth reading to keep feet on the ground. Of course one could say one beleives everything TKF say whilst ignoring the occasional nuanced differences inside and cherry picking the bits that suit one's argument.

Another link putting Kings Fund into a different perspective:

https://www.opendemocracy.net/ournhs/gary-walker/kings-fund-suggests-nhs-fees-but-is-it-really-independent (https://www.opendemocracy.net/ournhs/gary-walker/kings-fund-suggests-nhs-fees-but-is-it-really-independent)
Title: Re: The end of the NHS.
Post by: slackline on February 09, 2015, 10:31:19 am
The latest from Roy (evdidence links missing):

Via a tweet (https://twitter.com/cpeedell/status/564699362937536512) there appears to be an archive of Lilley's emails (http://archive.constantcontact.com/fs065/1102665899193/archive/1102874050221.html).  These include embedded links when he cites/quotes things.  Might be slightly more useful to readers/those interested and save you the hassle of copying and pasting from your email.
Title: Re: The end of the NHS.
Post by: Offwidth on February 09, 2015, 01:51:41 pm
Cheers: this one is Feb 9th. Ill modify and add the link later but Ive copied here as it's his response to the KF announcement and Ham:


"Nearly finished"

News and Comment from Roy Lilley

Chris Ham's King's Fund report, demolishing the NHS reforms, is excellent. But, like the 99 bus... a bit late.
 
In the turbulent days of 2010, healthcare's front line, commentators, academics, practitioners, politicians, Royal Colleges, unions and the public railed against the Health and Social Care Bill.
 
Then the KF wrote opaquely; "The King's Fund strongly supports the aims of the White Paper" and "... there are potential benefits if the reforms are implemented effectively" (and) ...significant risks if they are not" and "... there are strong arguments for moving quickly to test out how key elements... work in practice..." and "The organisation of the NHS could be progressively streamlined..."
 
Streamlined! Functioning organisations annihilated, replaced with a myriad of little ones, institutions demolished and senior people lost along with their a legacy, experience, history and knowledge. With one common-sense voice the NHS said; 'No!' What did the KF say?
They hid behind Don Berwick (Page 11). http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/liberating-nhs-right-prescription-cold-climate-oct10.pdf (http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/liberating-nhs-right-prescription-cold-climate-oct10.pdf)

The NHS has been ploughed up and nothing that was planted to replace it is growing.
 
KF's Ham now says; the NHS is "crying wolf" with "ill-founded" claims about privatisation. Rubbish. http://www.bbc.co.uk/news/business-29620329 (http://www.bbc.co.uk/news/business-29620329)
 
Anyway, the NHS has always worked with private partners! But, carving out chunks of hard pressed services, gifting them to private companies, transferring NHS staff, unwillingly, into their ranks, to provide identical services just to create a profit opportunity has a touch of the King George about it...
 
We asked; if the private sector gets fed up or fails ... what happens? It took Southern Cross, Circle, Serco, a number of dodgy nursing homes and BUPA to show us. The NHS picks up the pieces.
 
Whilst all of us were saying all of that Chris Ham accused decent working people who had genuine concerns of grand-standing. Well, Chris, I'm pleased that there were people with the guts and the courage to stand in the grandstand and shout and boo, stamp their feet and chant. I'm amazed there wasn't a pitch invasion.
 
Ham is wrong about privatisation. The fear is not privatisation it is the fear of privatisation failure. Fears that have been realised. There is not enough money in the contracts for private companies to do a decent job and make a profit.
 
It's all about the money. Tarzan's pact with Porrima is predicated on extra money for efficiency gains. Trusts have given Monitor a two fingered salute. They can't and won't work with the proposed tariff. That pretty well ends Tarzan's hopes of efficiency gains and puts the 5YFV in doubt. Traditionally, the NHS delivers 1.5% pa efficiency. What hope is there of 3% without root and branch changes and major investment.
 
Ham says present focus on quality and integrated care is to be welcomed. After 15 years of inspection there is no evidence services are any safer. In fact, under such pressure, they are probably getting worse. Health and social care still march to a different drumbeat because no one has the courage to merge their regiments.
 
What are the common-sense voices of the NHS saying today?  This is what I hear, repeatedly:
•   Dump Monitor, there is no market in healthcare and no prospect of one. Put the money into the front line.
•   Bulldoze the TDA; being an FT is an artificial distinction. FTs are just as skint and capable of poor care as the rest. Put the money into the front line.
•   Halve the number of CCGs and stop them tendering everything (they are terrified not to). Contracting costs around £16m and the money is better used at the front line.
•   Move, immediately, to population based, capitated budgets and get the money into the front line.
•   Cut admin and bureaucracy costs; use service level agreements to leverage front-line performance and quality.
•   One last heave-ho; vertically integrate primary, secondary and community services, include social care and focus on end2end services... start with the patient facing front-line and work backwards.

Chris Ham wants to get the KF on the right side of history; it never was. I know it, you know it and he knows it and his report has hacked a lot of good people right off.  This and this have been doing the rounds on Twitter, as well as this.
https://twitter.com/cpeedell/status/564095785663758336/photo/1 (https://twitter.com/cpeedell/status/564095785663758336/photo/1)
https://twitter.com/cpeedell/status/563841263854956545/photo/1 (https://twitter.com/cpeedell/status/563841263854956545/photo/1) http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/memo28june/hsr07.htm (http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/memo28june/hsr07.htm)
 
The reforms were a mare's nest and pretty well every organisation came right out and said so, except the King's Fund who were impenetrable, ambiguous, equivocal and mostly missing.
 
Ham may see a lot of us (and I include myself) as grand-standers but it's a whole lot better than being a by stander.
 
But, it's not all bad; the KF does sell exceedingly good chocolate muffins and their refurbished cafeteria is nearly finish.

  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net
Know something I don't - email me in confidence.




Title: Re: The end of the NHS.
Post by: slackline on February 09, 2015, 01:55:28 pm
Nearly Finished (http://campaign.r20.constantcontact.com/render?ca=42307b19-d6b5-4c98-ae45-107f9e9d1ae3&c=f94cc170-b42a-11e3-8c3a-d4ae52733d3a&ch=fa65ab80-b42a-11e3-8c47-d4ae52733d3a)

Title: Re: The end of the NHS.
Post by: GCW on February 26, 2015, 07:32:01 am
Why are part-time female partners a problem?

2012 (http://www.telegraph.co.uk/news/health/news/9549262/Part-time-women-doctors-are-a-risk-to-NHS.html).
2015 (http://www.thetimes.co.uk/tto/news/politics/article4365644.ece).
Title: Re: The end of the NHS.
Post by: slackline on February 26, 2015, 08:52:52 am
How is that different from any other area of employment?  :shrug:

Can't actually read more than the opening paragraph in the second 2015 article, but if they're both suggesting that the deficit is made up through visas for doctors trained abroad to come and work here how does that differ from other clinical roles where foreign doctors make up a deficit in staff levels (if my lay/crude understanding is correct)?

One solution, albeit with significant lag, might be to make training to become a doctor more appealing to youngsters considering going to University, but thats a potential  :worms: given the state of higher education funding these days.
Title: Re: The end of the NHS.
Post by: GCW on February 26, 2015, 11:30:51 am
It's a minor part of the whole shit storm, but it means less people are full time contractors so the current system is on the brink of failure.
Title: Re: The end of the NHS.
Post by: slackline on February 26, 2015, 11:38:21 am
Have zero-hour contracts started creeping into the NHS yet?

Quite a few people are on less than full time contracts where I'm currently working, and there are more females than males taken advantage of the flexibile work/life balance it affords.  It just means more of them are employed (i.e. 1 full-time == 2 x 0.5 Full Time Equivalent).  I don't see why women are or should be singled out for wanting such a work/life balance.

Each to their own, but I work to live, and don't live to work.
Title: Re: The end of the NHS.
Post by: GCW on February 26, 2015, 12:52:15 pm
What is being highlighted is that the number of places for GP training is (fairly) static, but the proportion of places going to women has increased and an increasing proportion of those work LTFT. It's not a blame thing, it's just maths that there are less sessions of GP time available and it will continue to shrink.
I don't blame them. I'd be gone if I could afford it.
Title: Re: The end of the NHS.
Post by: slackline on February 26, 2015, 12:59:04 pm
Thanks, that explains a bit more clearly why its a problem (amazed you recalled my question from almost two years ago).
Title: Re: The end of the NHS.
Post by: webbo on February 26, 2015, 05:16:02 pm
Have zero-hour contracts started creeping into the NHS yet?

Quite a few people are on less than full time contracts where I'm currently working, and there are more females than males taken advantage of the flexibile work/life balance it affords.  It just means more of them are employed (i.e. 1 full-time == 2 x 0.5 Full Time Equivalent).  I don't see why women are or should be singled out for wanting such a work/life balance.

Each to their own, but I work to live, and don't live to work.
Zero hour contracts have been in the NHS since the year dot. It's called the bank, you sign up to it then they ring you to offer you shifts. If and when they are short of staff, which these days is all the time.
Title: Re: The end of the NHS.
Post by: Sloper on March 04, 2015, 02:32:00 pm
Hmm views on this one?

http://www.theguardian.com/healthcare-network/2015/mar/04/charities-nhs-preferred-provider-andy-burnham (http://www.theguardian.com/healthcare-network/2015/mar/04/charities-nhs-preferred-provider-andy-burnham)
Title: Re: The end of the NHS.
Post by: Offwidth on March 10, 2015, 10:33:22 am
Several charities in my area have boasted how they can undercut NHS or private bids as they dont have to deal with the same strict terms and conditions. Scum exist in all the sectors so there need to be strict rules and penalties to stop such behaviour.
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 11:54:22 am
Rather than calling the charities scum, perhaps it would be better to ask whether the T&C imposed on the NHS are necessary and proportionate?

If the T&C are necessary and proportionate then why does the tender & contract process allow these to be avoided; shurley not NHS / civil service incompetence?
Title: Re: The end of the NHS.
Post by: tomtom on March 10, 2015, 12:33:28 pm
Ha ha the old 'no such thing as bad privatisation - just bad regulation' cobblers...
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 12:56:29 pm
Of course some privatisations are 'bad', the part privatisation of prisons is offensive in a variety of ways.

The question is, why does the NHS allow for a disparity of terms?

Now it could be that the private / non profit distributing providers meet the minimum terms of service and the NHS builds in ^burderns, pays its staff more and so on in which case there is no abuse, just the market in operation. 

For example, if say Boots can deliver the pharmacy @ £2.20 per item dispensed and remain within the regulatory framework and the NHS costs are £4.40 per item shouldn't we contract out?

I suppose we'd have to go back to Hansard and see what was discussed when Labour was enacting the legislation that has led to the current position.
Title: Re: The end of the NHS.
Post by: Offwidth on March 10, 2015, 03:27:50 pm
Rather than calling the charities scum, perhaps it would be better to ask whether the T&C imposed on the NHS are necessary and proportionate?

If the T&C are necessary and proportionate then why does the tender & contract process allow these to be avoided; shurley not NHS / civil service incompetence?

If the particular charitable organisation is scum why call them anything else? People need to think about some of the organisations under the charity unbrella, rather then thinking of them all being uniformly warm and fluffy. It would be nice if the good charities did more to defend their common brand in all this.

Maybe they don't insist on common T&C not because of incompetence but because the revolution of the market wouldnt happen otherwise. Same with Free Schools and Academies who get more money and less regs and cherry pick areas, yet perform pretty much the same. The East Coast rail tender is another good recent example the state imposed management turned out cheaper and more reliable but couldn't stay in place.  All examples of ideology over best value for meeting clear needs. It would be nice for once for evidence to take precedence in policy but I'm not holding my breath.
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 03:42:24 pm
Sit down old boy, I entirely agree with you as to the criticism of the East Coast cock up and have strong reservations about free schools and academies.
Title: Re: The end of the NHS.
Post by: webbo on March 10, 2015, 08:45:58 pm
Of course some privatisations are 'bad', the part privatisation of prisons is offensive in a variety of ways.

The question is, why does the NHS allow for a disparity of terms?

Now it could be that the private / non profit distributing providers meet the minimum terms of service and the NHS builds in ^burderns, pays its staff more and so on in which case there is no abuse, just the market in operation. 

For example, if say Boots can deliver the pharmacy @ £2.20 per item dispensed and remain within the regulatory framework and the NHS costs are £4.40 per item shouldn't we contract out?

I suppose we'd have to go back to Hansard and see what was discussed when Labour was enacting the legislation that has led to the current position.
Pharmacy services are contracted out lloyds provide ours. You can't beat driving half way across the city to pick up some  urgent medication and waiting in line with folk waiting to pick up their methadone. Rather just being able to ring up and get it delivered.
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 08:53:50 pm
That sounds crap, but how was it under the NHS (genuine question I have no idea and no axe to grind) and was the NHS value for money?
Title: Re: The end of the NHS.
Post by: webbo on March 10, 2015, 08:59:10 pm
Depends what you mean by value for money, it was more efficient for staff and patients but more expensive.
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 09:11:00 pm
I'm not doubting it was more convenient for staff & in many ways better for patients but let's say to maintain the service you need to have 4 staff, two cars / motorbikes plus admin and on costs, let's say they make 100 out of hour deliveries a month that's say £100 per delivery vs say 2 hours time and a few miles @ 40p per mile c. £30.

The difference over the year is I would expect, at least a nurses salary.

Title: Re: The end of the NHS.
Post by: webbo on March 10, 2015, 09:20:25 pm
But then if you then cost in having to drive to a team base so you can get a doctor to write a script making sure it's on the right pad for that pharmacy. Then drive to the pharmacy,get the meds and finally deliver it the patient.
Or ring up/send a fax and get it delivered to patient.
Title: Re: The end of the NHS.
Post by: Sloper on March 10, 2015, 09:22:01 pm
Your game not mine, but I can see having people sitting around to deliver scripts might be seen as OTT, out of interest how many times do/did you require this.
Title: Re: The end of the NHS.
Post by: webbo on March 10, 2015, 09:31:26 pm
Not that often, usually happens when the consultant is on leave. Part of the problem is that in order to reduce costs, medication is paid for by the patients GP. So has a script has to be requested and medication ordered via the pharmacy.
In the bad old days the consultant would write a med card and medication would be taken from stock which was ordered on a weekly basis from in house pharmacy.
We are no longer allowed to keep stock meds. It's all the patients own now.
Title: Re: The end of the NHS.
Post by: slackline on May 12, 2015, 10:11:47 am
Medicalising common ailments is one of healthcare's greatest threats by Kailash Chand* (http://www.hsj.co.uk/comment/medicalising-common-ailments-is-one-of-healthcares-greatest-threats/) writing in Health Services Journal.


* Ex-chair of NHS Trust and deputy chair of the BMA council (https://twitter.com/KailashChandOBE)
Title: Re: The end of the NHS.
Post by: johnx2 on May 12, 2015, 10:26:53 am
link doesn't work, this one should...

http://www.hsj.co.uk/comment/medicalising-common-ailments-is-one-of-healthcares-greatest-threats/5074016.article#.VVHGplOW-8B

...anyway, perfectly good piece from last year, representative of an ongoing discussion in medicine. Reasons for posting now??
Title: Re: The end of the NHS.
Post by: slackline on May 12, 2015, 10:32:19 am
Thanks for correcting the link.

Its an important discussion to have since increasing medicalisation has the inevitable consequence of increasing the cost of the service overall and feeds into the discussion about "The end of the NHS".

Reasons for posting now??

I only came across it today, no one linked to it last year (that I can recall).
Title: Re: The end of the NHS.
Post by: Offwidth on May 12, 2015, 10:55:00 am
Another good Roy Lilley...

Some ways to stop digging the NHS cost hole by utilising staff exoertise rather than distrusting it.

http://myemail.constantcontact.com/It-s-a-deal.html?soid=1102665899193&aid=h66V8tkyxHs
Title: Re: The end of the NHS.
Post by: johnx2 on May 12, 2015, 11:35:56 am
Quote from: slackline
I only came across it today, no one linked to it last year (that I can recall).
guess, but these are issues which confront every healthcare system:

 

- the medicalisation/over-medicalisation of part normal human life debate (HRT for menopause say)

 

- the mental health side to that (social anxiety disorder - so prescribe drugs - or shy?)

 

- the linked issue of paying more for new drugs/treatments which are no better than cheaper existing ones (Bad Pharma looks at this).

 

- incentives - once you start paying someone to do something they'll tend to do more of it - see the role of US urological surgeons in prostate cancer screening.

 - public health/prevention as per the 'how did you vote' thread

And on and on. All big and important, and certainly not irellevant as the strength of the NHS is that it can take a consistent and rational approach to all the above more easily than a more fragmented system, in theory at least. But different to the organisational, funding and political issues.

 
Title: Re: The end of the NHS.
Post by: johnx2 on May 12, 2015, 11:38:44 am
Sorry for the mangled phone post. Editing would make it worse. You get the gist
Title: Re: The end of the NHS.
Post by: webbo on May 12, 2015, 04:19:20 pm
I hope this link works.
http://www.nuffieldtrust.org.uk/sites/files/nuffield/media pack final-04-16-update.pdf

As its about the increase in privatisation in the nhs.
Title: Re: The end of the NHS.
Post by: johnx2 on May 12, 2015, 04:53:26 pm
they call me the link corrector, amongst other things*... anyway crucial hyphen omitted. This works:

http://www.nuffieldtrust.org.uk/talks/slideshows/facts-figures-and-views-health-and-social-care-pack-prepared-reports-ge2015


direct link to pdf:

http://www.nuffieldtrust.org.uk/sites/files/nuffield/media_pack_final-04-16-update.pdf






*willy head, probably.
Title: Re: The end of the NHS.
Post by: webbo on May 12, 2015, 08:03:44 pm
Thanks for that.
Anyhow it is stating contrary to what Sloper claimed there is an increase in NHS work going to private sector.
Title: Re: The end of the NHS.
Post by: johnx2 on May 13, 2015, 09:48:36 am
Reasons for posting now??
I only came across it today, no one linked to it last year (that I can recall).

...and now suddenly topical: "doctors warned of over-treating patients" -  http://www.bbc.co.uk/news/health-32717100
Title: Re: The end of the NHS.
Post by: slackline on May 13, 2015, 09:52:49 am
Reasons for posting now??
I only came across it today, no one linked to it last year (that I can recall).

...and now suddenly topical: "doctors warned of over-treating patients" -  http://www.bbc.co.uk/news/health-32717100

Not just doctors though, its also patients expectations of there being a "pill" for everything.
Title: Re: The end of the NHS.
Post by: Offwidth on May 13, 2015, 10:48:53 am
Thanks for that.
Anyhow it is stating contrary to what Sloper claimed there is an increase in NHS work going to private sector.

To be fair to Tom (I know!) he pointed out the previous  Labour Party increased private provision more than the Con Dems even if  as ever he was necessarily relying on slightly old KF data from a subset of the areas affected  (we pointed this out and he scoffed). His main thesis that the Conservatives do not intend to privatise the NHS any time soon remains true for the new government  (but not all tories)....as it would be electoral suicide to do anything else (a small majority including quite a few MPs with a conscience).
Title: Re: The end of the NHS.
Post by: Offwidth on May 14, 2015, 09:05:00 am
Roy Lilley on the crisis in nursing:

http://myemail.constantcontact.com/Crash.html?soid=1102665899193&aid=tnIjhOme88Y
Title: Re: The end of the NHS.
Post by: Offwidth on May 19, 2015, 01:57:28 pm
...and on Cameron's 7 day NHS promises with an almost 'irresistible force meets immovable object' situation developing:

http://myemail.constantcontact.com/No-he-can-t.html?soid=1102665899193&aid=xFzNLxB_h8c
Title: Re: The end of the NHS.
Post by: slackline on June 09, 2015, 03:33:11 pm
Not about the end of the NHS, rather the beginning, from 1948...

(https://pbs.twimg.com/media/CHCffxlXIAAyuI3.jpg:large)

Read it all here (https://en.wikipedia.org/wiki/File:The_New_National_Health_Service_Leaflet_1948.pdf).
Title: Re: The end of the NHS.
Post by: GCW on June 09, 2015, 04:06:31 pm
.......and the future of the NHS (http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf).....
Title: Re: The end of the NHS.
Post by: GCW on June 19, 2015, 05:05:52 pm
Two Hunt announcements within the past eight hours mean I am now extremely concerned this will precipitate an exodus. Oh dear.
Title: Re: The end of the NHS.
Post by: tomtom on June 19, 2015, 05:11:32 pm
Two Hunt announcements within the past eight hours mean I am now extremely concerned this will precipitate an exodus. Oh dear.

They really havnt got a clue have they! 5000 new GP's - when there are... erm lets see.. erm.. none? waiting to become one..

Wonder if they'll now start 'devaluing' the reputation of GP's work in the same way they have with Teachers over the last 5 years...
Title: Re: The end of the NHS.
Post by: GCW on June 19, 2015, 05:15:54 pm
£10m more to open 7 days. That's an average increase in funding of under 0.2% for a 20% increase in opening hours. Hmmmm.

Oh, and Mr Hunt- at 7pm I've been working for 12 hours already, so how exactly do I change my mentality that I can go home and it's not my responsibility?

People were holding off going to hear today's announcement. Not any more.
Title: Re: The end of the NHS.
Post by: tomtom on June 19, 2015, 05:31:23 pm
Do you recon I could become a 'physician associate'? I've a biology O level... ;)

All sounds a bit like pcso's for Gp's...
Title: Re: The end of the NHS.
Post by: Oldmanmatt on June 19, 2015, 09:49:06 pm
The "Physicians Apprentice"...

Visions of marching Syringes, dancing aspirin capsules and bubbling cauldrons of Piriton; conducted by a White Coated Mickey Mouse,  a'la Fantasia.


Sent from my iPad using Tapatalk
Title: Re: The end of the NHS.
Post by: bigtuboflard on June 20, 2015, 09:51:13 am
Do you recon I could become a 'physician associate'? I've a biology O level... ;)
Don't think you even need that, I walked in to Homerton hospital in East London hospital this week to visit a dying relative to be asked "which patient are you here to see Doctor?" by the nurse at the ward desk. Given that I was just wearing my smart work suit (London meetings) and carrying a brief case I could have made anything up at that point.
Title: Re: The end of the NHS.
Post by: Offwidth on June 20, 2015, 10:58:11 am

5000 new GP's



Its not 5000, its 5000 extra over the demographic loss which is higher than normal due to more than average being close to retirement. GPs can also retire early, do something else or maybe even emigrate (again increasing numbers are) The real gap is reported to be a good bit over 10000. The only real solution is to buy in doctors from other countries.
Title: Re: The end of the NHS.
Post by: lagerstarfish on June 20, 2015, 02:06:59 pm
how many doctors are just about to not get paid in Greece?
Title: Re: The end of the NHS.
Post by: GCW on June 20, 2015, 08:17:23 pm
5000 new GP's
Its not 5000, its 5000 extra over the demographic loss which is higher than normal due to more than average being close to retirement. GPs can also retire early, do something else or maybe even emigrate (again increasing numbers are) The real gap is reported to be a good bit over 10000. The only real solution is to buy in doctors from other countries.

Official figures:

Unfilled GP posts quadrupled in last three years (now 7.9%).  Lack of recruitment to training posts.
32,075 GPs in 2015; 32,110 in 2009.  RCGP estimate 40,100 are needed.
Increasing demand on appointments:  13% rise in numbers between 2008 and 2013.  370m appointments per annum, 60m up from 2010.
Increasing workload:  37% of GPs feel workload unmanageable, 93% say workload negatively impacts patient care.  543 practices are said to be at risk of closure imminently.
Title: Re: The end of the NHS.
Post by: Offwidth on September 29, 2015, 12:33:20 pm
Another depressing nail:

http://www.theguardian.com/global/2015/sep/28/nhs-junior-doctors-forced-out-contract-department-of-health
Title: Re: The end of the NHS.
Post by: mrjonathanr on September 29, 2015, 02:37:40 pm
To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.
Title: Re: The end of the NHS.
Post by: slackline on September 29, 2015, 03:14:31 pm
To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.

You are Noam Chomsky...

(https://s-media-cache-ak0.pinimg.com/736x/73/da/57/73da57a5bf40a11c732f2b250ec1220d.jpg)
Title: Re: The end of the NHS.
Post by: mrjonathanr on September 29, 2015, 03:18:03 pm
Not quite so illustrious I'm afraid.
Title: Re: The end of the NHS.
Post by: Wood FT on September 29, 2015, 03:20:15 pm
To a non-medic the thinking seems clear: degrade the system till -by degrees of course- a privately-run option will be acceptable to the voting public.

Depressingly clear, we'll also see the villification of the medical profession (see: Gove Teachers model 1.0)

5 more years of this shit.

"'The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which"
Title: Re: The end of the NHS.
Post by: fatdoc on September 29, 2015, 09:24:28 pm
Nice Guy. Deal is ive left this thread alone, as I've said before its all fucked, can't be stopped and the end is nigh. Sorry all... The foundation trusts last year were approx 5% in debt... Now it's predicted 85% by financial year end..
Title: Re: The end of the NHS.
Post by: petejh on September 30, 2015, 11:06:00 am
Is there any merit in the idea of nurses, doctors and surgeons being contractually obliged to work solely for one employer (or otherwise a tight limit on hours worked elsewhere), i.e. either the NHS or a private medical provider?

If not why not?
Title: Re: The end of the NHS.
Post by: drdeath on September 30, 2015, 12:34:26 pm
Contractually? Not really sure about that....

At the minute in Scotland Consultant Medic Job Planning (yearly process of laying out your role and responsibilities, working pattern etc) includes a declaration that the NHS will have first bite at any extra time you have in your week - i.e. you can go work privately one day a week, but only if the health board doesn't want you that day...

In practice it's a bit redundant as the vast vast majority of doctors work solely in the NHS and any who do private work, as I do myself, do it in their spare time - i.e. Saturday Mornings, week nights etc...

Would I come in and work for the NHS during those times?

It's not very practical for them to ask, as it would be overtime and paid as such...therefore more economical to hire someone else, more junior.

And if push came to shove, my private work pays £150 an hour: the NHS?.....does not.

Although Locum Consultant rates start at £100 and hour and go up rapidly from there...and there will be more of that coming as the shortage of doctors worsens...before all of these contract shenanigans we were in trouble...now its looking grim.

I gave a lecture to our local FY2 group last week, 30-40 doctors just out of training...I asked the question 'who here has plans to go abroad to work next year?' and out of that group I would say >50% raised their hand.

Cynical as I am, even I was shocked...they were determined, had plans, and a good many won't ever come back.



As for nursing staff etc. I wouldn't want to comment, due to complete ignorance.


D



Title: Re: The end of the NHS.
Post by: psychomansam on September 30, 2015, 01:09:33 pm
I now work for an NHS trust. Recent numbers had the trust at a shortfall of ~200 nurses. That is being at least halved with the next intake but, despite sending recruitment agents abroad to vet and import nurses, we will still be going into the winter with a shortfall.

I'm still trying to work out how this government plans on driving the economy with a chronic shortage of professionals. Engineers, web developers, doctors, nurses, teachers, who needs them? We've got bankers and consultants baby.
Title: Re: The end of the NHS.
Post by: petejh on September 30, 2015, 02:12:51 pm
Quote
I gave a lecture to our local FY2 group last week, 30-40 doctors just out of training...I asked the question 'who here has plans to go abroad to work next year?' and out of that group I would say >50% raised their hand.

Cynical as I am, even I was shocked...they were determined, had plans, and a good many won't ever come back.

Who pays for the medical training institutes and the lecturers/training staff in this country? Are they 100% privately funded, a mix of private/public, or 100% publicly funded?

Is there a case to be made for providing 100% publicly-funded (or heavily subsidised) medical training open to all students of all means, dependant on recipients being bound to a contractual obligation for full-time work in the nations public health service for x-years? I would have thought there would be an appetite among less priviliged students for this?

I think what I'm digging at, without any real knowledge or strong viewpoint either way, is what would an NHS look like if you could create a system geared toward providing expensive medical training to the great pool of people who - I get the impression - come from less privileged circumstances than has been the average for medical students over previous decades. And then impossed on them some kind of reciprocal obligations to the state.
I come from a military background btw where working hours/locations wasn't a choice open to me. So I'm perhaps less sympathetic than some and still see some roles that might be able to be best served with a dollop of 'duty' rather than choice.

Quote
And if push came to shove, my private work pays £150 an hour: the NHS?.....does not.
There's supply/demand at play. By which I mean demand for private treatment is increasing in this very unequal country.

It's inevitable that supply of willing medical people will increase to meet any increase in demand.
Title: Re: The end of the NHS.
Post by: GCW on September 30, 2015, 02:52:54 pm
Nice Guy. Deal is ive left this thread alone, as I've said before its all fucked, can't be stopped and the end is nigh. Sorry all...

Me too. Our local trust is under scrutiny from Monitor and has a £30 odd million deficit this year.

We will all be paying soon..
Title: Re: The end of the NHS.
Post by: drdeath on September 30, 2015, 05:07:34 pm

Who pays for the medical training institutes and the lecturers/training staff in this country? Are they 100% privately funded, a mix of private/public, or 100% publicly funded?

Is there a case to be made for providing 100% publicly-funded (or heavily subsidised) medical training open to all students of all means, dependant on recipients being bound to a contractual obligation for full-time work in the nations public health service for x-years? I would have thought there would be an appetite among less priviliged students for this?


AFAIK - Its a mix of public and private...the fees for English students is about £9000 a year for five years, but the actual cost is somewhat higher.

So, you are talking about letting them off the hook for £45000, at a maximum...

And the question then is what you expect in return?

It would have to be something likely to be seen as a fair exchange - and holding them for say 10yrs under the contract changes that are about to come in would never work...nobody would go for it, being aware of what they are giving up. Particularly as student debt is deferred and recovered over extended periods...

Also it may build a two tier system of training - the indentured drones who can't leave under pain of financial clawbacks and those able to leave for the sunlit financial uplands of the free world.

And could it be enforced? Would it run against European law (no idea...just wondering, although that may not be an issue after next year)...

For all the comments bandied about when this topic comes up in the media, the essential paradox never seems to be spoken...

Why, if the money is so great, the workload so manageable and the profession simply not aware of how good they have it, do we have a recruitment and retention crisis that leaves us shipping in doctors from all over the world, and still failing to fill posts?

Surely we should be bursting at the seams with doctors?

D



Title: Re: The end of the NHS.
Post by: Offwidth on September 30, 2015, 05:10:02 pm
When you look at this sort of thing as a bright kid from a poor background it's pretty scary:

http://www.westernmorningnews.co.uk/Newly-qualified-doctors-82-000-debts/story-26364020-detail/story.html

There are lots of routes to extra financial help but grants are now are moving to loan based support as well.

One of the biggest problems with the latest contract changes are they will very likley further hinder the numbers of women progressing to the best paid posts as balancing family and the much less favourable out of hours working arrangements, and the added disadvantages for those taking parental leave or working on fractional contracts.

On Pete's point the current supply economics is UK trained staff moving out to other nations and outside trained staff moving in alongside a big increase in expensive locums... not very healthy in the current political and financial climate.
Title: Re: The end of the NHS.
Post by: drdeath on September 30, 2015, 05:25:24 pm
Yup 82,000 in debt, with a training contract that pays 20% less than it did five years ago...

and the promise of a sub-consultant bottleneck, pure service-provision post in a top-down reorganised, target-driven trust where you been 'integrated' with social services so you now answer to a social work manager...

Who could say no to that?


D
Title: Re: The end of the NHS.
Post by: fatdoc on September 30, 2015, 10:14:31 pm
nail on the fuckin head there... i have 4 A stream kids.. not one has even thought of medicine as a sensible or viable career..

Title: Re: The end of the NHS.
Post by: tomtom on October 01, 2015, 07:36:59 am
82k in debt is alot. Medicine is an expensive degree to teach and for your 82k the Govt (and the taxpayer) will have paid 300-500k for your training. So in the UK a junior doctors (and ongoing) salary is going to reflect this debt to some degree.

Before any tea is spat out at the above - its a balance, and pay too little/make working conditions too bad (IE devalue the post), and people will leave after training ASAP to get a better deal elsewhere - leading to a shortage in doctors and therefore the balance is wrong..

Instead of reflecting some sort of balance, I suspect the Govt will next start mooting the idea of some sort of bond/contract making UK trained doctors work in the NHS for a set period of time etc...

*I may have explained the above badly - I disagree with the govts stance on this...
Title: Re: The end of the NHS.
Post by: drdeath on October 01, 2015, 08:56:29 am
Indeed,

And the idea that that's a solution is bonkers...

We can't fill the posts as it is, so adding an onerous 'indentured service' clause is really going to drag bright young things into medical training.

I can imagine it now - going out to high schools and career fairs across the country:

'So you are academically in the top tier of your school and are looking for an attractive career with huge potential? Well, do we have a deal for you...we will graciously permit you to study your arse off for five years and then a further grinding few years of on the job training for relatively low wages, and in return we will mandate that you can't leave the country for ten years...literally.

Now, I know what you're thinking - that's too good to be true, where's the catch?

Wait, come back...I haven't finished...what do you mean you are off to the Corporate /Banking/IT/Creative Industries stands...'

Same as Fatdoc above, I would not and will not advise any young people to pursue a career in medicine, at least in this country...I'll fully support them if they decide its for them...but I can't honestly sell it the way it looks like it's headed..


D
Title: Re: The end of the NHS.
Post by: GCW on October 01, 2015, 11:37:34 am
I'm getting out as soon as I hone my alternative skills.  GP is shockingly bad at the moment.
Title: Re: The end of the NHS.
Post by: Will Hunt on October 01, 2015, 12:57:31 pm
And the problem is not just limited to doctors.
A recent ward merge between an elderly and a stroke ward (sounds like a fab idea that, doesn't it?) at the missus' place was driven not because there was insufficient money to fund two distinct wards, but because they simply can't recruit the staff to run them both. I wonder which is more cost effective: to ship in a Spanish nurse whose first language is not English; or to make nursing seem a more attractive prospect to a young school-leaver?
Title: Re: The end of the NHS.
Post by: webbo on October 01, 2015, 01:53:55 pm
I was a day out for senior nurses in our Trust yesterday about 80 people present and someone asked how many of you are able to retire by 2018. About 55 people stuck their hands up.
That might sort of have impact on the future of the NHS as this is a National issue.
Title: Re: The end of the NHS.
Post by: petejh on October 01, 2015, 02:40:13 pm
And the problem is not just limited to doctors.
A recent ward merge between an elderly and a stroke ward (sounds like a fab idea that, doesn't it?) at the missus' place was driven not because there was insufficient money to fund two distinct wards, but because they simply can't recruit the staff to run them both. I wonder which is more cost effective: to ship in a Spanish nurse whose first language is not English; or to make nursing seem a more attractive prospect to a young school-leaver?

And if the Spanish nurse has perfectly good English, what then? Because they too would be as cost effective in your example. I imagine.

We're part of Europe, with all the opportunities for working in other countries that the EU brings.

And 'ship in' implies a cargo, not a person with aspirations.
Title: Re: The end of the NHS.
Post by: Offwidth on October 01, 2015, 05:35:33 pm
someone asked how many of you are able to retire by 2018. About 55 people stuck their hands up.
That might sort of have impact on the future of the NHS as this is a National issue.

A lot of public sector pensions are index linked based on past pay. Mine for instance is based on the average of the best three years in the last ten, index linked and hence being at the top of a scale, like a lot of my age group, my pensionable pay is now nearly 20% more than my real pay. There is hence a larger financial incentive to retire early soon, as beyond 2018 the gap between real pay and pensionable pay starts to close. When combined with flat pay for the forseeable future, and ever increasing workloads, and reduced union rights,  the public sector is facing a demographic perfect storm. A classic unintended consequence.

In the meantime if you are a medical student you better not kick up a, fuss.

http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract
Title: Re: The end of the NHS.
Post by: petejh on October 01, 2015, 10:09:47 pm
[quote author=Offwidth link=topic=21748.msg501350#msg501350 date=

In the meantime if you are a medical student you better not kick up a, fuss.

http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract
[/quote]

 :-\  Doesn't read as particularly 'threatening' to me, just practical advice from people who've 'been there done that'.
What are the facts of this new contract? So I can get a clear idea. Rather than the overwhelming sayers of 'nay' on this thread.

For instance - what is the hourly rate for
'Standard time'. And will the new
Contract continue with the 48 hour per week rule?


GPs - 'gatekeeper' roles are under threat everywhere due in part
to the democratisation of information. Media for e.g. That's
not to undervalue the importance of medical care but this isn't 1970 and deference toward GPs and other other gatekeeper professions is at an all time low for a reason.
Title: Re: The end of the NHS.
Post by: Offwidth on October 02, 2015, 08:56:18 am
It's just as if veiled threats are not a common establishment  tool in institutions that are supposed to be bastions of independant thought. Anyhow since information is democratised; if you go to sites run by both sides of the argument you can get the details you asked for. I'd suggest they are not going to help much as they are not the details causing the dispute. My concern is the service already has massive shortages and this sort of contractural brinkmanship is unnecceesary and dangerous.
Title: Re: The end of the NHS.
Post by: tomtom on October 02, 2015, 09:13:51 am
The govt and media language is often subtle but pervading.

Take this mornings headlines for example "GPs given bonuses to stop referring people for ops" etc.. another way of writing the same headline is "Govt NHS trusts bribing GP's to stop referring people for operations"...

Amazed higher education has not been subject to quite as much devaluation

"two-a-penny Profs spout shit on the internet" - oh..... ;)
Title: Re: The end of the NHS.
Post by: psychomansam on October 02, 2015, 09:32:07 am
[quote author=Offwidth link=topic=21748.msg501350#msg501350 date=

In the meantime if you are a medical student you better not kick up a, fuss.

http://www.theguardian.com/society/2015/oct/01/medical-schools-accused-of-stifling-protest-at-junior-doctors-contract

 :-\  Doesn't read as particularly 'threatening' to me, just practical advice from people who've 'been there done that'.
What are the facts of this new contract? So I can get a clear idea. Rather than the overwhelming sayers of 'nay' on this thread.

For instance - what is the hourly rate for
'Standard time'. And will the new
Contract continue with the 48 hour per week rule?


GPs - 'gatekeeper' roles are under threat everywhere due in part
to the democratisation of information. Media for e.g. That's
not to undervalue the importance of medical care but this isn't 1970 and deference toward GPs and other other gatekeeper professions is at an all time low for a reason.
[/quote]
I have to say I agree the email was probably supposed to be encouraging and supportive but was just worded stupidly.
I also would like to know the details of the new contract. I suspect the current situation is as it is for a reason - the government are trying to see how much screwing they can get away with while keeping the media on side. Sadly only the indie and grauniad appear to the care. The BBC appears to be using a barge pole. I have to say I'm increasingly hating bbc news. They are increasingly just the government news outlet. The result of all this probably means quite a lot of screwing over of Dr's.

Could you please explain your cryptic final paragraph?
Title: Re: The end of the NHS.
Post by: Offwidth on October 02, 2015, 10:20:48 am
I've worked with pragmatic aims with some of these buggers who run our august institutions and know many others in my situation. With the odd honorable exception modern VC's are craven when it comes to challenging even some of the most idiotic government policy and are terrified of bad press. If support was intended they could have quickly changed the message. Campaigning on campus used to be a widespread student sport showing intellectual freedom was in rude health; these days things are horribly quiet and the noisy exceptions are sometimes arrested.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on October 02, 2015, 12:20:29 pm

I've worked with pragmatic aims with some of these buggers who run our august institutions and know many others in my situation. With the odd honorable exception modern VC's are craven when it comes to challenging even some of the most idiotic government policy and are terrified of bad press. If support was intended they could have quickly changed the message. Campaigning on campus used to be a widespread student sport showing intellectual freedom was in rude health; these days things are horribly quiet and the noisy exceptions are sometimes arrested.

Because there seems little spirit in that generation.
The pursuit of minor celebrity on Farcebook/twitter/what ever is far more important.


Sent from my iPhone using Tapatalk
Title: Re: The end of the NHS.
Post by: a dense loner on October 02, 2015, 12:32:29 pm
And 8a
Title: Re: The end of the NHS.
Post by: Offwidth on October 05, 2015, 01:41:11 pm
Latest on the junior doctors' contract:

http://www.theguardian.com/society/2015/oct/04/deal-over-junior-doctors-contracts-was-torn-up-reveals-ex-health-minister
Title: Re: The end of the NHS.
Post by: petejh on October 05, 2015, 03:16:17 pm
Could you please explain your cryptic final paragraph?

Wasn't meant to be cryptic - just have a think about possible reasons why there may be less deference towards the medical profession comapred to 40 years ago, it isn't a difficult exercise. Note I'm not saying there's widespread disregard.


This thread is unbalanced.

In the context of the received wisdom about there not being enough doctors to staff the NHS, has anybody on here mentioned the reports about A&E departments staffed with one-third of expensive agency-hire doctors? And the reported extra £2billion per year figure this is reported to cost the nhs over using normal staff?

Or is that not relevant/untrue?

It seems pretty clear to me that there are enough doctors around in theory, or at least not exactly the shortage that some media portrays. But, like so many other skilled workers in the UK, doctors have acquired the taste for low-comittment high-pay short-term working at greater cost to the client - i.e. the health service.
Seems a bit rich to me to pin all the blame at the door of governemnt policies when a large and very expensive portion of the workforce are acting (quite within their rights) with the sort of monetised motives that defenders of the NHS want to protect it from - private contractors (n this case employment agencies) with profit motives first. That contract looks partly to be a reaction to this, maybe hamfistedly it's hard to tell..
Title: Re: The end of the NHS.
Post by: GCW on November 19, 2015, 10:28:59 am
Quote from: Pulse
There has been almost unanimous support from junior doctors for strike action, with a turnout of 76%, the BMA has announced.

The results of the ballot have revealed that 99.4% of junior doctors voted in favour of industrial action short of a strike, while 98% voted in favour of strike action.
Title: Re: The end of the NHS.
Post by: aly on November 20, 2015, 01:47:27 am


In the context of the received wisdom about there not being enough doctors to staff the NHS, has anybody on here mentioned the reports about A&E departments staffed with one-third of expensive agency-hire doctors? And the reported extra £2billion per year figure this is reported to cost the nhs over using normal staff?

It seems pretty clear to me that there are enough doctors around in theory, or at least not exactly the shortage that some media portrays. But, like so many other skilled workers in the UK, doctors have acquired the taste for low-comittment high-pay short-term working at greater cost to the client - i.e. the health service.
Seems a bit rich to me to pin all the blame at the door of governemnt policies when a large and very expensive portion of the workforce are acting (quite within their rights) with the sort of monetised motives that defenders of the NHS want to protect it from - private contractors (n this case employment agencies) with profit motives first. That contract looks partly to be a reaction to this, maybe hamfistedly it's hard to tell..

I disagree with this.
I currently work in an A&E department and yes, a proprotion of the doctors working at any time will be locums but certainly not a third of them, and most of them will be working on the SHO (lower grade junior doctor) rota or occasionally on the middle grade (registrar) rota.  Having said that I don't doubt that in some hospitals and some departments it could reach that level.  Locums are also extensively used through the hospital, to cover on-call shifts on the wards.  Most of this work is on an ad-hoc shift-by-shift basis to cover gaps in the rota and the vast majority of the locums I have worked with are working for 'trust rates'.  That is, they are or have been working for the trust on training programmes, and are contacted directly by the trust to fill the gaps.  From memory the rate for an FY1 locum was ~£20-25/hr at trust rates so not exactly a fortune.  If the hospital cannot fill the gaps they will have to use an agency which costs considerably more.

Now I haven't read up on the figures you mention but I don't doubt that locum doctors cost trusts a lot of money.  I suspect that number is significantly smaller than the amount the NHS spends on locum/bank nursing staff or support workers who are used far more frequently and the hourly rates are not dissimilar than for doctors.

The reason for all these locums?  It is absolutely about a shortage of doctors.   Every department has to recruit a certain number of doctors into training programmes to fill their operational rota and lots of specialties are struggling.  Emergency medicine, GP, psychiatry, even core medical and surgical jobs are going unfilled by trainees which leaves hospitals with big gaps in their rotas.   They either need to get locums to cover the shifts, or not have enough medical cover.  After completing medical school, doctors complete the first two years of their junior doctor career on series of 4-month rotations in different specialties (FY1 and FY2).  These two years come as a 'block' in the same area and the vast majority of posts are filled as you need to complete both years to be fully registered as a doctor and to (realistically) have enough experience to a)work elsewhere and b)know what you want to specialise in.  After these two years you apply to a training programme which could be emergency medicine, hospital medicine, GP training for anything from a further 3 to 8+ years.  It is these post which are simply not being filled, and it's not because of an "'acquired' taste for low-comittment high-pay short-term working".  On the contrary all doctors need to complete such training posts to ever become a consultant/GP and taking time out is ultimately prolonging, and possibly detrimental to, their career.

Doctors aren't filling these posts because they become disillusioned with 2 years of highly stressful work, antisocial hours, countless hours (indeed daily) of starting early and staying late outside your hours, being treated badly by their employers while the government tries to dismantle the health service they're trying to resuscitate around them.  Well I do anyway.  And all for what is really not that much money.  And that's why me and so many of my colleagues are going abroad, compounding the problem further.  And the irony is that I really love the job I'm doing at the moment, and I want to train in emergency medicine but there's no way I can work almost constant night shifts, 60-hour weeks, and most of my weekends for the next 6 or 7 years without it ruining my life.  So the recruitment crisis will continue.

And then the public wonder why we get upset when we're told we are having imposed upon us a pay cut, an increase in those unsociable hours, the removal of the limited protection against us being overworked and multiple other terms detrimental to career progression and equality.

The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?

Sorry for the rant, I guess I don't really disagree with you that much, but the problem is caused by crap working conditions pushing doctors out of training, which a) makes it worse for everybody else, and b) requires the use of locums to cover the gaps.  We live in a market economy and the only way to retain staff is to give them a lifestyle that they want.  Money isn't the issue for the vast majority of doctors, they enjoy their work, most likely don't even know how much they earn but I think that to say they want 'high pay, low commitment, short term working' does us all a disservice.
Title: Re: The end of the NHS.
Post by: webbo on November 20, 2015, 10:04:31 am
Good post that.
Title: Re: The end of the NHS.
Post by: GCW on November 20, 2015, 11:52:15 am
Quote from: GP Online
Health secretary Jeremy Hunt has rejected the BMA's offer of conciliation talks with the independent arbitration service Acas ahead of planned junior doctor strike action

Hilarity.
Title: Re: The end of the NHS.
Post by: lagerstarfish on November 20, 2015, 12:01:18 pm
The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?

it'll be interesting to see how low thay can go before doctors from developing countries feel that they'd rather stay in the country where they were trained (and are still needed)
Title: Re: The end of the NHS.
Post by: Wood FT on November 20, 2015, 12:04:23 pm
Quote from: GP Online
Health secretary Jeremy Hunt has rejected the BMA's offer of conciliation talks with the independent arbitration service Acas ahead of planned junior doctor strike action

Hilarity.

Well, he has been told to be 'deeply muscular' with Doctors by high command

http://www.theguardian.com/society/2015/nov/19/nhs-bosses-pressure-hunt-arbitration-junior-doctors

Quote
“Number 10 sees this as a miners moment and wants him to look tough,”
Title: Re: The end of the NHS.
Post by: Footwork on November 20, 2015, 12:06:53 pm

The rota is not a hamfisted way to address these problems with the NHS, it's a calculated move to break the NHS.  By imposing a the contract on junior doctors they will either accept the pay cut/hours increase and the govt wins, or they will leave the NHS is even more fucked.  Then you cap locum rates, and locums will either continue to cover the shifts for a huge pay cut (and the govt wins), or they will go elsewhere and...you see where I'm going here?


This.

The awful thing is watching interviews and media reports completely (intentionally?) missing the point and failing to tell the public that their health service they take for granted is being fvcked over by dave and his mates.

Title: Re: The end of the NHS.
Post by: tomtom on November 20, 2015, 12:25:24 pm
I've been mightily fucked off with how the BBC have been handling this... Barracking the JDocs representative time after time that this was about pay - and him clearly responding every time that it was about safety/conditions. Like listening to Fox news....

Grr. Angry TomTom.
Title: Re: The end of the NHS.
Post by: Will Hunt on November 20, 2015, 12:55:36 pm
And the problem is not just limited to doctors.
A recent ward merge between an elderly and a stroke ward (sounds like a fab idea that, doesn't it?) at the missus' place was driven not because there was insufficient money to fund two distinct wards, but because they simply can't recruit the staff to run them both. I wonder which is more cost effective: to ship in a Spanish nurse whose first language is not English; or to make nursing seem a more attractive prospect to a young school-leaver?

And if the Spanish nurse has perfectly good English, what then? Because they too would be as cost effective in your example. I imagine.

We're part of Europe, with all the opportunities for working in other countries that the EU brings.

And 'ship in' implies a cargo, not a person with aspirations.

I missed this.

The comment about English not being a native language is not that important (though it still needs scrutiny. Passing a test on the Queen's English does not necessarily mean you will be able to converse fluently with a Bradfordian who was born and raised in West Bowling) and draws attention away from the real point - that it is inevitably more expensive to ship/bus/fly nurses from overseas to work here when you consider the relocation package.
Title: Re: The end of the NHS.
Post by: abarro81 on November 20, 2015, 01:09:50 pm
it is inevitably more expensive to ship/bus/fly nurses from overseas to work here when you consider the relocation package.

Got anything to back that up? Wouldn't surprise me if it's cheaper given that 1. you don't have to pay for the training and 2. you might be able to pay less.
Title: Re: The end of the NHS.
Post by: webbo on November 20, 2015, 01:24:10 pm
If they are Nurses working for an NHS trust, they would have to be paid under agenda for change pay scales.
Title: Re: The end of the NHS.
Post by: Will Hunt on November 20, 2015, 01:38:13 pm
it is inevitably more expensive to ship/bus/fly nurses from overseas to work here when you consider the relocation package.

Got anything to back that up? Wouldn't surprise me if it's cheaper given that 1. you don't have to pay for the training and 2. you might be able to pay less.

I had been about to say that I think employment law would preclude you from paying less - but Webbo has just come up with some fact.

It costs something like 70k to train a nurse in the UK.

Consider that foreign nationality nurses are likely to be young, single, and relatively inexperienced in the profession. They are likely to return home if and when their home governments relax austerity and they can get jobs there again, or they get bored of the UK, or they want to return home to start a family. When they leave they take the experience they have gained on the job with them and you have to start again with somebody new.

If we were training enough of our own nurses to develop and act as more experienced mentors to newer recurits who are filling the odd gap then this might be sustainable. Unfortunately we are training precious few nurses, and this is possibly associated with the fact that jobs in nursing, and the NHS as a whole, are looking very unattractive to bright young things today.
Title: Re: The end of the NHS.
Post by: abarro81 on November 20, 2015, 01:52:02 pm

Consider that foreign nationality nurses are likely to be young, single, and relatively inexperienced in the profession. They are likely to return home if and when their home governments relax austerity and they can get jobs there again, or they get bored of the UK, or they want to return home to start a family. When they leave they take the experience they have gained on the job with them and you have to start again with somebody new.

If we were training enough of our own nurses to develop and act as more experienced mentors to newer recurits who are filling the odd gap then this might be sustainable. Unfortunately we are training precious few nurses, and this is possibly associated with the fact that jobs in nursing, and the NHS as a whole, are looking very unattractive to bright young things today.

Good point
Title: Re: The end of the NHS.
Post by: Lund on November 20, 2015, 11:36:56 pm
I've been mightily fucked off with how the BBC have been handling this... Barracking the JDocs representative time after time that this was about pay - and him clearly responding every time that it was about safety/conditions. Like listening to Fox news....

Grr. Angry TomTom.

Actually, I heard an interview with Jeremy Hunt on the (BBC) radio yesterday.  He was crucified, and they made him sound like a real pecker.  Asking him over and over again why he wouldn't talk to the doctors via the conciliation service.
Title: Re: The end of the NHS.
Post by: Offwidth on November 24, 2015, 02:39:01 pm
His 'negotiations' involved 23 points in which the doctors reps had to agree to 22 in advance. He banged on and on about the 11% on basic pay but said nothing about stuff like increments going, reduced rates for evening and Saturday work, the effect on those taking time out for maternity, and the bit that seems to bug even the bluest tory voting Junior Doctors... removal of safety mechanisms so exploitation could get worse. He lied over and over about most junior doctors being better off and how safety would definitely improve... how can this be if the costs are flat or reduced and the protections were diluting??. All this is in the context of criticism from his own previous tory (ex GP) Junior Minister saying that they pretty much had a deal last year. In terms of 24 hour working they do it anyway so the real problem in the NHS is elsewhere (esp consultants). So as its not the money or 24 hours but as recruitment is arguably at crisis levels, the motivation for such a potentially damaging dispute is unfathomable. 98% for a group like junior doctors on that sort or turnout is unheard of.
Title: Re: The end of the NHS.
Post by: slackline on January 07, 2016, 04:56:23 pm
Lost to the NHS: a mixed methods study of why GPs leave practice early in England (http://bjgp.org/content/early/2016/01/05/bjgp16X683425)
Title: Re: The end of the NHS.
Post by: Offwidth on January 15, 2016, 05:49:12 pm
At least someone sees the funny side:
NHS Networks weekly news
RL
Robinson Lynn - Deputy Head of Contracting and Performance <Lynn.Robinson@nottshc.nhs.uk>
Fri 15/01/2016 4:32 PM
To:
Clark, Steve;
 
Read the blog and then the top story!

Lynn Robinson
Deputy Head of Contracting and Performance
Local Services Division

Tel:        0115 9691300 (Ext 11345)
Mobile:  0797 9111912

"From: NHS Networks [mailto:websupport@networks.nhs.uk]
Sent: 15 January 2016
Subject: NHS Networks weekly news

Picket line: do not cross

There is no blog this week due to an industrial dispute.

We have reached agreement over 14 of the 15 disputed paragraphs but cannot agree which one we still disagree about.

The details are extremely complicated, so unless you’re very clever or have a lot of time on your hands (the leader of a doctors’ union or a minister of state, for instance) you won’t be able to get your head round it.

All the evidence suggests that the day the blog comes out corresponds with an increase in mortality compared with the previous day, thanks to the number of people who die in the intervening period.

According to the government, there is a clear link between these deaths and the appearance of the blog. A new contract is expected to sort it all out.

In a statement, the government said: “We made a clear manifesto commitment to deliver a seven-day week and that’s exactly what this government has done ever since we were elected. We’re not going to let a bunch of lefty doctors stop us.”   

Sir Bruce Keogh has agreed to review the evidence for blog-related mortality. The blog will re-appear once both sides have been assured that the safety of NHS staff and patients will not be compromised.

The editor could not be reached for comment. According to a report in The Sun, he was last seen leaving BMA House in his Bentley en route to a cocktail party in Belgravia with his champagne swilling junior doctor chums.

A spokesman for the BMA said: “We’re very close to understanding what the dispute is all about. If you find out before we do, please let us know.”

Guest editor: Junior Patterson

@jtweeterson

julian.patterson@networks.nhs.uk"
Title: Re: The end of the NHS.
Post by: GCW on January 31, 2016, 10:05:37 am
Interesting stuff about the LMC special conference yesterday, the first since 2003 which says a lot.

Plenty about primary care being on the brink, services becoming unsafe, funding poor, workload increasing.  150,000 more appointments each day in England compared to five years ago, but no more funding. Less than 40p per patient per day for unlimited access. The only other part of the system that doesn't get "full" is A&E and they get paid per attendance, and a lot more per visit than primary care is funded per patient per year. Workforce crisis worsening with many GPs saying they will leave within five years.

The big news that the conference overwhelmingly voted to ballot on mass resignation if nothing changes within six months.

And what is in the papers?  I've seen one article about "GP leader demands government stops penny pinching" followed by loads of comments about £100k+ salaries and lazy GPs.

If you have any interest, I'd suggest a browse around this (http://www.gponline.com/special-lmcs-conference-dr-chaand-nagpaul-speech-full/article/1381522). 

I think the public are being kept in the dark about a lot of this, on purpose. Why can't you get an appointment? Because of this why can't you get to see the GP you know?  Because of this. Etc etc ad infinitum.

And it's only going to get worse unless drastic action is taken. People need to understand it's not just about the money, or the huge demand, or the workforce. It's not safe, and it's not sustainable.

And it's getting hidden away.
Title: Re: The end of the NHS.
Post by: Footwork on January 31, 2016, 10:38:29 am
The number of junior Dr friends who are leaving the country is pretty overwhelming too. No one really wants to do it anymore. The trusts cover up seriously unsafe conditions and won't hesitate to point the finger of blame at you. The amount of spin and lack of factual information the government has put on all of this has given me motion sickness.
Title: Re: The end of the NHS.
Post by: GCW on January 31, 2016, 10:56:22 am
Like this sort of nonsense:  http://www.thesundaytimes.co.uk/sto/comment/columns/article1662348.ece
Title: Re: The end of the NHS.
Post by: Footwork on January 31, 2016, 11:05:12 am
yeah, complete idiot. But you know, so long as you aren't affected or anything... :shrug:

If GP's went on strike A&E would be mental.
Title: Re: The end of the NHS.
Post by: mrjonathanr on January 31, 2016, 11:31:23 am
I can't see beyond the first few paragraphs but her stall is clearly set out by then.

The point is that what superficially appears to be idiotic is written by an educated and literate writer whose copy has been passed by editorial consent, so its effect is carefully aimed.
Title: Re: The end of the NHS.
Post by: GCW on January 31, 2016, 11:38:04 am
Precisely - there is an agenda set here.
Title: Re: The end of the NHS.
Post by: GraemeA on January 31, 2016, 12:26:19 pm
Definately seems like an agenda, I don't know about others on here but my last 2 GP surgery's have emergency appointments (Hollies Med Centre and the Sloan Med centre).

My recent dealings with the NHS have been amazing in all bar 1 thing: On Friday I called in 2 ask for a home visit due to excruciating pain in my leg following on from a microdiscectomy 7 days prior. Within 1 hour GP arrived, checked me out and gave me a script. This was where the error occurred, he hadn't put the quantity of pills down. But within 30 minutes of discovering the error I had got through to 111, talked to someone who understood what I was saying, and then got the GP Collaborative of at the NGH to ring me and 1 hour later a new script was ready for pick up at the late opening chemist (which is luckily at bottom of t'road). This being a Saturday.

So yes the Govt are doing their best to remove the NHS but at the moment the troops are playing a blinder (excuse the mixed metaphor!) and I have nowt but praise.

BTW it is not just the end of the NHS, it is the end of the state as we know it. Thursday's announcement of BIS shutting it's Sheffield office and then the Minister letting slip that it was about losing jobs NOT re-locating to economise was yet another example of how Francis Maud is shutting down the Civil Service to replace it with highly politicised teams of consultants. We are already seeing the Govt losing lots of legal challenges to new laws due to unseeming haste in pushing stuff through, this will get worse.
Title: Re: The end of the NHS.
Post by: GCW on January 31, 2016, 12:54:36 pm
Definately seems like an agenda, I don't know about others on here but my last 2 GP surgery's have emergency appointments (Hollies Med Centre and the Sloan Med centre).

We have between 40 and 60 on the day ("emergency") appointments Monday to Friday, and 8-12 on Saturdays.  The ones in the week always go plus more extras, the Saturday ones rarely do.  I doubt we are much different to others.

EDIT:  One thing people forget is that GP services aren't emergency services.  They can offer booked appointments, visits when practical or sit and wait clinics, but there isn't the ability to walk in and be seen just like that.  This seems to be an assumption a lot of people have.
Title: Re: The end of the NHS.
Post by: mrjonathanr on January 31, 2016, 01:00:23 pm


BTW it is not just the end of the NHS, it is the end of the state as we know it.
Title: Re: The end of the NHS.
Post by: GCW on February 01, 2016, 06:26:50 pm
Very much not alone:

http://youtube.com/watch?v=LAnAyRmuAoE
Title: Re: The end of the NHS.
Post by: slackline on February 10, 2016, 11:59:42 am
Does anyone understand the government’s plan for the NHS? (http://www.bmj.com/content/344/bmj.e399.long) by     Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, London, UK

(He doesn't understand the plans)
Title: Re: The end of the NHS.
Post by: GCW on February 10, 2016, 12:13:05 pm
Just a few thoughts about the current position and the use of media to keep the populace in the dark about it. (http://gcwallis.blogspot.co.uk/2016/02/junior-doctors-strike-10022016.html)
Title: Re: The end of the NHS.
Post by: Will Hunt on February 10, 2016, 12:38:11 pm
When's the revolution booked in for?

Oh, that's right. Never. Rupert Murdoch is still alive and has secured his legacy of world domination through little James, and Jeremy Corbyn is leader of the Labour party.
Title: Re: The end of the NHS.
Post by: GCW on February 10, 2016, 12:41:40 pm
Absolutely, but if we don't even try them we are complicit.
Title: Re: The end of the NHS.
Post by: Footwork on February 10, 2016, 01:42:30 pm
I would think one of two things might happen.

Contract imposed - some leave but enough stay to keep the NHS running on (even more) blood sweat and tears.

Contract imposed - No one takes up medicine at university, everyone leaves the country as soon as they can. Hospitals look something like 28 days later.
Title: Re: The end of the NHS.
Post by: mrjonathanr on February 10, 2016, 01:47:29 pm
I'd expect retention will be a crisis.
Title: Re: The end of the NHS.
Post by: lagerstarfish on February 10, 2016, 02:06:28 pm
Contract imposed - No one takes up medicine at university, everyone leaves the country as soon as they can. Hospitals look something like 28 days later.

slightly less able students would apply for medicine instead

universities might lower fees for foreign students - which would be very attractive to some nationalities since it would probably lead to a job and permission to stay in the UK afterwards (until they get a better offer somewhere else, of course)
Title: Re: The end of the NHS.
Post by: Offwidth on February 10, 2016, 02:37:25 pm
The only way to fill the increasing recruitment gaps in the wider health context is to import trained staff. It simply takes too long to do anything else. Even when they try and train more (like they did for nurses) the unintended consequences of austerity end up hobbling their efforts. We train medical staff for other countries with better staff conditions and pay and other countries with worse pay and conditions train staff for us (and the home countries at the bottom suffer the most).

A forgotten important area is Public Health which has moved into the financial fire-storms in local authorities... see how many doctors are applying to be consultants there and remember how much cheaper it is to prevent illness rather than cure it.

None of this 'car crash' was inevitable... we have one of the lowest per capita funding levels of any western country for pretty good outcomes, including less per capita than the US state spends (before the citizens pay a penny of their huge insurance premiums) for its pretty dreadful outcomes for the bottom half of its population in wealth terms.
Title: Re: The end of the NHS.
Post by: Mumra on February 10, 2016, 02:59:53 pm
I've nothing to add apart from my praise and thanks to all in the NHS and education system, despite cunts like Jez Hunt making their lives hell
Title: Re: The end of the NHS.
Post by: Offwidth on February 11, 2016, 02:49:10 pm
So its to be imposition and escalation rather than further negotiation. Sadly we face interesting times ahead.... not a good period to be ill.  An academic colleague of mine I spoke to an hour ago is utterly convinced junior doctors are just being greedy (no one else gets more on a Saturday etc).Thinking on this, if industrial action become more difficult I suspect the central BMA line may become a lot harder to sell as having majority public support... ie that this is about safety and protecting the NHS, including the difficult argument that any extra income for doctors on a Saturday is more about retaining financial penalties for employers who overwork their GP's out of hours. Hunt is obviously a liar and easy to dislike but members of the public are going to get caught much more in the crossfire now.

On the international comparisons point I found this nice summary on the guardian:

http://www.theguardian.com/society/2016/feb/09/which-country-has-worlds-best-healthcare-system-this-is-the-nhs

Title: Re: The end of the NHS.
Post by: Footwork on February 11, 2016, 06:08:36 pm
I watched Hunt's 'speech' around midday today.

I lost it when he started talking about how the public would thank him in a couple of years time when the NHS is truly 7 days a week  :furious: :furious: :furious:

What a complete fucking tosspot.

Yes, that public will love a '7 day' NHS @ £50 a week. Will climbers have to get specific health insurance policies in the future? No more free rides in the big yellow taxi etc.

Title: Re: The end of the NHS.
Post by: Will Hunt on February 11, 2016, 06:18:03 pm
I heard him speaking on the PM programme. What struck me was that there were only mutterings of assent in the chamber. Where were the jeers, heckles, catcalls? Where the fuck is the Labour party?
Title: Re: The end of the NHS.
Post by: Mumra on February 11, 2016, 06:35:19 pm
Most people I know get more money to work outside the general 9-5......though I'm guessing that most work >12 hour shifts anyway. If people in education/NHS were to work t rule like other industries we would all be screwed. I'd rather have less money an know my children would be educated and fixed properly!
Title: Re: The end of the NHS.
Post by: tomtom on February 11, 2016, 06:46:11 pm

I heard him speaking on the PM programme. What struck me was that there were only mutterings of assent in the chamber. Where were the jeers, heckles, catcalls? Where the fuck is the Labour party?

Obviously benefiting from their new leadership....

If ever there was need for a sarcasm icon....
Title: Re: The end of the NHS.
Post by: GCW on February 12, 2016, 11:59:58 am
An academic colleague of mine I spoke to an hour ago is utterly convinced junior doctors are just being greedy

Which is exactly what Mr Hunt wants - see Ken Clarke on BBC yesterday, purely about income.  Nonsense.

I doubt there will be much more industrial action.  But imagine what would happen if nobody signs the contract and there are no junior doctors for the month of August?
Title: Re: The end of the NHS.
Post by: a dense loner on February 12, 2016, 01:49:29 pm
Double the amount will sign in September?
Title: Re: The end of the NHS.
Post by: GCW on February 12, 2016, 02:51:49 pm
The contracts are from August to Feb, dense.
Title: Re: The end of the NHS.
Post by: a dense loner on February 12, 2016, 05:05:23 pm
So what you're telling me is there will be no junior doctors til nx March?
Title: Re: The end of the NHS.
Post by: GCW on February 12, 2016, 05:42:57 pm
The blocks are usually six or 12 months starting in August or February, so if no one takes up the contract when the imposition starts in August then , yes, you are correct.
Title: Re: The end of the NHS.
Post by: a dense loner on February 12, 2016, 06:06:46 pm
Sweetest four words in the world :P

What a shit state of affairs! :shit:
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 12, 2016, 06:24:25 pm

So its to be imposition and escalation rather than further negotiation. Sadly we face interesting times ahead.... not a good period to be ill.  An academic colleague of mine I spoke to an hour ago is utterly convinced junior doctors are just being greedy (no one else gets more on a Saturday etc).Thinking on this, if industrial action become more difficult I suspect the central BMA line may become a lot harder to sell as having majority public support... ie that this is about safety and protecting the NHS, including the difficult argument that any extra income for doctors on a Saturday is more about retaining financial penalties for employers who overwork their GP's out of hours. Hunt is obviously a liar and easy to dislike but members of the public are going to get caught much more in the crossfire now.

On the international comparisons point I found this nice summary on the guardian:

http://www.theguardian.com/society/2016/feb/09/which-country-has-worlds-best-healthcare-system-this-is-the-nhs

Yep, clearly they are all lazy and simply holding us to ransom by withholding that healthcare which they are duty bound to give us.
They should be paying us really.
Not.
What utter bollocks. Which field of Academia does your colleague put in 60 hour weeks, mainly at night? How much vomit, excrement and death/suffering does it involve?

I wouldn't want to do it and I find it surprising that people could feel the way your colleague does. Different strokes I guess.

(http://uploads.tapatalk-cdn.com/20160212/c1118cab17a47b243c59a97a3ff9e79c.jpg)
 





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Title: Re: The end of the NHS.
Post by: Offwidth on February 13, 2016, 10:14:25 am
"Which field of Academia does your colleague put in 60 hour weeks, mainly at night? How much vomit, excrement and death/suffering"

He is actually a very hard working chap... worked himself to the edge of illness on a few occasions. He is unusually conservative for an academic but not so much for the professional classes. The reason I mentioned him is that for the doctors to win, such arguments from the sceptical public need answers. Many people just dont get the reasons behind the dispute. They haven't thought through the implications of 98% in a ballot of doctors: that this can't be about party politics or greed. Railing against such views doesn't help the doctors win.

Jeremy,as ever, contines to help the doctors case with his inept attempts at spin:
http://www.theguardian.com/society/2016/feb/12/health-chief-letter-whatever-necessary-contracts-not-agreed
Title: Re: The end of the NHS.
Post by: GCW on February 13, 2016, 03:08:03 pm
Amazing stuff coming through.  (http://gcwallis.blogspot.co.uk/2016/02/you-could-write-it.html)
Title: Re: The end of the NHS.
Post by: Offwidth on February 13, 2016, 04:15:18 pm
More news:

http://www.theguardian.com/society/2016/feb/13/gp-surgeries-london-planning-to-shut
Title: Re: The end of the NHS.
Post by: tomtom on February 19, 2016, 01:00:45 pm
Just tried to get a GP appointment. March 7th. :(
Title: Re: The end of the NHS.
Post by: webbo on February 19, 2016, 02:03:25 pm
Just post your symptoms up on here and I'm sure between the lot of us. We will come up with a diagnosis and some sort of treatment.
Title: Re: The end of the NHS.
Post by: webbo on February 19, 2016, 02:23:29 pm
If you really want to know what's going on. Google nhsnetworks
Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 11:21:44 am
So...
What I'd like to know in this argument is what are the terms being offered (or rather,now imposed). Nowhere, as far as I can tell - as a daily listener of R4, online Guardian reader, interested in current affairs - economist, spectator, various other sources - have the BMA or government laid out in simple terms what the new contract actually looks like.

The government appear to me to have tried (I could be wrong, maybe they just have greater presence), and the BMA appear to me to take a line of hysterically drowning out the governments figures with the quickly-getting-irritating line about 'it's about patient safety'. Sorry, I don't trust anyone - neither the Government nor the BMA/Junior Doctors - if they can't explain something in simple-to-understand terms. The public aren't idiots (many are but most can get a sense of unspoken agendas and bullshit).

I'm confident I'm not alone in that when I listen to BMA representatives I can't help thinking they're spinning the argument just as much as the other side = instant mistrust.

As it stands I simply don't trust what the BMA is saying - I haven't heard them give a coherent outline of the pay deal as it compares to now, nor a coherent argument of why 'patient safety' will decline. It smells too much to me of a powerful cohort (medical professionals) wanting to protect their position and using 'patient safety' as a powerful and evocative way to do so. This to me comes across as a patronising 'we know best' type of thinking..

Nor do I trust Hunt, but that's for a different reason, that being he's a politician. He gives the impression of trying to do good but maybe he's just a good actor.

Just give me the figures. Then I'll be able to make my own mind up about whether I should believe the apparently hysterical BMA line, or the apparently heartless Goverment line.

What's the big picture? - Doctors are getting less powerful, nurses are becoming more professional and more powerful (a good thing imo). Technology is increasing patient power and knowledge. Data science is allowing more and more specifically targeted medicine (stratified medicine). This is only going in one direction.
This looks partly to me about the power struggles of an under-threat group of people indispensable to society but not so indispensable that others won't take their place in years to come.

And what about the reported £2.9 billion paid in agency fees for Doctors and Nurses in the previous 9 months  - agencies which the government have had to put a cap on? Who's 'safety' is being protected by these agencies and the staff they hire out? It's just a case of profiteering, as in many other trades that roll over and get sucked dry by parasitic middlemen at the expense of the taxpayer.

What happens to patient safety 5 years down the line in the new contract. Does it really suffer, could it remain the same, or could it improve? I'm open-minded but I don't know enough not to be.

(none of that is meant to disregard how vital medical professionals are - all the targeted medicine and technology in the world won't make up for inadequately trained/motivated Doctors and Nurses in the event of serious life-threatening trauma)
Title: Re: The end of the NHS.
Post by: mrjonathanr on February 20, 2016, 11:42:55 am
Do you think Hunt is trying to improve patient care in the face of retrenched professional opposition or prepare for full privatisation?

Are we confident that the weekend staffing changes will improve patient safety? Mr Hunt's department seems unsure: http://www.independent.co.uk/news/uk/politics/leaked-document-reveals-jeremy-hunts-own-officials-doubt-his-evidence-on-a-seven-day-nhs-a6876476.html (http://www.independent.co.uk/news/uk/politics/leaked-document-reveals-jeremy-hunts-own-officials-doubt-his-evidence-on-a-seven-day-nhs-a6876476.html)

7 days a week written into staff contracts would be a better model for maximising profit in a privatised industry, just ask John Lewis, Tesco, Debenhams etc. I imagine private contractors would rather that battle be won before they take up the reins.

Title: Re: The end of the NHS.
Post by: GCW on February 20, 2016, 12:01:34 pm
Very briefly, The government say it's about quality. They say having more juniors at the weekend will achieve this (although they have also said it's senior cover that makes a difference). There is no evidence for this.

They say it is cost neutral. There will be no more doctors.

So, for the same money and number of staff they will increase working at weekend.

Logic dictates that either weekday covers falls, or people work longer hours for less.
Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 12:08:57 pm
7 days a week written into staff contracts would be a better model for maximising profit in a privatised industry, just ask John Lewis, Tesco, Debenhams etc. I imagine private contractors would rather that battle be won before they take up the reins.


Well the bottom line to that is that I'd rather an efficiently run and good value John Lewis/Tesco etc. than an inefficient/expensive/not open on weekends State-run supermarket.
(To the rest of your Q's, I don't know)

Very briefly, The government say it's about quality. They say having more juniors at the weekend will achieve this (although they have also said it's senior cover that makes a difference). There is no evidence for this.

They say it is cost neutral. There will be no more doctors.

So, for the same money and number of staff they will increase working at weekend.

Logic dictates that either weekday covers falls, or people work longer hours for less.

Is there evidence against?

Logic also dictates that, while there may be 'no more Doctors', there are also 'no more patients'. Therefore weekday cover should fall - in line with a 7 day spread of patients. It's simple isn't it - you spread the 'customers' and mirror that by spreading the Staff. How is that not correct?

(I can see how politics might preclude the gov saying weekday cover will fall. Cue knee-jerk dumb reaction by some public, media and the BMA. But it should.)
Title: Re: The end of the NHS.
Post by: GCW on February 20, 2016, 12:21:24 pm
No, the plan is for seven day elective work so patients will increase.

Bottom line is its unfundable.
Title: Re: The end of the NHS.
Post by: Footwork on February 20, 2016, 12:22:13 pm
Just give me the figures. Then I'll be able to make my own mind up about whether I should believe the apparently hysterical BMA line, or the apparently heartless Goverment line.

Regarding pay deal

I don't think this is an easy thing to show. Dr's are all in different training programmes, specialities and bandings (pay scale). Some work more on the weekends, at nights etc. There are a LOT of variables. The contract affects everyone in a different way so it's very difficult to just say 'here are the figures'.

I haven't read the contract but coming from the Dr's themselves and not the BMA, it sounds like a lot of them are getting shafted. Pay protection is being offered but at the cost of selling out future DR's down the line.

Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 12:26:52 pm
No, the plan is for seven day elective work so patients will increase.

Bottom line is its unfundable.

I don't understand, how will patients increase? Logically, there are only so many sick/injured people at any one time. This number doesn't change depending on which days Doctors work.
Title: Re: The end of the NHS.
Post by: GCW on February 20, 2016, 12:28:16 pm
These are already covered by current working patterns. The government want to do routine work on Sat and Sun too, which currently doesn't happen.
Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 12:34:19 pm
Just give me the figures. Then I'll be able to make my own mind up about whether I should believe the apparently hysterical BMA line, or the apparently heartless Goverment line.

Regarding pay deal

I don't think this is an easy thing to show. Dr's are all in different training programmes, specialities and bandings (pay scale). Some work more on the weekends, at nights etc. There are a LOT of variables. The contract affects everyone in a different way so it's very difficult to just say 'here are the figures'.

I haven't read the contract but coming from the Dr's themselves and not the BMA, it sounds like a lot of them are getting shafted. Pay protection is being offered but at the cost of selling out future DR's down the line.

I accept it's complicated but it isn't THAT unfathomable to provide an overview and some details for the person in the street to chew over. People all over society work in pay bands, specialities etc. (cue 'it might be brain surgery but it's hardly rocket science'). What I'm getting at is the BMA/Jnr Doctors are asking the public believe them without giving any details to believe other than their word - 'look just trust that we're right we're Doctors'. That era has passed.

Also - I think a lot of Doctors are taking their stance from what the BMA is telling them rather than a clear understanding of the real terms and conditions. My GP friend doesn't disagree with that view.
Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 12:35:39 pm
These are already covered by current working patterns. The government want to do routine work on Sat and Sun too, which currently doesn't happen.

And that to me, and most of the public, seems quite correct - you're a service industry, not a 9-5 office job. What are the arguments against routine working on Sat and Sun?

You're saying patient patterns are 'already covered by current working patterns'. Is it not likely to be the case that Doctor's current working patterns dictate patient patterns?

I don't try to visit the post office on a Sunday and expect to find it open.
Title: Re: The end of the NHS.
Post by: GCW on February 20, 2016, 12:45:53 pm
Do it. But you'll need to increase staff and funding by 2/7.
Title: Re: The end of the NHS.
Post by: webbo on February 20, 2016, 02:20:57 pm
Pete
You say nurses are becoming more powerful, where not in the NHS I work in. The only ones who are becoming more powerful are the managers, who appear to be driven to reduce costs no matter how if it might effect the day to day delivery of care.
They seem to be driven to do this by constantly changing government targets.
My own area of work has some new standards and apparently £250,000 was supposed to be given in order to meet these standards, however what was offered was do you really want the 250K up front or would you rather have 300K off your efficiency savings.
So you end up trying to deliver improved care with no extra money.
The outcome of all this is that Australia and New Zeland will have the best health services on the planet
Title: Re: The end of the NHS.
Post by: petejh on February 20, 2016, 03:17:17 pm
The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.

Title: Re: The end of the NHS.
Post by: Fultonius on February 20, 2016, 03:54:46 pm
From where I'm sitting it's mostly about minimising pay and maximising working hours,  so that *when* it all gets privatised the companies can be more profitable.

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Title: Re: The end of the NHS.
Post by: GCW on February 20, 2016, 03:59:16 pm
I wouldn't worry too much, it's about collapse anyway.
Title: Re: The end of the NHS.
Post by: webbo on February 20, 2016, 09:37:51 pm
The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.
With your line of reasoning clearly there is a career in NHS management just waiting for you.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 21, 2016, 07:40:26 am

The outcome of all this is that Australia and New Zeland will have the best health services on the planet

Don't they already? Or at least very decent.

And this ^ line belies the BMA bullshit of 'it's about patient safety', because underlying it is the (completely understandable) attitude of 'well I'm going where they pay us eqully well/more, for working less than I would in the UK (and the weather and quality of life are better)'.
 
From what I can tell it's mostly about money and power, and a bit about patient safety.

Is it?

Or is it sheer hell being a Jnr Dr and about to get much worse.

One of our regulars at the Bunker is a Jnr Dr called Rose Polge, along with her friends and boyfriend. I'll ask them what it's like, when they come in again; they've been searching for her body for the last week or so.


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Title: Re: The end of the NHS.
Post by: a dense loner on February 21, 2016, 08:07:10 am
Just what is that supposed to mean in this discussion?
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 21, 2016, 08:47:02 am
I know what was written in her note. The rest you can work out for yourself surely?

If you fall for the Gov. ploy of greedy Doctors, then you are, in my opinion, a moron.


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Title: Re: The end of the NHS.
Post by: a dense loner on February 21, 2016, 09:24:40 am
I'm sorry Matt the way you present things is bizarre. Whenever you make a long post I think where are we going to end up with this? As always by the time I've finished reading I don't know what you're talking about or have tried to talk about. The passions there but that's it. Plus the way you finish your posts is quite definitive as if that's the last word on the subject, it might be if people understood what you were trying to say.
Title: Re: The end of the NHS.
Post by: petejh on February 21, 2016, 09:56:02 am
That's extremely sad Matt but is it relevant, or appropriate? People commit suicide every day for a multitude of reasons, work pressure being one. Other than suggesting that 'being a Doctor can be extremely tough' which I think everyone over the age of 18 probably already realises - including anyone considering entering the profession, I don't see what your point adds. Probably best left there.

I'm not suggesting falling for a 'government ploy' (as you put it) of 'greedy doctors' - but I do happen to believe the NHS should provide a genuine 7-day service to the public, which currently it doesn't. It is after all a public health 'service'.

But neither am I taken in by the BMA 'ploy', if you want to use that word, of this being about 'patient safety'. I'm suggesting the BMA argument doesn't come across to me as convincing because it seems overly reliant on the use of emotive rhetoric about wanting to do 'what's best for the public'.

Btw, I don't buy GCW's (or the BMA's) 'staffing spread reflects patient spread': if that were so why - over a ten year period of seeing doctors, physios, having scans, seeing consultants, having operations - was I never once offered a Saturday or Sunday appointment to any of the NHS services? Hint: it wasn't because I chose to be treated only on a weekday.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 21, 2016, 10:45:46 am
Because I'm sick of everything being about the numbers. I was an Engineer Dense, I understand numbers; they are laid out all over Social media and any news outlet you care to choose. So are the comparisons to what you might earn working similar hours at Lidls. How is reproducing that of any benefit?
Damn it, you're the one who likes to remind us how useless it is.

This is about the death of the NHS and the fundamental change to life in this country that that means. The root of all of this is people, not numbers, the numbers are a blind for an ideological putsch.
The consequences will fall upon first those employed by the machine and very shortly after the rest of us.
And this has been brought home to me by a young girls (apparent) suicide. Because I got to hear from her friends just how hard it is. One of my staff was a close friend of hers. I'm old, I've seen too much shit and life should never be about the numbers. If the "2% of the wealthiest own 90% of the wealth" theory is even half right, then this whole debate is an obscenity. A world where epidemics of obesity and famine exist either side of an imaginary line on a map? What a load of Cunt-bollocks-twatfetishness we put up with.

I suppose I hoped that was all implicit in my two liner. Any fool can google up a storm of statistics, equating those to real world consequences that include the intangibles of human emotion and suffering takes far more thought.
As I see it (and I know it might be wrong), people are going to suffer; a lot of people and they won't care that this is good for the Gov's books.

I'm not a stranger to "intensive" sleep deprived training or work conditions. Personally, I think Doctors have been the victims of the "holier than the next generation" attitude of their teachers, who seem to think each class needs less sleep and more stress than the class before. In each telling of the fairy tale the "In my day" gets a little harder until they reached; what seemed from the outside, to be a ridiculous and counterproductive meat grinder or a training regimen.
And now they want to make it harder. Why harder? Because the prospects of a career in medicine made it seem worthwhile.
Now, you've heard from many in the profession in the course of this thread and I don't recall any positivity in any of those comments.
The days of the cushy country practice (that involved more fly fishing or climbing, than Doctoring) are at least 50 years in the past and yet the public still cling to that image.

So, given that we are already desperately short of Doctors, that this will result in many more leaving the profession and stop many more from ever embarking on that route; what do you think the consequence will be?

Now, I confess at the end of all that, that I am biased. Because of Rose and because I spent last night in A&E and am currently making a shaky recovery from a darling little Sepsis. A Sepsis, which had it not been spotted by a Junior Doctor, would have taken the middle finger of my left hand, or my left hand, or me (if the Mrs hadn't insisted on taking me in, I thought I had a cold).

So, long, emotional and not a single statistic, for which I do not apologise.


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Title: Re: The end of the NHS.
Post by: GCW on February 21, 2016, 12:50:56 pm
Btw, I don't buy GCW's (or the BMA's) 'staffing spread reflects patient spread': if that were so why - over a ten year period of seeing doctors, physios, having scans, seeing consultants, having operations - was I never once offered a Saturday or Sunday appointment to any of the NHS services? Hint: it wasn't because I chose to be treated only on a weekday.

Sorry, Pete - I don't follow - it reads like you've just contradicted your previous argument completely.  Unless I'm missing the point?

Interesting that the government now have a bill about the EWTD that specifically excludes doctors from being covered by it.
Title: Re: The end of the NHS.
Post by: petejh on February 21, 2016, 11:26:15 pm
My point was that staffing levels likely to determine patient spread rather than patient spread determine staffing levels; because you currently can't access regular NHS services at weekends - regular appointments, diagnostics, elective procedures, physio etc. etc. So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.

EWTD  -interesting how? Every person working on offshore installations in the UK continental shelf has signed a form to agree to be excluded from the EWTD.  If it's good enough for the people who power the country (and Dense)...
Title: Re: The end of the NHS.
Post by: a dense loner on February 22, 2016, 07:48:51 am
Yes, I've not understood any reply to why almost anyone in the medical profession shouldn't work at the weekend. It's 2016. The replies of its busier in the week are absolutely baffling.
Title: Re: The end of the NHS.
Post by: GCW on February 22, 2016, 08:09:58 am
Doctors already work weekends, Dense.

We already have a seven day NHS for urgent conditions, all evidence suggesting a continual increase in demand.

We have a five day NHS for routine work, as you say. If that's opened to seven days, all indicators suggest it won't make a significant decrease to weekday demand.

EWTD- one of the big selling points on this contract was protecting juniors from longer hours etc, which it doesn't really. Funny that a couple of weeks after forcing this through they want to remove the limits.

Listen, I'm happy for there to be a seven day NHS. But, if can't be staffed at present and the cost increase is unfundable. It leads to payment by the public.

If people think it's just about doctors being lazy and greedy, that's ok. Big we will all get the NHS we deserve.
Title: Re: The end of the NHS.
Post by: a dense loner on February 22, 2016, 08:23:10 am
Neither Pete or myself suggested it was doctors being lazy or greedy. We've asked about wknd work and Pete has separately asked for a few sets of figures, which no one has been able to supply. Apart from to say it's complicated there's no point doing it.
Hospitals, certainly in sheffield, are a ghost town at wknds and after 6-7pm. I can't remember what time we were there it was just after one of them, a couple of cleaners n medical staff in the whole of the hospital. Luckily I went to see the one that was working late.

I have suggested doctors are lazy and greedy many times but not in the context of a serious discussion :-*
Title: Re: The end of the NHS.
Post by: GCW on February 22, 2016, 08:51:10 am
It's how it's spun though Lee, and I think many people believe if.

Figures are just that. Hunt's claims that weekend mortality can be reduced by more staffing has been denied by the person that wrote the paper Hunt quotes. Some stats suggest mortality is higher on a Friday.

We can quote figures back and forth, and we can select data to support either argument. I suppose it comes down to who you trust more.

Personally, I think this is the crossroads for the whole system. Two years, I give it.

Also- GPs get a 3.2% uplift in funding, but the move is towards Saturday opening. It doesn't add up either.
Title: Re: The end of the NHS.
Post by: galpinos on February 22, 2016, 02:41:05 pm
So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.

I seem to remember when the GPs trialed weekend appointments they only had a take up of about a third, despite being fully booked through the week.

I would say, as did the research that Mr Hunt is basing his plan on, is that there IS a requirement for more doctors in SOME areas over the weekends, but the more important changes would be to have the full suite of support services available, i.e., scans, bloods, various analysis etc so the hospital can actually offer a full diagnostic service instead of keeping people alive until Monday. I see no reason to have knee replacements and the like on a Sunday.

What has baffled me is that there seems to be no provision in Hunt's plan to up the number of doctors. If the same number of doctors spread them selves over the weekend, doing similar shifts as they previously did through the week, there will either be fewer doctors available in the week or they'll have to work more hours, which, when the average week is 60+, doesn't seem a great idea.
Title: Re: The end of the NHS.
Post by: mrjonathanr on February 22, 2016, 03:15:11 pm
If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.
Title: Re: The end of the NHS.
Post by: Wood FT on February 22, 2016, 05:00:04 pm
So saying 'staffing levels mirror patient spread' isn't telling you much at all - it's like the owner of a  shop that has never opened on Saturdays saying 'we don't ask our staff to work on Saturdays, in fact we don't open, because people aren't queuing up outside'.
What has baffled me is that there seems to be no provision in Hunt's plan to up the number of doctors. If the same number of doctors spread them selves over the weekend, doing similar shifts as they previously did through the week, there will either be fewer doctors available in the week or they'll have to work more hours, which, when the average week is 60+, doesn't seem a great idea.

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

 :no: So obvious
Title: Re: The end of the NHS.
Post by: GCW on February 22, 2016, 06:02:30 pm
I get the end game. What I don't get is how they expect to run it with far fewer doctors.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 22, 2016, 06:19:07 pm

I get the end game. What I don't get is how they expect to run it with far fewer doctors.
A crisis in numbers, leads to "Agency" supply of cheaper (ie non-British trained) Doctors and, after all, if the "Agency" is supplying and recruiting already; why not let them run the provision too?
You know what? We could even lease them the buildings, they'd be paying us!
All we have to pay for is the care package, no managers, no doctors, no nurses, no support staff, no pensions, no training hospitals (we'll keep a couple of really high fee institutions of course for our spare heirs).

If your doctor is over worked, under qualified or dangerous; it's not our fault it's the agency.

I'm sure all the opening bids will be so low, it will be too good to be true.
The renewal might go up a bit, maybe.

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?


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Title: Re: The end of the NHS.
Post by: slackline on February 22, 2016, 08:51:05 pm
If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

I'm sure I've posted this before....

(https://seattleducation2010.files.wordpress.com/2015/05/11377129_377891525734082_3814919793007449897_n.jpg)

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?

I'm sure its a rhetorical question but just in case anyone was in any doubt...

The Guardian : Companies with links to Tories ‘have won £1.5bn worth of NHS contracts’ (http://www.theguardian.com/politics/2014/oct/03/healthcare-companies-links-tories-nhs-contracts) - Unite research claims 24 MPs and peers who backed health reforms have links to 15 private healthcare companies

The Wall Street Journal : How the House of Lords mixes business and pleasure (http://www.wsj.com/articles/how-the-house-of-lords-mixes-politics-and-business-1415693056)

The Mirror : 1 in 5 Tory MPs have links to private firms that could profit from NHS privatisation (http://www.mirror.co.uk/news/uk-news/selling-nhs-profit-tories-liberal-4645961)
Title: Re: The end of the NHS.
Post by: webbo on February 22, 2016, 09:01:28 pm
Will it end before March 16th this year. If so I'd better get another sick note.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 22, 2016, 10:07:21 pm

If the endgame is public dissatisfaction to the extent that any improvement, including prvatised services, will be welvome it makes perfect sense to overstretch capacity.

I'm sure I've posted this before....

(https://seattleducation2010.files.wordpress.com/2015/05/11377129_377891525734082_3814919793007449897_n.jpg)

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?

I'm sure its a rhetorical question but just in case anyone was in any doubt...

The Guardian : Companies with links to Tories ‘have won £1.5bn worth of NHS contracts’ (http://www.theguardian.com/politics/2014/oct/03/healthcare-companies-links-tories-nhs-contracts) - Unite research claims 24 MPs and peers who backed health reforms have links to 15 private healthcare companies

The Wall Street Journal : How the House of Lords mixes business and pleasure (http://www.wsj.com/articles/how-the-house-of-lords-mixes-politics-and-business-1415693056)

The Mirror : 1 in 5 Tory MPs have links to private firms that could profit from NHS privatisation (http://www.mirror.co.uk/news/uk-news/selling-nhs-profit-tories-liberal-4645961)
.

Nope, genuine question, thanks. [emoji3]


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Title: Re: The end of the NHS.
Post by: psychomansam on February 22, 2016, 11:03:25 pm

I get the end game. What I don't get is how they expect to run it with far fewer doctors.
A crisis in numbers, leads to "Agency" supply of cheaper (ie non-British trained) Doctors and, after all, if the "Agency" is supplying and recruiting already; why not let them run the provision too?
You know what? We could even lease them the buildings, they'd be paying us!
All we have to pay for is the care package, no managers, no doctors, no nurses, no support staff, no pensions, no training hospitals (we'll keep a couple of really high fee institutions of course for our spare heirs).

If your doctor is over worked, under qualified or dangerous; it's not our fault it's the agency.

I'm sure all the opening bids will be so low, it will be too good to be true.
The renewal might go up a bit, maybe.

Anyone have an idea how many MPs/ Ministers are already heavily invested in Nursing agencies?


Sent from my iPad using Tapatalk

Levels of medical staff are at crisis levels in various areas already. Agency staff are more expensive, but are used as a last resort, required due to a huge lack of doctors being trained up. Yes, we have retention issues, but we're still taking far more in than we're losing. We're just not training nearly enough, haven't been for a long time, and can't even fix that in the term of any government coming in to replace the tories. (5 years to train a doctor. Another 5 to have them trained into any specific specialty.) We need to invest in training. In the meantime, we're attempting to plug gaps with Advanced Nurse Practitioners and Physicians Associates, with mixed results.
Still, if you know any Biomed, Biology or similar graduates looking for a worthwhile career, tell them to look into PA courses.

But yes, gap-filling rather than solutions. Privatisation of staffing to create a flexible (though more expensive) workforce. Enforced financial destruction of trusts. And I'm currently asking a trust for something essentially amounting to £1m of funding. Wish me luck.  :icon_beerchug:

Lots more to be said, but...
Title: Re: The end of the NHS.
Post by: GCW on February 25, 2016, 07:19:00 am
http://youtu.be/lMlA4gPtrBk
Title: Re: The end of the NHS.
Post by: Wood FT on February 25, 2016, 07:53:12 am
http://youtu.be/lMlA4gPtrBk

Never mind all those sensible questions, these money grabbing fizz guzzling doctors want to kill my gran on a sunday!
Title: Re: The end of the NHS.
Post by: Oldmanmatt on February 25, 2016, 07:56:56 pm
I think, the stats tend to suggest "Granny" did something to herself that caused her to die within 30 days, or "people fuck themselves up at weekends" and doesn't have any bearing on or draw any causation from; treatment received.

(http://uploads.tapatalk-cdn.com/20160225/ff990cfd2823f13e33c093488799744a.jpg)

I admit, Mark is a Zoologist, so not sure if he can read anything not written in Latin.


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Title: Re: The end of the NHS.
Post by: webbo on February 26, 2016, 08:26:43 am
As much as the current situation with the junior doctors will likely bring the end of the NHS here are a few other examples that may speed its demise.
A trust employs a new chief executive so they want a new management structure. They employ an interim Nurse Director through an agency they are paid £30,000 a month for 8 months.
 A trust decides it needs more lower level managers as in it recent restructuring it got rid of them so they offer staff secondments on a pay scale of up to £40,000 per annum. These are staff currently paid £30,000. In order for one staff member to take up the secondment they employ agency staff to cover his old post costing £60,000 per annum.
Title: Re: The end of the NHS.
Post by: Footwork on February 26, 2016, 10:37:45 am
They just don't have a fucking clue do they :no:
Title: Re: The end of the NHS.
Post by: webbo on February 26, 2016, 11:03:58 am
I'm currently off sick due to my ruptured Achilles. My manager wants to do some work from home which is ok.
When she rings me she tells me she has offered the secondments mentioned above and the job title is team leader. I say hang on a minute that's my job, it sounds like you given my job to someone while I'm on sick. When I said I would be speaking to the union she accused me of being paranoid
When I see the job description for the new posts it turns out to be my old job description from 12 months ago when I got put at risk and had to move to my current job as they no longer needed those posts.
It's a classic case of new manger and someone brought in as a consultant to transform services both of whom have no idea about the history of the service.
I'm sure this will not be unique to my area of work.
Title: Re: The end of the NHS.
Post by: GCW on March 03, 2016, 01:51:12 pm
Interesting survey and discussion. (http://www.generalpracticesurvival.co.uk/press-release-almost-300-gp-practices-facing-closure-with-a-half-of-gps-planning-to-leave-the-nhs/)
Title: Re: The end of the NHS.
Post by: GCW on March 16, 2016, 01:18:50 pm
Interesting back story (http://surreycardiologist.blogspot.co.uk/2016/03/junior-doctors-dispute-and-fight-to.html?m=1)

Quote
There are some who would rather see the junior doctors’ contract dispute as a straightforward workplace dispute about terms and conditions (1). Others see it is as a key battlefront in efforts to save the NHS. If the battle to destroy/save the NHS can be likened to a chess match, then the junior doctors’ contract dispute marks the beginning of the 'end game' and its outcome will determine the survival of the NHS. 

In 2010, KPMG’s head of global health stated that ‘in the future, the NHS will be a state insurance provider and not a state deliverer of healthcare’ and that the 'NHS would be shown no mercy' (2). If we are not careful, the battle to save the NHS as the dominant provider of universal healthcare is about to be lost. The three stages of this battle are/were as follows:
 
The Opening Game:

The creation of an internal market within the NHS (2002) was an apparently benign opening gambit, followed by a much needed but poorly thought out hospital building programme. The PFI intiative was worth £12 billion but turned out to be a hopelessly expensive mortgage that would eventually cost the NHS £80 billion in repayments (3).

Once elected in 2010, the present government began an expensive top down NHS reorganisation, dismantling PCTs (Primary Care Trusts) while appearing to hand over power to GPs in the form of CCGs (Clinical Commissioning Groups). This poisoned chalice would come into play during the end game.

In 2012, the Health and Social Care (HSC) Act removed the Secretary of State’s legal obligation to provide healthcare for everyone and meant that the NHS became subject to EU Competition law. This compelled CCGs to invite bids for ALL health services from ALL willing providers, leading to a free market based system where expensive tendering processes would consume much of the CCG budgets and time. The architect of this act, Andrew Lansley, now works for Bain and Company to ‘improve its odds of gaining access to £5.8 billion of NHS work that is commissioned to the private sector’ (4).

To add insult to injury, NHS funding almost froze after 2010 (rising by only 0.7% per year compared to the long term average of 3.7% per year). ‘Efficiency targets’, a pseudonym for funding cuts, brought NHS hospitals to their knees. Significant cuts in social care and district nursing budgets as well as the privatisation of NHS 111 led to increasing hospital activity and a critical shortage of hospital beds. As a percentage of GDP, UK healthcare spending (8.5% of GDP) fell even further below the average for OECD countries (below Slovenia and Finland) (5).

The Middle Game:

As predicted by many (see my ‘election plea’), the flavour of the contest changed after the 2015 election and the government chose to directly attack frontline staff. On 16 July 2015, the Health Secretary Jeremy Hunt declared that ‘6000 people lose their lives each year because we do not have a proper 7 day service in NHS hospitals’ and that ‘by the end of this parliament, the majority of hospital doctors will be on 7 day contracts’ (6). The implication was that hospital consultants were opting out of weekend work (later proven to be a wildly exaggerated claim), being overpaid if they did work weekends, and directly responsible for excess patient deaths. He also accused doctors of lacking a sense of vocation and professionalism. For reasons that are not clear, his attack then shifted onto junior doctors (consultants should not assume that we are off the hook). In a ‘shock and awe’ approach, the government has also removed training bursaries for student nurses.

Weekend mortality data was distorted (7) to justify what the government described as a ‘7 day NHS’. No mention was made of world class 24/7 emergency services that the NHS already provides and it is still not clear what the government means/meant by a ‘7 day NHS’. Provision of elective (non-emergency) services over 7 days instead of 5 would require a 40% increase in resources (at an extra cost of £900 million), yet the government insists on a ‘cost neutral’ approach that would stretch existing 5 day resources over 7 days.

At the same time, significant amounts of money were being spent on a number of chaotic, poorly thought out vanity projects including the creation of a ‘paperless NHS’.

By this stage of the contest, the ‘save the NHS’ camp was/is on the backfoot (Did I mention that the line between middle and end game is blurred?).
 
The End Game:

This stage of the contest probably began a while ago but media attention has been poor if not misleading, and most of us have been kept in the dark.

With CCGs struggling to cope, CCG support services run by companies like KPMG, McKinsey and US health insurer United Health will now carry out many of the ‘back office’ jobs (eg. the design of future services), previously done by the NHS for the NHS (8).

Following the HSC Act 2012, 40% of CCG contracts (worth £3.54 billion) have been awarded to private healthcare companies (compared to 41% awarded to the NHS) (9). This figure is set to increase to £20 billion over the next few years. Note at this point that private healthcare must cherry pick profit making services (for example, elective hip replacements rather than emergency trauma surgery; they have a legal obligation to their shareholders to do so) while the NHS is left to provide less profitable services.

When TTIP (an EU US trade deal) goes ahead at the end of the year, many of the above changes may become irreversible (according to Michael Bowsher QC, a former chair of the Bar Council’s EU law committee) (10). US healthcare companies have already begun to invest heavily in UK facilities (11).

To make things worse, the PFI burden is only just about to kick in for many NHS trusts. Annual PFI repayments will peak at £2.7bn in 2029/30. 

According to Professor Keith McNeil, former CEO of Addenbrooke’s Hospital, the ‘only thing holding NHS together now is the dedication, passion, commitment of frontline workers’. This is precisely why the junior doctors’ contract is such an important battlefront and why we should resist attempts to break the backbone of acute and elective NHS care. If the government imposes the current contract, recruitment and retention of high quality junior doctors to provide 24/7 care will become even more of a challenge. It doesn't take a rocket scientist to work out that patient safety will be compromised by this contract.

In many ways, shifting the attack from consultants to junior doctors after July 2015 was an error of judgement by government in this fight, a single mistake in what has otherwise been a powerful ‘shock and awe’ onslaught. The government underestimated the courage and political will of 54,000 junior doctors, and the conflict has highlighted the looming threat to the entire NHS.   

Anyone who says that the junior doctors’ contract dispute has nothing to do with saving the NHS is at best missing the whole picture, at worst cheering for the wrong team. In the ongoing battle to save the NHS, we should all be supporting junior doctors and at the very least hope for a draw. A check mate would be a huge but unlikely bonus.
 
Vinod Achan is a Consultant Cardiologist at a well known NHS Foundation Trust

Title: Re: The end of the NHS.
Post by: Fultonius on March 16, 2016, 02:06:17 pm
Does anyone else get the feeling this is all "hidden in plain sight"? It's as if we can:1) see what's happened, 2) easily predict what's going to happen and 3) do fuckall about it.

Powerless. Fucking referendum on the EU but we let those shower of self-serving, smug arrogant pricks decide things like this for us.  >:(
Title: Re: The end of the NHS.
Post by: Footwork on April 02, 2016, 12:09:45 am
So details of the new Junior Dr Contract has emerged. Here's the section that has been causing a bit of controversy:

"Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim. Whilst this may disadvantage lone parents (who are disproportionately female) due to the increased cost of paid childcare in the evenings and weekend, in some cases this may actually benefit other women, for example where individuals have partners, it may be easier to make informal, unpaid childcare arrangements in the evenings and weekends than it is during the week due to the increased availability of partners and wider family networks at weekends and in the evenings"

Are the DoH complete fuck nuggets.

What if your family live many hours away or don't even live in the country anymore? What about single Dads and actually seeing your kids? This coming after the DoH saying that 7-10pm and Saturdays are not classed as anti social working hours.

f&*@ing Tory w&@$ers  :furious:
Title: Re: The end of the NHS.
Post by: a dense loner on April 02, 2016, 08:59:17 am
Eh? I don't understand your rage? Nor do I understand why that section has caused any controversy? Why is it even in there? None of that has any relevance to anything?

Title: Re: The end of the NHS.
Post by: GCW on April 02, 2016, 09:02:42 am
The DoH have effectively said that the contract hits certain groups more, in a way that is "disproportionate" but justified. Women quite rightly realise that it will affect single parents more.
Title: Re: The end of the NHS.
Post by: petejh on April 02, 2016, 11:49:49 am
How could it hit single parents less?

Being a single parent hits work/income more, there's a non-headline.
Title: Re: The end of the NHS.
Post by: GCW on April 02, 2016, 03:03:04 pm
It's the governments own assessment. If you aren't full time you have a disproportionately higher loss of income with the new contract, ie pro rata pay is less than full time.

Brief article.  (http://www.independent.co.uk/voices/how-can-david-cameron-claim-to-be-a-champion-of-women-when-the-junior-doctor-contract-treats-them-as-a6962956.html)
Title: Re: The end of the NHS.
Post by: GCW on April 02, 2016, 06:16:29 pm
More filtering out.

http://www.theguardian.com/society/2016/apr/01/female-doctors-new-contract-medical-royal-colleges?CMP=Share_iOSApp_Other

https://www.rcplondon.ac.uk/news/rcp-and-rcs-joint-statement-publication-junior-doctors-contract-and-equality-analysis

Quote from: J Hunt
Any indirect adverse effect on women is a proportionate means of achieving a legitimate aim
Title: Re: The end of the NHS.
Post by: Oldmanmatt on April 25, 2016, 07:10:45 pm
Is this not the most fucking desperate act of twatishness you've ever heard of?

I Know Che was a Doctor, but ffs.

Junior doctors' leaders 'trying to topple the government'
http://www.bbc.co.uk/news/health-36126740


Sent from my iPhone using Tapatalk
Title: Re: The end of the NHS.
Post by: webbo on April 25, 2016, 07:35:20 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.
Title: Re: The end of the NHS.
Post by: davej on April 25, 2016, 08:12:37 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance.
Title: Re: The end of the NHS.
Post by: davej on April 25, 2016, 08:14:52 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance  and other bollocks:wall: :wall: :wall: :wall: :wall:

Title: Re: The end of the NHS.
Post by: GCW on April 25, 2016, 09:16:09 pm
Is this not the most fucking desperate act of twatishness you've ever heard of?

Junior doctors' leaders 'trying to topple the government'
http://www.bbc.co.uk/news/health-36126740


Quote
That's why I find it so amusing that the latter-day saints of our business (1) attribute to me motives that just weren't there, and (2) accuse me of corrupting morality, which I wish I had the power to do.
Title: Re: The end of the NHS.
Post by: lagerstarfish on April 25, 2016, 09:20:55 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

Same in my dept 40-60% understaffed most days yet we still have to find time to do Information Governance.

at our place they just set the computers to lock you out unless you do the e-learning (info governance etc)

fortunately, at my level anyway, it's the kind of thing you can pass most efficiently by just redoing the test in rapid succession without doing the learning part

what's the point?

just make sure you get a screen shot of your pass mark - that's all that counts
Title: Re: The end of the NHS.
Post by: psychomansam on April 25, 2016, 10:04:28 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

It's about patient care, confidentiality and reputational damage among other things. They are all important issues. Making sure people understand and are regularly reminded of their responsibilities for IG is important. Pre-assessment can reduce the time taken to 10 mins if people already know what they need to. Not a big ask. And it's not bollocks.

As a student, I left things to the last minute. As a student. And for a trust to do that on this week, with major strikes planned, is ridiculous. Cancelling appointments with patients to achieve the compliance levels sounds like a clear a case of poor* planning, probably at numerous levels.

*I suspect the top level planning resulting in the staffing shortages to be intentionally destructive and thus effective rather than poor planning.
Title: Re: The end of the NHS.
Post by: monkoffunk on April 26, 2016, 06:08:17 am
“No trade union has the right to veto a manifesto promise voted for by the British people."

What a joke. The "British people" never voted for their butter to be spread so thin that it decided to walk off the plate.
Title: Re: The end of the NHS.
Post by: Offwidth on April 26, 2016, 01:31:07 pm
Its not a manifesto promise that the Junior doctors are blocking, they are simply a non issue in 7 day working, the extra cost is lost in the noise in the funding gap to achieve genuine 7 day working and other contracts are far more of an issue. Hunt is a lying liar who has lied again. On the subject of porkies, even the £8 billion the government say they will put in to achieve this was exposed as smoke and mirrors by ex minister Laws: the money needed was £30 billion (including mostly efficiency savings that many experts doubt can happen in a huge organisation where inflationary costs routinely exceed standard inflation measures) of which Stevens wanted half up front:

http://www.huffingtonpost.co.uk/entry/nhs-leaned-on-8bn_uk_56ee8229e4b0fbd4fe080b93


One of the junior docs on the bbc news this morning asked the very pertinent question if the new contracts guarantee safer working, why do they need to remove financial penalties from trust breaches and replace this very successful expensive punishment with some vague guardian role.

Then we have the new new costs of GP changes

http://www.theguardian.com/society/2015/jul/24/jeremy-hunts-seven-day-plan-for-gp-surgeries-could-cost-nhs-3bn-a-year

Are all these uncertainties in estimating the real costs of 7 day working real, or are the potential tens of billions involved and almost impossible gap filling in recruitment of new consultants (where will they all come from ffs??) political game changers.

http://www.nhsconfed.org/resources/2014/01/what-are-the-financial-implications-of-seven-day-working


Even the £1-2 billion numbers quoted from the 'government' side would be better spent elsewhere according to researchers:

http://www.manchester.ac.uk/discover/news/resources-needed-for-the-seven-day-nhs-services-may-be-better-spent

https://aheblog.com/2015/06/04/the-economics-of-a-7-day-nhs/

and a conservative MP health expert

http://www.telegraph.co.uk/news/nhs/12015006/The-seven-day-NHS-is-a-dangerous-obsession-until-we-fix-social-care.html

... finally, does anyone else here smell a rat that this dispute looks so impossible to solve that the right wing desire of local contracts will become the 'only possible solution'??
Title: Re: The end of the NHS.
Post by: webbo on April 26, 2016, 02:30:53 pm
I have staff in my Team currently cancelling appointments with patients so that they can do their Information Governance training. Apparently if the Trust doesn't achieve a 95% compliance by the end of the week, they will get a large fine/ reduction in funding.
It's all about improved patient care so they tell me.

It's about patient care, confidentiality and reputational damage among other things. They are all important issues. Making sure people understand and are regularly reminded of their responsibilities for IG is important. Pre-assessment can reduce the time taken to 10 mins if people already know what they need to. Not a big ask. And it's not bollocks.

As a student, I left things to the last minute. As a student. And for a trust to do that on this week, with major strikes planned, is ridiculous. Cancelling appointments with patients to achieve the compliance levels sounds like a clear a case of poor* planning, probably at numerous levels.

*I suspect the top level planning resulting in the staffing shortages to be intentionally destructive and thus effective rather than poor planning.
As Lagers says you can usually pass it without doing the learning. So despite it being important in the way you describe above, it is set at level which has no value to anyone. So everyone forgets about it and gets on with seeing patients.
Title: Re: The end of the NHS.
Post by: Will Hunt on April 26, 2016, 02:49:52 pm
I appreciate Sam's point and agree that a certain amount of corporate bollocks and training is useful and necessary in a large organisation - though not when it is poorly managed. I'm not sure if I've mentioned this on here before but Webbo's final point is actually quite illustrative of why I think the NHS actually works:

So everyone forgets about it and gets on with seeing patients.

All the people (the good ones anyway, there's plenty of shite people in the NHS) are completely focussed on the patient and get the job done in spite of the management, not because of it.
Title: Re: The end of the NHS.
Post by: lagerstarfish on April 26, 2016, 02:57:08 pm
what we need is a 5 minute Victoria Wood and Julie Walters sketch explaining the Caldicott principles in an amusing way with hilarious examples

everyone would enjoy watching it and would remember it for years
Title: Re: The end of the NHS.
Post by: slackline on April 26, 2016, 05:47:30 pm
Good speech (https://amp.twimg.com/v/3308792e-081c-496d-93c8-b867cc029a71)
Title: Re: The end of the NHS.
Post by: monkoffunk on April 26, 2016, 07:29:43 pm
Its not a manifesto promise that the Junior doctors are blocking, they are simply a non issue in 7 day working, the extra cost is lost in the noise in the funding gap to achieve genuine 7 day working and other contracts are far more of an issue. Hunt is a lying liar who has lied again.

I agree. And we aren't asking for anything extra, just the status quo, and that's bad enough! It's not surprising that doctors were targeted, the Tories are working their way through the whole public sector. And yes, other contracts will be next. It's got nothing to do with a 7 day NHS, it's the Tories economic policy.
Title: Re: The end of the NHS.
Post by: Offwidth on April 27, 2016, 09:31:40 am
what we need is a 5 minute Victoria Wood and Julie Walters sketch explaining the Caldicott principles in an amusing way with hilarious examples

everyone would enjoy watching it and would remember it for years

I'm sympathetic to the importance of such training but how does that square with such dull time consuming material often so badly scheduled and that a moron could pass. Such things eat away at the soul. Victoria Wood would have been a lovely touch, preferably with music from Prince and Bowie.
Title: Re: The end of the NHS.
Post by: Fultonius on April 27, 2016, 09:35:16 am
The way (c)unt and the rest of the "government" are behaving to me only means one thing - Hunt has been appointed to dismantle the NHS, come hell or high water he'll have full government backing. Why? Because he's probably been offered a peerage in the future with a few well paying exec roles on the board of healthcare providers.

"weather the storm Jeremy, and all will be repaid"
Title: Re: The end of the NHS.
Post by: rich d on April 27, 2016, 11:46:26 am
Jeremy Hunt was co author of this http://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantling back in 2009. Seems the perfect person to then put in charge of the NHS  :wall:
Title: Re: The end of the NHS.
Post by: GCW on April 27, 2016, 12:07:27 pm
If anyone is interested in history, I (re-)commend to you "NHS SOS" as a read.
Title: Re: The end of the NHS.
Post by: slackline on April 27, 2016, 03:04:12 pm
http://www.youtube.com/watch?v=uK7DRJx9nbU
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 02:16:53 pm
Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?

* In order to do this, it's very complicated, but essentially doctors will have to swap a shift during the week for one at the weekend.

* There were arguments about not working too many hours, and lots of other things.  During the talks over the winter, the BMA and the government agreed on all of these things.

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

QUESTION 2: ARE THE PREVIOUS TWO BULLETS CORRECT?  IF NOT, WHAT IS IT ACTUALLY ABOUT?  WHAT SPECIFIC POINTS ARE STILL REMAINING IN CONTENTION?

That's it.  I'm not interested in privatisation, Jeremy Hunt being a cunt, Tory vs. Labour, whether Labour started it in 2002, or whatever, just the things above...  Neither do I care if you are for or against doctors salaries going up, or whatever.... we can talk about that after if necessary...   Just some answers to a couple of questions... that's all...

Can someone please answer the above?

Title: Re: The end of the NHS.
Post by: 36chambers on April 28, 2016, 02:47:27 pm
Does this help in any way?

(https://scontent.xx.fbcdn.net/hphotos-xfp1/t31.0-8/s960x960/13047743_10101666374339630_5444456350116307646_o.jpg)
Title: Re: The end of the NHS.
Post by: monkoffunk on April 28, 2016, 03:03:20 pm
* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.
* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.
* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

The concept of full 7 day services are certainly laudable. To suggest this can be done in a cost neutral way is ridiculous. It will be hugely expensive to fully extend services. Patients seen will undoubtedly increase. Do you expect that clinics on a Wednesday will suddenly not be fully booked? That there will be empty operating theatres with nothing to do? Services are pushed to breaking as it is, and the population is getting older and more sick. Advances in medicine are hugely increasing the size of the population living with chronic illness. Pressures are increasing all the time. Increase the number of appointments/elective theatre slots and patients will rapidly fill them. Maybe waiting lists will reduce initially, but doctors taking it easy during the week to make up for Saturday clinics? No way. On that point, taking doctors away from the week day shifts to put them on the weekend will pressurise rotas further and already there are gaps in many specialties (particularly acute services such as A+E). Regardless of the debate over pay, I don't think it unreasonable to be unhappy with the idea of working more weekends for no pay increase, but it seems highly likely that pay will go down. This does not seem fair, but really its not what this is about. The sort of sample rotas we are seeing which spread doctors around to cover these extra shifts look like they have been written with someone with no clue what it means to work outside of 9am-5pm. It looks almost intended to induce a state of perpetual jet lag. The government clearly know this is an issue and that rotas will be disruptive to any form of work life balance. Their own equality assessment confirms this. They accept that the new contract will discriminate against women, but do not seem overly concerned by this. Its likely the situation will then worsen as doctors quit the profession and go abroad. This isn't idle speculation, I already know doctors who will be off to work for banks from August and others seriously looking into options in Canada and Australia, who never planned to leave the country.

Further background: http://www.bma.org.uk/working-for-change/doctors-in-the-nhs/seven-day-services

http://www.independent.co.uk/news/uk/politics/junior-doctors-outraged-over-new-contract-that-discriminates-against-single-women-a6963356.html

"Doctors have reacted furiously after the Government’s own impact assessment of the new junior doctor contract said any “adverse effect” impact on women’s pay was a “proportionate” means to an end.
The Department of Health’s Equality Impact Assessment of the controversial new contract, which was published in full this week, found that aspects of the new contract would “impact disproportionately on women”, with particular disadvantages for single mothers. "

http://www.theguardian.com/society/2016/apr/28/equality-watchdog-warns-junior-doctors-contract-potentially-illegal

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

Give me a moment will get back on this one...
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 03:21:00 pm
Does this help in any way?

(https://scontent.xx.fbcdn.net/hphotos-xfp1/t31.0-8/s960x960/13047743_10101666374339630_5444456350116307646_o.jpg)

No.  It's partisan.
Title: Re: The end of the NHS.
Post by: i.munro on April 28, 2016, 03:24:20 pm

That's it.  I'm not interested in privatisation,
Can someone please answer the above?

Then nobody can answer as this is entirely driven by the desire for privatisation.
Title: Re: The end of the NHS.
Post by: duncan on April 28, 2016, 03:35:25 pm
Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?


There are three linked variables: cost, quality, and flexibility (“choice” is the government's buzz-word for the latter). Cost: the NHS is cheap by affluent western standards. Quality: health outcomes are middling-good. Consequently NHS cost-effectiveness is probably the best amongst affluent western countries. High cost-effectiveness is achieved through a relatively inflexible system: waiting times, no 24/7 access to non-emergency care. Greater flexibly means less efficiency: if you are offering a choice of appointment times there has to be some slack in the system. Making things a little awkward for people also has a filtering effect and reduces demand.

The NHS also has good staff buy-in to the idea of a fair system for all, even if it isn't. Extra voluntary hours helps efficiency.

If you increase the flexibility of a service demand will go up so it either has to cost more or quality goes down for the same cost. This is irrespective of political hue: French healthcare has more flexibility, slightly better quality but costs more and is less cost-effective. US private healthcare is slightly more flexible still and slightly higher quality at double the cost and is much less cost-effective. Hunt says he wants to increase flexibly with no increase in cost or deterioration in quality. This simply can't be done.

If you piss-off your staff, efficiency deteriorates.
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 03:37:02 pm
* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.
* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.
* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

The concept of full 7 day services are certainly laudable. To suggest this can be done in a cost neutral way is ridiculous. It will be hugely expensive to fully extend services. Patients seen will undoubtedly increase. Do you expect that clinics on a Wednesday will suddenly not be fully booked? That there will be empty operating theatres with nothing to do? Services are pushed to breaking as it is, and the population is getting older and more sick. Advances in medicine are hugely increasing the size of the population living with chronic illness. Pressures are increasing all the time. Increase the number of appointments/elective theatre slots and patients will rapidly fill them. Maybe waiting lists will reduce initially, but doctors taking it easy during the week to make up for Saturday clinics? No way. On that point, taking doctors away from the week day shifts to put them on the weekend will pressurise rotas further and already there are gaps in many specialties (particularly acute services such as A+E). Regardless of the debate over pay, I don't think it unreasonable to be unhappy with the idea of working more weekends for no pay increase, but it seems highly likely that pay will go down. This does not seem fair, but really its not what this is about. The sort of sample rotas we are seeing which spread doctors around to cover these extra shifts look like they have been written with someone with no clue what it means to work outside of 9am-5pm. It looks almost intended to induce a state of perpetual jet lag. The government clearly know this is an issue and that rotas will be disruptive to any form of work life balance. Their own equality assessment confirms this. They accept that the new contract will discriminate against women, but do not seem overly concerned by this. Its likely the situation will then worsen as doctors quit the profession and go abroad. This isn't idle speculation, I already know doctors who will be off to work for banks from August and others seriously looking into options in Canada and Australia, who never planned to leave the country.

This is the key bit really.  You can't have some of this as part of your argument directly as it doesn't make the razor: yes, it's relevant, but it's not ONLY relevant.  Increasing pressures on the NHS as a result of increasing demands on the increasing population will happen with or without a seven-day NHS - unless the seven day thing makes it worse... because all the doctors fuck off to Oz... don't get me started on that, Oz is not all that as many will discover... but that's a different topic too.

Now you could have an argument that said at present, patients cannot get an appointment.  At the moment they would go on a waiting list, and one that is eternally growing longer and longer as there are not enough appointments - i.e. supply is lower than demand and remains so overall.  I don't think waiting lists are getting longer and longer?  (Yes there are peaks and troughs?)  Or is this not the case?  But in any event: this too doesn't make the razor...

... the "same cost" thing works if and only if there are the same number of appointments overall.  Keeping the same number of hours worked per doctor the same (another thing I hear is agreed) = the same number of appointments overall?  This is why I don't understand the argument that changing to a model that has doctors available on a saturday and a sunday as well as M-F *increases costs* (unless you pay more for doctors to work saturday and sunday which is quite the point).

The fundamental thing I'm not getting though is really about the appointments and the hours and whether or not the move to seven days is in fact asking doctors to see more patients, or just to the same number of patients all week?

I get the rest.  There is loads of interesting stuff there.  The penalising women thing - at first glance I don't agree with that, sorry, because it's OK for Dad's to get fucked but not Mum's?  What about Mum being able to work weekends when Dad is about instead because she can choose saturday shifts?  But we should leave that for the time being and I may well be missing something.  Just like we should also leave the fact that A&E is surely stuffed at the moment because nobody chooses a speciality where you have to work regular, 12 hour, unsociable shifts... it's much easier to be a single body part doctor M-F....

I guess the summary is: in the sample rotas, compared to the rotas now, are there more hours worked, or the same?

Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 03:40:14 pm
Despite a feeling that I'll be going against the wind here, and apologies if I missed the answer, but I'm really struggling to understand what this is all about.  Pete JH keeps trying to wield Occam's razor, and not really getting anywhere, but I guess it's worth a go...  humour me, perhaps I'm stupid.

I want facts only - and as little politics as possible...

* The Tories want a 7-day NHS.  That is, they want non-emergency cover to be available on saturday and sunday too.

* They are starting with junior doctors.  They'll need to do it for the rest (technicians etc.) too, but have started with junior doctors.

* They want the new junior doctors contract to be cost neutral.  Justification for this is that the overall number of patients seen will not increase - people can take a sunday appt instead of taking time off on a friday, for example.

QUESTION 1: IS THIS WRONG?  IF IT IS WRONG, WHY?  WHY WILL THE OVERALL WORKLOAD INCREASE?


There are three linked variables: cost, quality, and flexibility (“choice” is the government's buzz-word for the latter). Cost: the NHS is cheap by affluent western standards. Quality: health outcomes are middling-good. Consequently NHS cost-effectiveness is probably the best amongst affluent western countries. High cost-effectiveness is achieved through a relatively inflexible system: waiting times, no 24/7 access to non-emergency care. Making things a little awkward for people has a filtering effect and reduces demand.

The NHS also has good staff buy-in to the idea of a fair system for all, even if it isn't. Extra voluntary hours helps efficiency.

If you increase the flexibility of a service demand will go up so it either has to cost more or quality goes down for the same cost. This is irrespective of political hue: French healthcare has more flexibility, slightly better quality but costs more and is less cost-effective. US private healthcare is slightly more flexible still and slightly higher quality at double the cost and is much less cost-effective. Hunt says he wants to increase flexibly with no increase in cost or deterioration in quality. This simply can't be done.

If you piss-off your staff, efficiency deteriorates.

Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

This isn't elective really btw.  It's non-emergency.  Cancer care is hardly elective.  But we can keep using elective as the word if that is best.
Title: Re: The end of the NHS.
Post by: slackline on April 28, 2016, 03:48:22 pm
I want facts only - and as little politics as possible...

They can't be separated in this issue because as has been clearly stated in the news the other day "No trade union has the right to veto a manifesto promise voted for by the British people,” (http://www.independent.co.uk/news/uk/home-news/jeremy-hunt-accuses-junior-doctors-of-trying-to-veto-election-pledge-a7000421.html).

It is about dismantling the NHS and privatising it, why else would someone who's previous experience is public relations and conveniently having co-authored a book published in 2005 on dismantling the NHS (http://www.theguardian.com/politics/2009/aug/16/tory-mps-back-nhs-dismantling) would have been appointed to the position of Health Secretary.

Its a tried and tested method....

(http://40.media.tumblr.com/8bab6c10710f18ce9cc308ac638bc321/tumblr_nsq00cPlyk1uu6cgso1_1280.jpg)


There are tons of statistics I'm too busy to look up and quote for you right now on the efficacy of public v's private healthcare, but you're outlooks (all-cause mortality) are worse and more expensive under the later.
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 04:00:35 pm
For fuck's sake Slackline, if you can't discuss it without banging on about left wing right wing tory labour privatisation etc. etc. etc. despite being asked please just shut up for ten (non-literal) minutes.  Jesus Titty Fucking Christ on a bike I'm trying to from an actual cunting opinion here without all the partisan bullshit.

I know it's more complicated, I know Labour started it when they were in their Tory period, I know a doctor should get more than a tube driver and starts with higher debts, I know a consultant makes more than me, I know skipping appointments is bad, I know we should just skip getting eye treatment and just look through pinholes made by our fingers when we need to see in focus, in I know Jeremy Corbyn cures AIDS with his bare hands, I JUST WANT TO LEAVE IT OUT FOR THE MINUTE PLEASE
Title: Re: The end of the NHS.
Post by: galpinos on April 28, 2016, 04:04:35 pm

* There were arguments about not working too many hours, and lots of other things.  During the talks over the winter, the BMA and the government agreed on all of these things.

* The one remaining piece of disagreement between the BMA and the government was saturday pay.  The BMA want it to go up; the government don't.

QUESTION 2: ARE THE PREVIOUS TWO BULLETS CORRECT?  IF NOT, WHAT IS IT ACTUALLY ABOUT?  WHAT SPECIFIC POINTS ARE STILL REMAINING IN CONTENTION?

The two previous bullets are not correct.

Shifts - The BMA were not happy with the DoH's classification of shifts. DoH "day shift ends at 2am, so a 9am to 2am shift is a day shift, you then start at 9am the next day. BMA wants between 10pm - 6am to be classed as a night shift to prevent a succession of long shifts.

Overworking Protection - Currently, there is a robust system of hours monitoring (that is a system signed up to by trusts and doctors) that CAN be used to stop the Trust from implementing shift patterns/hours that are outside the contract for that post. (Doctor's contracts differ depending on what "band" they are in, higher ban, more hours, moe antisocial shift, more money). If the trust is breaking it's agreement, the trust is obliged to modify the shift or pay more money. This isn't often used (most doctors, when monitored, lie to say they work less) but when trusts start to take the piss, the doctors have somewhere to turn. This is effective when required. The DoH want to get rid of this and have an appeal system to a "Guardian" who is a trust employee. No independent monitoring, no independent body, no appeal system, just consideration by the trust.

Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)
Title: Re: The end of the NHS.
Post by: Footwork on April 28, 2016, 04:05:23 pm

I guess the summary is: in the sample rotas, compared to the rotas now, are there more hours worked, or the same?

I'll try and dig one out as I've seen a few. They look like they've been written by an algorithm rather than a person.

There are cases of 4 nights worked 9pm - 9am. Say this finishes Monday 9am. Monday has been coloured in green and counted as a 'day off' before being back at work on days Tuesday. Any idiot can see that this doesn't count as a day off but is a non day spent sorting out sleeping pattern.

Next is the average hours worked a week. Their average has got two wild extremes. From 35 hour weeks to 100 hour weeks. Again, the body does not cope well with these inconsistent work patterns.

The contract removes financial penalties on trusts for overworking their Dr's. Why the fuck would you do this other than being able to abuse your staff and it not being wrong.

EDIT: Didn't see post above by galpinos. If the "guardian" is as good as some rota co-ordinators (and yes there are some good ones!) then having the matter sorted will be as much use as an honesty box outside Westminster

Title: Re: The end of the NHS.
Post by: galpinos on April 28, 2016, 04:09:11 pm
This isn't elective really btw.  It's non-emergency.  Cancer care is hardly elective.  But we can keep using elective as the word if that is best.

Cancer treatment is mostly elective*. There is sometimes an "emergency" element to it at the start but then treatment can be scheduled. There is also sometimes an emergency element at the end but the bulk of it is classed as elective.

*elective in the medical sense has a definition of non-urgent.
Title: Re: The end of the NHS.
Post by: duncan on April 28, 2016, 04:09:50 pm
Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

I edited my last post as you replied - in part anticipating this.

There are several reasons why increasing flexibility increases demand, a similar process occurs when you build a new road. People get better, or no longer see the need for healthcare, as they wait on waiting lists. Make it harder to seek non-urgent care and borderline-necessary consultations will drop. There are a lot of these, ask any GP or A+E department. I probably avulsed my middle finger collateral ligament last December. I considered going to my GP but it was Christmas and there was a three week wait for appointments so I managed it myself. Had I been able to get an appointment the same day I would have done.

In any service industry I'm aware of, it costs to increase flexibility: if Apple wanted to reduce the waiting time to see a Genius they would employ more Geniuses per number of Mac users. Why should healthcare be different?
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 04:16:30 pm
Oooh.  This is another good reply.  So can you explain why flexibility and demand are linked in a non-emergency healthcare setting?  Or rather: why flexibility and supply are linked - as that is the Q PeteJH and I are asking I think...

I edited my last post as you replied - in part anticipating this.

There are several reasons why increasing flexibility increases demand, a similar process occurs when you build a new road. People get better, or no longer see the need for healthcare, as they wait on waiting lists. Make it harder to seek non-urgent care and borderline-necessary consultations will drop. There are a lot of these, ask any GP or A+E department. I probably avulsed my middle finger collateral ligament last December. I considered going to my GP but it was Christmas and there was a three week wait for appointments so I managed it myself. Had I been able to get an appointment the same day I would have done.

In any service industry I'm aware of, it costs to increase flexibility: if Apple wanted to reduce the waiting time to see a Genius they would employ more Geniuses per number of Mac users. Why should healthcare be different?

I think you've answered my counter here inline.  Increasing flexibility at front line services DOES increase demand: so A&E and GPs.  I think we can split those off from this discussion they are governed differently.  The ability to get an antenatal appointment on a saturday as opposed to having to take a wednesday morning off is the kind of thing we're talking about really: you need it, it's not an emergency, it's not "elective" in sense of "optional" - and as such I argue that the increased flexibility will not increase demand by much if anything.  Until we wade into things like missed appointments.
Title: Re: The end of the NHS.
Post by: slackline on April 28, 2016, 04:22:02 pm
Jesus Titty Fucking Christ on a bike I'm trying to from an actual cunting opinion here without all the partisan bullshit.

You normally come across as someone who is well informed on issues, so go and do your own fucking research on which to base your cunting opinion.



Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 04:22:46 pm
Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)

Great post, thanks.  (And the same to Footwork.)

In the bit I've split out - is that a typo?  What do you get 10% extra for - working more than four shifts in one week?  And do you mean the BMA would not move?

Title: Re: The end of the NHS.
Post by: 36chambers on April 28, 2016, 04:24:13 pm
My girlfriend is half way through doing a PhD looking into the relationship between GP wellbeing, burnout and patient safety. This is not directly related to the current junior doctor affair.

Having recently submitted a lit review for publication, studies have shown that doctors are already worked too hard and have a higher than average rate of burnout, and that patient safety is compromised due to stress related medical errors. The (crude) conclusion being that doctors need much greater support and more breaks. (A rough example, trucks drivers are expected to have a break every 3 hours but a doctors is expected to have one every 6)

There is great concern that the new contracts will put even more strain on doctors and thus cause even more medical errors.
Title: Re: The end of the NHS.
Post by: galpinos on April 28, 2016, 04:30:46 pm
Pay - Doctors currently have pay bands as described above. DoH want's no extra pay for Saturday, a standard day to move from 9-7 to 7-9 and the extra 10% for working over 1 in 4 weeks* to go. BMA conceded to move the standard working day to 8 - 8 as that is the standard day for a doctor but would move on the Saturday pay and weekend supplement.

*This is to incentivise doctors into the emergency care as the shifts are pretty horrible so as a pay-of for spending your life in a hospital, you get a bit more money

(Run out of time to say more, maybe later.....)

Great post, thanks.  (And the same to Footwork.)

In the bit I've split out - is that a typo?  What do you get 10% extra for - working more than four shifts in one week?  And do you mean the BMA would not move?

The extra 10% is for juniors who work more than 1 weekend in 4. (a weekend is classed as a Saturday and Sunday shift, day or night). This is pretty much only relevant for those in emergency disciplines.

And yes, I did mean they would NOT move on the 10% for weekends and the classing of Saturday as a standard working day.
Title: Re: The end of the NHS.
Post by: galpinos on April 28, 2016, 04:37:18 pm
There were other bits they didn't agree on but those were the ones relative to the points you made.

My wife is a doctor (cancer) so I have a vested interest/bias.
Title: Re: The end of the NHS.
Post by: monkoffunk on April 28, 2016, 04:54:16 pm

This is the key bit really.  You can't have some of this as part of your argument directly as it doesn't make the razor: yes, it's relevant, but it's not ONLY relevant.  Increasing pressures on the NHS as a result of increasing demands on the increasing population will happen with or without a seven-day NHS - unless the seven day thing makes it worse... because all the doctors fuck off to Oz... don't get me started on that, Oz is not all that as many will discover... but that's a different topic too.

Now you could have an argument that said at present, patients cannot get an appointment.  At the moment they would go on a waiting list, and one that is eternally growing longer and longer as there are not enough appointments - i.e. supply is lower than demand and remains so overall.  I don't think waiting lists are getting longer and longer?  (Yes there are peaks and troughs?)  Or is this not the case?  But in any event: this too doesn't make the razor...

... the "same cost" thing works if and only if there are the same number of appointments overall.  Keeping the same number of hours worked per doctor the same (another thing I hear is agreed) = the same number of appointments overall?  This is why I don't understand the argument that changing to a model that has doctors available on a saturday and a sunday as well as M-F *increases costs* (unless you pay more for doctors to work saturday and sunday which is quite the point).

The fundamental thing I'm not getting though is really about the appointments and the hours and whether or not the move to seven days is in fact asking doctors to see more patients, or just to the same number of patients all week?


Seven day NHS might not make pressures worse, but it is truly impossible to provide identical levels of care on a Saturday and Sunday in a cost neutral fashion. As has been said already junior doctors are the tip of the iceberg in terms of infrastructure and other staff required. Regardless of length of hours work, there is a massive difference when you spread people too thin, before accounting for people leaving. Spread the same number of doctors out over more time and you will increase pressure on those doctors. This is separate to more global issues of increasing patient numbers, increasing burden of chronic illness, which is going on anyway, and will mean no shortage of patients to fill expansion of service.

There will not be the same number of appointments over all. The point is they want full services 7 days a week. Not reduced weekday services. They want to increase service provision without (official) increased doctor hours. That is unsafe.

I get the rest.  There is loads of interesting stuff there.  The penalising women thing - at first glance I don't agree with that, sorry, because it's OK for Dad's to get fucked but not Mum's?  What about Mum being able to work weekends when Dad is about instead because she can choose saturday shifts?  But we should leave that for the time being and I may well be missing something.

I don't believe its ok for Dads to get fucked and not Mums, but my point is that if the government themselves are saying anyone is getting fucked then doesn't that make the point that this isn't just junior doctors throwing their toys out of the pram?

Just like we should also leave the fact that A&E is surely stuffed at the moment because nobody chooses a specialty where you have to work regular, 12 hour, unsociable shifts... it's much easier to be a single body part doctor M-F....

Yes its increasingly screwed as it is. I worked 3 in 4 weekend rota. It was horrible and I'd never go back.

I'm still not quite sure whether you think its fair to view Saturday working as the same as Wednesday? Do you value your weekends at all?
Title: Re: The end of the NHS.
Post by: monkoffunk on April 28, 2016, 05:01:19 pm
As a side point on how much of a pipe dream this whole thing is:

Quote from:  The BMA
There is a growing movement towards more NHS services being available seven days a week.

This is being driven by three primary factors:

A desire to improve quality of care
Services redesign and reconfiguration
Improving access and convenience.

In practical terms, achieving the same care quality throughout the week will mean more NHS staff, especially senior doctors, on site at hospitals at weekends and evenings. There are also implications for access to general practice.

It also requires other services being available to enable clinicians to provide high quality care as usual. This includes diagnostic and clinical support, social care, transfer services and administrative support.

Some individual hospitals have developed the availability of some services over seven days. But as yet there has been no robust modelling of what the impact of seven-day services would be more generally on staff numbers or working patterns, the financial implications, or clinical outcomes for individual specialties.

The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

In the current and foreseeable economic climate, with huge financial pressure on the NHS, we do not believe resources could be freed up to deliver routine and elective services seven days a week.

Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 05:14:42 pm
I don't believe its ok for Dads to get fucked and not Mums, but my point is that if the government themselves are saying anyone is getting fucked then doesn't that make the point that this isn't just junior doctors throwing their toys out of the pram?

....

I'm still not quite sure whether you think its fair to view Saturday working as the same as Wednesday? Do you value your weekends at all?

Thanks for your reply.  Two to answer.  In reverse order. :-)

1. I haven't said what my opinion is - because I don't really have one yet.  Do I think doctors should strike?  No.  You're not fucking tube drivers or French farmers.  For some reason I hold all doctors up like I hold MSF: paragons of heroism and virtue, choosing to be a doctor for reasons other than money and personal worth.  That is exactly why I stepped right not left at 18 and chose Physics over medicine.  But that's an emotive feeling, not a considered one.  My father is a doctor.  He's been through all this before, and chose to not leave to Australia (to the endless chagrin of my mother) - because the NHS and free healthcare was to important for him to abandon.  He detests the BMA too though.  But on the flipside - what are you to do?  So I'm forming my opinion on this bit - and I need information.

Saturday working?  On the one hand, you've got to work it.  No use bleating about it, this is the 21st Century, and I despise the Scots and the religious types for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.  But then... I have worked Saturday.  I still work weekends sometimes.  I don't get paid for it at all now.  When I did, I got time and a half.  So I think you should work it - but get paid a bit more for it.

2. My biggest problem here is with the communication paths.  I don't know who to believe.  The fact that everyone keeps banging on and on and on and on and on and on about privatising the NHS and being childish about the Health Secretary's name just makes me irritated and question everything I hear as bullshit.

The women thing is an example of poor comms: it's a smokescreen from the real issue, and has no value in the communication of the core arguments.  We can spend too long discussing whether it's OK to break eggs to make an omelette.

Negative publicity brings everyone down the same level.  A low one.  Which makes me not give a fuck: everyone = Drumpf.

Finally I decided to step away from my irritation and find out some facts, and then think about it.  Which I'm now doing.

I hope that makes sense.  And thanks for your input.
Title: Re: The end of the NHS.
Post by: Lund on April 28, 2016, 05:18:54 pm
As a side point on how much of a pipe dream this whole thing is:

Quote from:  The BMA
There is a growing movement towards more NHS services being available seven days a week.

This is being driven by three primary factors:

A desire to improve quality of care
Services redesign and reconfiguration
Improving access and convenience.

In practical terms, achieving the same care quality throughout the week will mean more NHS staff, especially senior doctors, on site at hospitals at weekends and evenings. There are also implications for access to general practice.

It also requires other services being available to enable clinicians to provide high quality care as usual. This includes diagnostic and clinical support, social care, transfer services and administrative support.

Some individual hospitals have developed the availability of some services over seven days. But as yet there has been no robust modelling of what the impact of seven-day services would be more generally on staff numbers or working patterns, the financial implications, or clinical outcomes for individual specialties.

The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

In the current and foreseeable economic climate, with huge financial pressure on the NHS, we do not believe resources could be freed up to deliver routine and elective services seven days a week.


I get that.  And it makes a lot of sense.  But... the government said in their manifesto that they would provide 7-day services.

So they have to do it right?  Or at least try?

Whatever you believe, the democracy we are stuck with means that has to happen.  And the BMA - which isn't representative of everyone in the country - they can't fight against that... it's not right.

On the flip side, they can represent their member's interests and fight for the right pay and working conditions...
Title: Re: The end of the NHS.
Post by: GCW on April 28, 2016, 05:42:06 pm
The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on April 28, 2016, 05:47:03 pm
The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.

Amen.


Sadly...
Title: Re: The end of the NHS.
Post by: monkoffunk on April 28, 2016, 06:07:52 pm
Thanks for your reply.  Two to answer.  In reverse order. :-)

1. I haven't said what my opinion is - because I don't really have one yet.  Do I think doctors should strike?  No.  You're not fucking tube drivers or French farmers.  For some reason I hold all doctors up like I hold MSF: paragons of heroism and virtue, choosing to be a doctor for reasons other than money and personal worth.  That is exactly why I stepped right not left at 18 and chose Physics over medicine.  But that's an emotive feeling, not a considered one.  My father is a doctor.  He's been through all this before, and chose to not leave to Australia (to the endless chagrin of my mother) - because the NHS and free healthcare was to important for him to abandon.  He detests the BMA too though.  But on the flipside - what are you to do?  So I'm forming my opinion on this bit - and I need information.

I'm on the flip side. I truly believe that if this contract goes through it will be far worse for patients than the impact of the strike. I can't ethically stand by and let it happen. I can't seen any other option. Striking causes inconvenience and is unsustainable in the long run, but it doesn't cause patient harm. Go to A+E on Monday or Tuesday and you'd have been seen by a consultant.

We aren't striking for the money. We never asked for a pay rise. We aren't asking for one now. We have taken real term pay cuts for years, we haven't complained (whilst MPs pay goes up, irrelevant I know).

Saturday working?  On the one hand, you've got to work it.  No use bleating about it, this is the 21st Century, and I despise the Scots and the religious types for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.  But then... I have worked Saturday.  I still work weekends sometimes.  I don't get paid for it at all now.  When I did, I got time and a half.  So I think you should work it - but get paid a bit more for it.

Again I already work Saturdays. I'm not complaining about it. I weekends, I work nights. In four months of A+E I worked 11/18 weekends of which some were nights. 1/4 structure accounting for annual leave. Hated it, but did it. I don't know how many I'll be expected to work in future, but the government does not want to pay extra for extra shift. And I don't want that anyway. I want more doctors to provide more care. I have also work probably hundreds of hours for free due to the impossibility of leaving on time in certain jobs, but again, irrelevant.

2. My biggest problem here is with the communication paths.  I don't know who to believe.  The fact that everyone keeps banging on and on and on and on and on and on about privatising the NHS and being childish about the Health Secretary's name just makes me irritated and question everything I hear as bullshit.

Fair enough. Jeremy Hunt's name has been listed as an author on documentation calling for the NHS to be dismantled, although he denies that it reflects his views. I'll admit to being partisan. I do personally believe he would like to see the end of the NHS and I do personally believe that an attempt to cut junior doctor pay reflects wider Tory economic policy, reflected in the treatment of all public sector workers. All of this is separate from the issue of patient safety. Motives aren't relevant, outcomes are.

The women thing is an example of poor comms: it's a smokescreen from the real issue, and has no value in the communication of the core arguments.  We can spend too long discussing whether it's OK to break eggs to make an omelette.

Negative publicity brings everyone down the same level.  A low one.  Which makes me not give a fuck: everyone = Drumpf.

Finally I decided to step away from my irritation and find out some facts, and then think about it.  Which I'm now doing.

I hope that makes sense.  And thanks for your input.

Thanks for yours.
Title: Re: The end of the NHS.
Post by: monkoffunk on April 28, 2016, 06:13:48 pm

the government said in their manifesto that they would provide 7-day services.

So they have to do it right?  Or at least try?


Introducing a truely 7 day elective NHS requires a spending commitment they aren't willing to make. It was a stupid thing to put in their manifesto if they didn't intend to implement it in a sensible way. This way is unworkable. And no, they don't have to. Governments often break manifesto promises (LibDems and tuition fees spring to mind); they only act like it's some unbreakable pact when it suits their purposes.
Title: Re: The end of the NHS.
Post by: Offwidth on April 28, 2016, 06:30:53 pm
I think the insults are because Hunt IS telling lies and the vast majority of the very intelligent and dedicated medical professionals are very upset about this.. Enough to include many conservatige voting doctors.. So I see no sense in debating the niceties of the highly complex detail of contractural rights and wrongs in isolation, when the real issue is the funding gap for safe 7 day working and the NHS workers next in line for major contract 'cost neutral' changes. Also that the reasons behind the need for 7 day working are wrong and best solved in other ways in the expert research based links provided up thread (for those who can be bothered to look). The manifesto commitment doesn't make sense, isn't anywhere close to be funded and would be the latest in a long line of daft ideas in manifestos from all parties consigned to the dustbin. No-one gets to vote on which specific policies they want in a manifesto so its just political rhetoric as usual...move on... no logic to see here.

I'm all for devils advocate type arguments but in this case the numbers just dont add up and the fight was one Hunt chose to pick with a group who work way more Saturdays than most professionals, and certainly enough such that the extra cost would have been chicken feed compared to extra consultant costs.

I also am saddened that people still think the equality issues raised in this dispute are not important. Women are the majority of those training to be doctors and could easily do other things in organisations who care about equality proofing to retain talent. Arguing we are doing down men is daft: equality proofing is just ensuring gender isn't an issue.
Title: Re: The end of the NHS.
Post by: Fultonius on April 29, 2016, 09:45:26 pm
and I despise the Scots ... for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.

Wait a fucking minute here pal - how exactly do we stop you going to the supermarket?  You do realise we've had Sunday opening for....decades!
Title: Re: The end of the NHS.
Post by: drdeath on April 30, 2016, 11:54:27 am
As a doctor (whose wife is also a doctor) I would make the following point...

I keep hearing 'it's not about money' from the juniors in the media etc, and I agree that there is a lot here about safety/service provision etc...

But if I was still a junior it would sure as shit ALSO be about money to me...

Example - my wife is a junior (just about to be consultant) in a lab-based specialty.

When she is on the on-call rota for this specialty, she works perhaps ONE evening a fortnight at 5-9pm...in addition to her 9-5 day.

For this she receives, after tax, and additional £1000 a month.

For essentially 8hrs work.

This, anyone can see, is bonkers.

And, unsurprisingly, the Govt think it's an excellent place to save money.

But, the problem is that without this extra payment, her basic take-home pay is, while more than many
folks take home, unattractive/insufficient etc to keep someone of her talents in the specialty/profession.

For years, the basic pay element of salary has been bolstered by 30 and 40% on-call supplements/antisocial working supplement etc - adding up to what doctors have become used to seeing as 'their pay' fullstop.

No 'junior' I knew ever saw their basic pay as what they REALLY earned 9-5, with the addition as some kind of overtime - the pay was the pay and taken as a piece.

The levels of basic pay, in my opinion, are simply not enough to keep folk in the profession - which is having a recruitment and retention crisis as it is.

So, it may not be all about money, but if someone wanted to take a grand a month off my pay, while offering the mouth-watering incentive of working more weekends for nowt, it would sure as shit be about money to me.

D

 


Title: Re: The end of the NHS.
Post by: monkoffunk on May 01, 2016, 09:37:10 am
For years, the basic pay element of salary has been bolstered by 30 and 40% on-call supplements/antisocial working supplement etc - adding up to what doctors have become used to seeing as 'their pay' fullstop.

No 'junior' I knew ever saw their basic pay as what they REALLY earned 9-5, with the addition as some kind of overtime - the pay was the pay and taken as a piece.

Just want to add a point on this common misconception that it is 'overtime' we are complaining about. It isn't. We do not get paid any overtime, it is simply a way of discriminating between jobs with more or less out of hours commiments. This is necessary it a profession with very heterogenous work patterns.

As an example, I did a job on respiratory medicine which had a lot of on call commiment covering general medicine. This meant working lots of weekends, evening and nights. This meant my pay for the period was basic + 50%. On days when I was not on call I worked on the respiratory ward and effectively my salary was calculated for a 0900-1700 pattern. However it was never possible to leave at that time because it was so busy. 0900-1900 was the norm, sometimes later. I think 2100 is the latest I've left on a non on call day, I've heard of worse. After 1700 you were working for free. The government would never admit it, but they rely on an awful lot of goodwill for hospitals to run safely.
Title: Re: The end of the NHS.
Post by: Offwidth on May 05, 2016, 11:33:08 am
Interesting development just as JD contract talks restart:

http://www.theguardian.com/society/2016/apr/28/equality-watchdog-warns-junior-doctors-contract-potentially-illegal
Title: Re: The end of the NHS.
Post by: Stewart on May 05, 2016, 12:55:47 pm
and I despise the Scots ... for making it so that I can't go to the supermarket early on a Sunday with my toddler before the hordes awake.

Wait a fucking minute here pal - how exactly do we stop you going to the supermarket?  You do realise we've had Sunday opening for....decades!

I believe the learned gentleman refers to this. Will still be voting for them this afternoon but don't agree they should have got involved with this one. Couldn't resist the opportunity to give Cameron a bloody nose i think.

http://www.itv.com/news/2016-03-08/why-has-the-snp-decided-to-veto-sunday-trading-law-changes/

PS all you doctors should think about heading North of the border rather than to Oz. Dumfries is always on the look-out for more consultants and is nice and central for Lakes/County/Dumby/Lomondside etc (and my missus can stay part-time if they get another consultant for her team  :ninja:)
Title: Re: The end of the NHS.
Post by: Fultonius on May 05, 2016, 01:36:26 pm
Ah....that makes some sense. That one passed me by. I also agree they probably should have abstained from that one.

Go on...bung your list vote on the Greens....you know it makes sense  :jab:
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 10:44:19 am
Study Casts Doubt On Hunt's Doctor Contracts (http://news.sky.com/story/1691141/study-casts-doubt-on-hunts-doctor-contracts)

(http://i.imgur.com/EwFrDbc.jpg)

Original Paper (http://hsr.sagepub.com/content/early/2016/05/05/1355819616649630.full)


If paywalled (can't check at moment) you might be able to access it from https://sci-hub.bz/ in a few days.
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 10:53:37 am
Nice to see a paper backing up the evidence that Hunt has already ignored.

(http://i2.kym-cdn.com/photos/images/facebook/000/185/502/no-shit-sherlock.jpg)
Title: Re: The end of the NHS.
Post by: petejh on May 06, 2016, 11:00:48 am
That just confirms what everybody already knows - that the health service isn't a true 7 day per week service because it turns into more of an emergency only service at weekends.


Quote
'The Government's main argument for imposing a new junior doctor's contract'
I thought the main argument underpinning the doctors contract was that the health service should be a true 7 day service, rather than an emergency service at weekends.

The weekend death rate is just one of those rhetorical devices that politicians - in government and the BMA - use to make their point.
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 11:07:09 am
I'm sure its not the first as I recall other studies debunking this myth, quick search has thrown it up and its essentially the same thing...

Original Paper (http://www.bmj.com/content/351/bmj.h4596)
Editorial piece (http://www.bmj.com/content/351/bmj.h4840)
Summary with key points (http://www.nhsconfed.org/resources/2015/09/the-bmj-revisit-study-looking-at-increased-weekend-mortality-rates)

Even did some work related to this as we were looking at risk factors that predicted seven day mortality in emergency medical admissions (http://www.bmj.com/content/344/bmj.e2904), although never published the comparison of mortality by day of admission it was something investigated post-hoc in light of these studies that claimed there was a higher risk.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 11:12:38 am
So what about this paper then?

http://www.internationaljournalofcardiology.com/article/S0167-5273(16)30317-5/abstract

I can't read the whole thing, but

Quote
Results
13,988,772 ACS admissions were identified. Adjusted mortality was higher for weekend admissions for Non-ST-Elevation Acute Coronary Syndromes [OR: 1.15, 95% CI, 1.14–1.16] and only somewhat higher for ST-Elevation Myocardial Infarction [OR: 1.03; 95% CI, 1.01–1.04]. Additionally, patients were significantly less likely to receive coronary revascularization intervention/therapy on their first day of admission [OR: 0.97, 95% CI: 0.96–0.98 and OR: 0.75, 95% CI: 0.75–0.75 for STEMI and NSTE-ACS respectively]. For ACS patients admitted during the weekend who underwent procedural interventions, in-hospital mortality and complications were higher as compared to patients undergoing the same procedures on weekdays.

Conclusion
For ACS patients, weekend admission is associated with higher mortality and lower utilization of invasive cardiac procedures, and those who did undergo these interventions had higher rates of mortality and complications than their weekday counterparts. This data leads to the possible conclusion that access to diagnostic/interventional procedures may be contingent upon the day of admission, which may impact mortality.

Obviously, I haven't read it as I don't have access, but from a layman's perspective it seems pretty clear: don't have a heart attack on the weekend in the US.

I also presume that "adjusted mortality" and the secondary points they make mean they didn't do something so stupid as to not correct for the number of overall admissions per day...

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.



Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 11:13:24 am
That just confirms what everybody already knows - that the health service isn't a true 7 day per week service because it turns into more of an emergency only service at weekends.

Another view might be that there are people going to A&E during the week when its not an emergency, this has the effect of diluting the mortality rate during those days relative to the weekend.  :devangel:
Title: Re: The end of the NHS.
Post by: 36chambers on May 06, 2016, 11:30:34 am
Interesting looking paper published today from the University of Manchester

"National study casts doubt on higher weekend death rate and proposals for seven-day hospital services"

Summary here (link to full paper at the bottom)

http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR
Title: Re: The end of the NHS.
Post by: tomtom on May 06, 2016, 11:31:12 am

Obviously, I haven't read it as I don't have access, but from a layman's perspective it seems pretty clear: don't have a heart attack on the weekend in the US.

US healthcare is organised in a very different way from us, non?

I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

The problem here, is that the evidence used by the Government (the papers and studies they have cited) does not actually show what they say it does...

In many ways, a 7 day NHS is great for many people (myself included) - and if the Govt said that they were doing this to make it more convenient, useful etc.. for the users of the NHS then I would have more respect for their argument.

But instead they have honed their argument over an incorrect interpretation of weekend mortality rates - politics of fear etc....

Given the  stealth privatisation of the NHS (I don't mean to sound all Corbyn, but its true - and its happening - talk to anyone who works there..) then its hard not to think that there is some underlying reason why Gove and the Govt have taken this as far as they have... (e.g. its a reason/excuse to privatise/outsource/breakup more of it..).
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 11:42:25 am
I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 11:48:54 am
Obviously, I haven't read it as I don't have access

Plug the DOI into https://sci-hub.bz

A quick scan and Table 1 shows that there are differences in the baseline characteristics on admission for a host of co-morbidities, suggesting disease severity is different between weekday and weekend e.g. in NTSE-ACS sub-group those admitted at weekend were more likely to have hypertension, be morbidly obese, suffer from other co-morbidities like Chronic Obstructive Pulmonary Disorder.

EDIT (read a bit more now I'm on lunch) : They do adjust for these as co-variates in a multivariable (not multivariate as they incorrectly call it) logistic regression, but they report Odds Ratios which are not optimal, it would be preferable to have reported the Relative Risk as these are easier to interpret and more appropriate when conducting such cohort studies (I can't be bothered doing the conversion I'm afraid as my Pot Noodle is ready to eat), regardless the effects are small (they are statistically significant at the arbitrary p < 0.05 because of the large sample size).

Another draw-back is that it only considers in-hopsital mortality among admitted patients.  You could have your heart-attack walk out after recovery then keel over and die in your arm-chair three days later from another heart attack but that wouldn't be counted. 30-day mortality (or any fixed period) as used in the other papers cited gives a more reliable picture.



"While it is easy to lie with statistics, it is even easier to lie without them." - Frederick Mosteller
Title: Re: The end of the NHS.
Post by: petejh on May 06, 2016, 12:29:47 pm
I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 12:41:29 pm

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

And why are you, as a member of the public, dissatisfied?

They are not emergencies and therefore do not have to be seen urgently and......can wait until the weekdays.
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 12:42:50 pm
I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

I'm not sure I get you Pete.

Your comment was that you thought it made sense that death rates increased at weekends.  This doesn't make sense to me for the above reason - cover is already the same as weekdays so the issue won't alter with the new contract.

The elective (7 day) comment you make still needs full elective cover for an extra two days every week.  For the same cost.  With the same staff.  Still doesn't add up.

I suspect within a couple of years it'll all collapse anyway, and I await the day with interest.
Title: Re: The end of the NHS.
Post by: 36chambers on May 06, 2016, 01:03:11 pm
Interesting looking paper published today from the University of Manchester

"National study casts doubt on higher weekend death rate and proposals for seven-day hospital services"

Summary here (link to full paper at the bottom)

http://www.manchester.ac.uk/discover/news/national-study-casts-doubt-on-higher-weekend-death-rate-and-proposals-for-seven-day-hospital-services/?utm_source=Facebook&utm_medium=Social&utm_campaign=SocialPR

Interestingly, "the study was rejected by the BMJ [British Medical Journal] after it was peer reviewed by the author [Professor Freemantle] of a previous analysis used by health secretary Jeremy Hunt to justify his imposition of a new junior doctor contract."

Source: http://www.pulsetoday.co.uk/hot-topics/seven-day-gp-access/excess-deaths-at-weekends-a-statistical-artefact-finds-major-new-study/20031777.article

I would love to see what Freemantle's reasons were for rejecting the new paper. 

Title: Re: The end of the NHS.
Post by: Will Hunt on May 06, 2016, 01:08:25 pm
Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

As worthy as the point they are trying to make is, little posters like this:
(https://scontent.xx.fbcdn.net/hphotos-xfp1/t31.0-8/s960x960/13047743_10101666374339630_5444456350116307646_o.jpg)

don't convey what is actually happening because Jeremy actually has many thousands of doctors and, presumably, the same number of sick people (providing elective care on the weekends won't make more people sick) to care for across the week. So there will be elective work on more days of the week but there should be lower staffing requirements on weekdays.

The counter-argument is that with more access to the service, more people will use it, and the NHS already has a big problem with people wasting doctors' time by accessing the wrong service.

The counter-counter argument is "Well don't you want sick people to be able to get access to healthcare?" - which makes the doctors look shit.

I hope Mr Cunt isn't reading this. It probably doesn't make any sense but that shouldn't matter to him.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:09:52 pm
I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 01:10:29 pm
Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

It won't as there is plenty of evidence that shows increasing ease of access increases usage.

Besides, you'd still have to fully staff the clinics/ theatres etc even if running at 71.4% of current capacity.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:12:44 pm
Has the government not used the argument yet that because elective cover is spread over 2 extra days, there will be less work per day (and thus less staff requirement) across the period?

It won't as there is plenty of evidence that shows increasing ease of access increases usage.

Besides, you'd still have to fully staff the clinics/ theatres etc even if running at 71.4% of current capacity.

Where is this evidence?  I asked for it earlier, nobody gave it up.  Don't GPs and the need to get referral and stuff protect the hospital staff from that kind of jazz?

Even if so... is it OK to put obstacles (such as M-F only) in the way of people accessing healthcare?

Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 01:14:58 pm
I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.

The weekend effect = a higher proportion of people admitted at the weekend die. 
Fewer people are admitted.  Same number die.  Proportion is higher.
Doesn't really prove anything, which is why people start using statistical adjustments liked weighting of death rates.

If you think about it - someone is admitted late on a Friday, "the weekend effect" states they have less chance of dying, even though they are then cared for by the supposedly reduced weekend cover.  Equally someone admitted late on a Sunday is more likely to die, even though they have the "increased" weekday cover.

Nonsense.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:17:38 pm

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

And why are you, as a member of the public, dissatisfied?

They are not emergencies and therefore do not have to be seen urgently and......can wait until the weekdays.

Why should they have to wait?  My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

Oh wait, no - we can't.  SHIT I FORGOT.  God said I have to rest and think about Him at the weekend!  I forget if he said Saturday or Sunday - he's a dumb cunt, says different things to different people - so we should just do nothing on both.
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 01:19:26 pm
Where is this evidence?  I asked for it earlier, nobody gave it up.  Don't GPs and the need to get referral and stuff protect the hospital staff from that kind of jazz?

Even if so... is it OK to put obstacles (such as M-F only) in the way of people accessing healthcare?

Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in the England: A systematic review. Health Policy (2014)
Plus others I haven't time to dig out yet.

No, I'm more than happy to remove those obstacles.  But you need more staff and more funding, and with what we have now it is impossible.

£106.5 billion budget now, true 7 day access would need an additional £30.4 billion.  If the government can afford that, let's do it!!  (in 10 years time once we have managed to increase all the staffing levels).
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 01:31:12 pm

Interestingly, "the study was rejected by the BMJ [British Medical Journal] after it was peer reviewed by the author [Professor Freemantle] of a previous analysis used by health secretary Jeremy Hunt to justify his imposition of a new junior doctor contract."

Source: http://www.pulsetoday.co.uk/hot-topics/seven-day-gp-access/excess-deaths-at-weekends-a-statistical-artefact-finds-major-new-study/20031777.article

I would love to see what Freemantle's reasons were for rejecting the new paper.

It could be as simple as the topic was already covered in his previously published work...

I'm sure its not the first as I recall other studies debunking this myth, quick search has thrown it up and its essentially the same thing...

Original Paper (http://www.bmj.com/content/351/bmj.h4596)
Editorial piece (http://www.bmj.com/content/351/bmj.h4840)
Summary with key points (http://www.nhsconfed.org/resources/2015/09/the-bmj-revisit-study-looking-at-increased-weekend-mortality-rates)

...from the last of the above three links... "cohort admitted at weekend included a greater prevalence of patients with higher predicted mortality risk than those admitted during the week.” which is what the Sutton et al paper I linked to (and you subsequently did) is saying.

The BMJ and Lancet are notoriously hard to get published in and one of the reasons is that they tend not to publish findings which are already out there.

Why should they have to wait?  My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

Oh wait, no - we can't.  SHIT I FORGOT.  God said I have to rest and think about Him at the weekend!  I forget if he said Saturday or Sunday - he's a dumb cunt, says different things to different people - so we should just do nothing on both.



This really has nothing to do with the religious heritage that our now secular country has. 

You and your wife chose to have a kid and everything that entails, deal with it.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:37:01 pm
I don't know.  But from what I can see, the weekend effect IS real.  There seems to be study after study after study noting its existence.  I'm not mixing correlation and causation up here, haha, been given a slapping for that from someone in the past.

The weekend effect = a higher proportion of people admitted at the weekend die. 
Fewer people are admitted.  Same number die.  Proportion is higher.
Doesn't really prove anything, which is why people start using statistical adjustments liked weighting of death rates.

If you think about it - someone is admitted late on a Friday, "the weekend effect" states they have less chance of dying, even though they are then cared for by the supposedly reduced weekend cover.  Equally someone admitted late on a Sunday is more likely to die, even though they have the "increased" weekday cover.

Nonsense.

http://www.nejm.org/doi/full/10.1056/nejmoa063355#t=articleResults

This paper says that

Quote
Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays. Also, the time between admission and performance of procedures was longer for patients admitted on weekends. The percentage of patients who underwent a procedure on the day of admission (possibly reflecting primary PCI) was also lower on weekends. Quaas and colleagues found that patients admitted on weekends were one fourth as likely to undergo coronary angiography as were those admitted on weekdays.21 Observational data and randomized trials have shown a survival benefit of both PCI and CABG in at least some subgroups of patients.8,22-25 In our study, invasive procedures were also associated with a lower adjusted 30-day mortality. Our finding that the increase in mortality was no longer significant after additional adjustment for invasive procedures implies that the worse outcome of weekend admissions may be due in part to a lower rate of invasive intervention.

That seems to me to be entirely against the spirit of what you're saying.

So you're saying that

* during a weekday, 10 people are admitted, 4 die.
* on a weekend day, 8 people are admitted, 4 die.

This accounts for the increased percentage of deaths due to weekend admissions.

The paper above doesn't comment on the above, but it does say that (with different numbers obvs)

* During the weekday, the 10 that are admitted - 50% of them have a procedure that could save their lives.  (5 people).
* During the weekend, the 8 that are admitted - 25% of them have a procedure that could save their lives (2 people).

They can find no reason for the fact that we would have expected two more of the admitted people on a weekend day to have the procedure.  It's something about it being the weekend that they haven't been able to adjust for.

Oh, and the also say that if you change the numbers to correct for the difference between 50% and 25% in terms of that procedure - the difference in the number of people dying who were admitted goes away.

Seems to me like they are saying if you rock up at the weekend, you have a lower chance of getting a procedure that might save your life, and that will give you a higher chance of dying.

No?

Or is that too, nonsense?



Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:39:58 pm
You and your wife chose to have a kid and everything that entails, deal with it.

 :clap2:

BRILLIANT.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:47:05 pm
Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in the England: A systematic review. Health Policy (2014)

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

I certainly would agree that making it easier to got to A&E or to your GP = more people going... but that's not the issue at hand?

BTW - just so that we get this out of the way - I've hopped off the fence, and I'm all for the junior doctor strike.  But just so that the safeguards stay in place and they get more money for the changes in Ts and Cs.  Not because I'm against a seven day NHS.
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 01:53:11 pm
You and your wife chose to have a kid and everything that entails, deal with it.

 :clap2:

BRILLIANT.

Do you really expect the world to bend over backwards because you've got kids and work? 

You're not the only ones and everyone else manages.  I can't quite believe that...

My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

...what you seem to be saying is that you'd make your wife delay attending clinic so she can go on a weekend so you don't have to take time off of work.

I hope I've interpreted that incorrectly though because thats a whole new level of selfishness I've not encountered before.
Title: Re: The end of the NHS.
Post by: Lund on May 06, 2016, 01:57:59 pm
You and your wife chose to have a kid and everything that entails, deal with it.

 :clap2:

BRILLIANT.

Do you really expect the world to bend over backwards because you've got kids and work? 

You're not the only ones and everyone else manages.  I can't quite believe that...

My wife looks after the child.  To attend a clinic during the week, I have to take time off work to look after the child so that she can go.  If that were at the weekend, then I wouldn't have to.  And the world would be a better place for us as users of a service.

...what you seem to be saying is that you'd make your wife delay attending clinic so she can go on a weekend so you don't have to take time off of work.

I hope I've interpreted that incorrectly though because thats a whole new level of selfishness I've not encountered before.

Keep going, you're doing really well.  More!  More!
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 02:59:35 pm
http://www.nejm.org/doi/full/10.1056/nejmoa063355#t=articleResults

This paper says that

Quote
Patients admitted on weekends were less likely to undergo invasive cardiac procedures than were those admitted on weekdays.

That seems to me to be entirely against the spirit of what you're saying.

This paper specifically talks about the provision of PCI and allied procedures, which are not uniformly provided even on weekdays.  They need allied staff in theatre, radiology consultants, cardiologists, anaesthetists etc.  If you rock up at night you are no better off than on Sunday, so it's not a weekend effect at all.  And it has absolutely nothing at all to do with junior doctor provision, so I'm not sure why it keeps getting used to support the imposition of their contract.  The same could be said about thrombolysis for ischaemic stroke I expect.

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?

That one is, but there are more that show if you increase access to secondary care and reduce waits, referrals increase in response.  I have plenty of evidence of this from the commissioning side, but can't share it.  There are various other papers that corroborate it.  Part of my point about posting that one (other than it's the only one I could remember details for) is that Mr Hunt's pushing for a seven day GP system will increase access, increase patients being seen, and therefore increase referrals to hospital.

Here are my thoughts:

1.  There is enequality of provision of service in the NHS, both geographically and across the week
2.  There isn't enough staff or money to provide the current level of service. This is clear since trusts are failing RTTs left, right and centre and going into tens of millions of deficit.
3.  Patient demand and expectation are both going up and up, partly stoked by politicians.

We can either:

1.  Create a truly 24/7 NHS by increasing staffing and putting an extra, say, £50 billion per year into it.
2.  Accept that what you get now is beyond the limit of what we can afford, and lump it.
3.  Force juniors to work more for less, try to balance the books and provide an extra 28.6% of service for the same money with fewer staff and still keep it safe.  Errr.......


BTW - just so that we get this out of the way - I've hopped off the fence, and I'm all for the junior doctor strike.  But just so that the safeguards stay in place and they get more money for the changes in Ts and Cs.  Not because I'm against a seven day NHS.

As above, the two are separate issues.  And as I said last week, I've been pushed past the point of really being that bothered if it all falls apart by the ongoing mistruths from the government mixed with bashing from the media.  All the goodwill that once made the NHS work has been crushed in recent times, which was the one thing holding it together - without that, it's falling apart.


The NHS was created as a safety net for those that couldn't afford private care - it has become a bloated behemoth trying to give everyone anything they want, whenever they want it.  For that reason, it isn't fit for purpose and that's also why it's falling apart.

Title: Re: The end of the NHS.
Post by: petejh on May 06, 2016, 03:14:23 pm
I have to say, people saying that there isn't a weekend effect do sound a bit like greenhouse effect deniers, but what the fuck do I know.

There is the same provision for emergency cover throughout hospitals at weekends as there is in the week, so why would an increase in mortality at weekends be logical?

This is the nub of it for me. Your argument rests on the public being satisfied with having just emergency cover at weekends and having non-emergency issues seen to only on weekdays.

I'm not sure I get you Pete.

Your comment was that you thought it made sense that death rates increased at weekends.  This doesn't make sense to me for the above reason - cover is already the same as weekdays so the issue won't alter with the new contract.

The elective (7 day) comment you make still needs full elective cover for an extra two days every week.  For the same cost.  With the same staff.  Still doesn't add up.

I suspect within a couple of years it'll all collapse anyway, and I await the day with interest.

You don't get me.
I'm not that interested in the death rate weekend thing - like someone said it might be explained by the types of cases admitted on weekends versus weekdays and remains to be cleared up without political involvement.

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

GCW - all the goodwill etc. Times change. The UK's population has grown and in my opinion weekday only elective care isn't acceptable for a national service paid for by the people.

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 03:18:49 pm
As above, I'm not against 7 day elective care.

Why is it too expensive?  Because trusts are paid a tariff per clinic appointment, op, everything. This is set centrally and had nothing to do with doctors pay.

Times change, I know. But now the huge amount of extra work done by people just to make the service work will need to be picked up somehow.

And correct me if I'm wrong, but the last time I got my car serviced on a weekend I paid a couple of hundred quid for the privilege.
Title: Re: The end of the NHS.
Post by: slackline on May 06, 2016, 03:57:21 pm
Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?

Nothing stopping you, its called private healthcare, just as all the other activities you mention are services provided by private companies and are not provisions of the government (although public transport should be in my opinion, and on reflections pubs should give out free booze too).
 
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Ah but as you say we already pay for healthcare don't we, see GCWs points in his post @15:39 under 'Either' and his closing sentence.  What to do?  Ok, lets push up taxes to fund the increased cost of seven day health care.  Hmm, can't see that happening, even though it could be applied to higher band taxes so the less well off aren't penalised.  Not going to happen is it. 

The current government are not interested in increasing the funding available for the NHS.

EDIT : I don't know why being able to have elective procedures at weekends would have a direct improvement on an individuals quality of life.  There are laws governing sick pay which means if you need time off for medical reasons you are entitled to it.


Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

Yes its down to the economics, improving quality of life is expensive, look at the years of training required, the equipment, medical devices and drugs (both of which require years of investment by manufacturers to pass the standards required for them to be used in humans and they expect a return on that investment), support staff etc. etc. etc.

The NHS its struggling as it is and simply can't do more for the money it has available.  There is no will in the government to change the amount of money available, just the bullshit of "More for Less".

One thing that seems to have been lost in all of this "I want my healthcare at the weekend" bitching is that actually for the cost of the current system the performance is  pretty good, some even go as far as to say it is world class, despite not provisioning for weekends  :o.  I've posted links and infographics on this before but heres a report from last year, the NHS comes out pretty good...

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf


You ask...

is there an underlying reason why privatising parts of the nhs is so terrible?

If you look at private health care systems such as those employed in the US they cost more per capita and have worse outcomes (see above plus links/figures etc. posted waaaay back in this thread).
Title: Re: The end of the NHS.
Post by: a dense loner on May 06, 2016, 04:23:56 pm
Are you impotant slackers?
Title: Re: The end of the NHS.
Post by: Fultonius on May 06, 2016, 04:31:11 pm

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?

Erm...profiteering, lack of control of care quality - this is not just based on idealogical fear of privatisation, just on the results of the fiascos that have occurred.

There's no reason why quality of care couldn't be better under a privatised system. But better or worse, it will be more expensive.
Title: The end of the NHS.
Post by: Oldmanmatt on May 06, 2016, 04:59:56 pm
I've spent most of my adult life living in countries with private healthcare systems.

They have never been accessible without considerable financial resources; at least not beyond the most basic care.

I cannot for even a moment imagine that a privatised system in the UK would be anything other than elitist and discriminatory; it has been in every other jurisdiction I've witnessed.

I'm sure it will all be very nice for those who can afford it, available 7/7 and top notch; as it already is for those who can afford it.


Sent from my iPhone using Tapatalk
Title: Re: The end of the NHS.
Post by: GCW on May 06, 2016, 05:10:19 pm

Final point - Will, GCW, if parts of the health service get privatised and the outcome is a decent national health system accessible to the public 7 days a week, is that bad becaseu it's private? Is it the public institution (a la British Rail) ideology you're so attached to, or is there an underlying reason why privatising parts of the nhs is so terrible?

Sorry, missed that bit.

What do you mean by privatised?  A lot is already provided by private providers. Or do you mean that if you need a hip doing it has to be done privately I've a two tier system where elective and emergency are separated?

The problem is there is a lot of cross over and grey areas. I think a private system would provide an excellent service...  for those that can afford it.
Title: Re: The end of the NHS.
Post by: tomtom on May 06, 2016, 05:23:06 pm
As above, I'm not against 7 day elective care.

Why is it too expensive?  Because trusts are paid a tariff per clinic appointment, op, everything. This is set centrally and had nothing to do with doctors pay.

Times change, I know. But now the huge amount of extra work done by people just to make the service work will need to be picked up somehow.

And correct me if I'm wrong, but the last time I got my car serviced on a weekend I paid a couple of hundred quid for the privilege.

As GCW said, you've got to pay people to work the weekend...

Pete - by extension of the same logic - shouldn't you be able to demand to get elective care at 2.30 am if you want?

Me, having to wait in all day today (and not go climbing) for a fecking parcel to be delivered is a classic example. I didn't want to spend the extra £15 to have it delivered at 8pm on Thursday evening... Maybe that will be the future.. pay a bit more, go out of office hours, or pay a bit more and jump the que...

That seems to be the way Barnet Council are going (EasyBarnet as they are now nicknamed) - want your planning application dealt with sooner then pay etc...
Title: Re: The end of the NHS.
Post by: Will Hunt on May 06, 2016, 05:25:16 pm
I work in the water industry. We make profit out of providing people with clean drinking water and sanitation. I don't like that.
However, in 1989 the water industry was crap. Rivers were in a terrible state and the network didn't work well. With a large amount of investment we've since cleaned up the rivers (still more to do but they're in a very good place at the moment by and large), leakage is down to an all time low etc etc. We've really reaped the benefits. Privatisation can drive efficiency but we shouldn't fool ourselves into thinking that this comes at no cost. Investors will always want their cut in the end. The question is (much like with a mortgage I suppose), is the asset worth the long term increase in cost?
Healthcare is a different market so not entirely comparable. We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world. It seems like a stupid idea to me. If the Tories, who are wedded to the ideology of the small state, suggest privatisation on the sole motivation that it will lead to improvement in service then you'd be a mug to take them at their word.
And then there's the example of privatisation from the rail sector which seems to have produced a shit outcome.
Title: Re: The end of the NHS.
Post by: tomtom on May 06, 2016, 05:36:49 pm
I work in the water industry. We make profit out of providing people with clean drinking water and sanitation. I don't like that.
However, in 1989 the water industry was crap. Rivers were in a terrible state and the network didn't work well. With a large amount of investment we've since cleaned up the rivers (still more to do but they're in a very good place at the moment by and large), leakage is down to an all time low etc etc. We've really reaped the benefits. Privatisation can drive efficiency but we shouldn't fool ourselves into thinking that this comes at no cost. Investors will always want their cut in the end. The question is (much like with a mortgage I suppose), is the asset worth the long term increase in cost?
Healthcare is a different market so not entirely comparable. We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world. It seems like a stupid idea to me. If the Tories, who are wedded to the ideology of the small state, suggest privatisation on the sole motivation that it will lead to improvement in service then you'd be a mug to take them at their word.
And then there's the example of privatisation from the rail sector which seems to have produced a shit outcome.

Water industry is possibly not the best comparison - as there is no competition... if the water companies had to bid for the franchise every 5 years (like in the rail system) then it might..

Thats a moot point (sorry Will - I'm being picky) in relation to the Health service. All my recent dermatology appointments in Manchester are being dealt with by a private company (in London) subcontracted by the local NHS - and then the private company hires local doctors to do the work, that the NHS would formerly have done... Its kind of working for me (in this case) but seems a bit crazy to have to add an extra layer. I once had an argument with one of our local MP's (a Tory) about privatisation and he said theres no such thing as bad privatisation, just bad regulation.. He was (and still is) a bellend - but he has a point.

Anyway, the day to day operation of the NHS is being passed along to companies (next time you go to hospital play spot the Serco or G4S uniform among the non nursing/clinical staff)...
Title: Re: The end of the NHS.
Post by: Will Hunt on May 06, 2016, 08:59:48 pm
I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.
Title: Re: The end of the NHS.
Post by: Footwork on May 06, 2016, 09:16:24 pm
I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.

Sticking to water as an example of privatisation and profit. As far as I'm aware, I pay a water bill for water. I know what I'm getting, water. Yorkshire Water aren't saying, hang on a second you also need to buy this kind of other water.

When health care is privatised unnecessary testing becomes a problem. Operations might be offered when they shouldn't be because there's money to be made. Additional blood tests/ lumbar punctures etc might be pushed even though a patient doesn't need them. The problem is that the man on the Clapham Omnibus doesn't know what's best for him medically and would trust the consultant. I wouldn't trust Will as far as I could throw him and he doesn't weigh very much!  ;)

I say this from past experience. I needed braces when I was a kid. First orthodontist said I would need train tracks, retainers, headset at night (  :o ), the lot over 2 and half years. My young self said no thanks and went away. Seeing as my teeth were proper mashed my mum convinced me to try again. We went back to the same place but saw someone else. Train tracks for a year and retainer for 6 months. Why was there such a difference? Well probably because the orthodontist was getting paid for the add ons. (I may be wrong!)

Another example. Had a lump in my breast when I was a teenager. Pretty scared (men get breast cancer too). Turns out it was some kind of gynecomastia. One (private) consultant was pretty pushy about operating on me and getting the lump removed. I got a second opinion which was "don't worry it will go away", which it did. The private consultant was pretty rude when I phoned him I wasn't getting the op.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on May 06, 2016, 11:22:41 pm
I made the points about the water industry more to demonstrate to Pete that I  don't just make the last assumption that all privatisation is all bad and that I can see the potential benefits of privatisation in some circumstances. I don't think our healthcare system would benefit from further privatisation though.

Sticking to water as an example of privatisation and profit. As far as I'm aware, I pay a water bill for water. I know what I'm getting, water. Yorkshire Water aren't saying, hang on a second you also need to buy this kind of other water.

When health care is privatised unnecessary testing becomes a problem. Operations might be offered when they shouldn't be because there's money to be made. Additional blood tests/ lumbar punctures etc might be pushed even though a patient doesn't need them. The problem is that the man on the Clapham Omnibus doesn't know what's best for him medically and would trust the consultant. I wouldn't trust Will as far as I could throw him and he doesn't weigh very much!  ;)

I say this from past experience. I needed braces when I was a kid. First orthodontist said I would need train tracks, retainers, headset at night (  :o ), the lot over 2 and half years. My young self said no thanks and went away. Seeing as my teeth were proper mashed my mum convinced me to try again. We went back to the same place but saw someone else. Train tracks for a year and retainer for 6 months. Why was there such a difference? Well probably because the orthodontist was getting paid for the add ons. (I may be wrong!)

Another example. Had a lump in my breast when I was a teenager. Pretty scared (men get breast cancer too). Turns out it was some kind of gynecomastia. One (private) consultant was pretty pushy about operating on me and getting the lump removed. I got a second opinion which was "don't worry it will go away", which it did. The private consultant was pretty rude when I phoned him I wasn't getting the op.


Yep, a trip to the American Hospital in Dubai, with a sniffle, could quite easily end with a couple of CAT scans, an MRI and several specialists; just to rule out a few things...
Title: Re: The end of the NHS.
Post by: monkoffunk on May 07, 2016, 06:59:01 am

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?


What does this mean? Quite a confusing statement!
Title: Re: The end of the NHS.
Post by: slackline on May 07, 2016, 07:43:20 am
We do have to ask ourselves whether we need to take the long term hit of privatisation when at least one well regarded independent report (somebody care to link?) has named the NHS as the best healthcare system in the world.

Don't know if this is what you're referring to....

One thing that seems to have been lost in all of this "I want my healthcare at the weekend" bitching is that actually for the cost of the current system the performance is  pretty good, some even go as far as to say it is world class, despite not provisioning for weekends  :o.  I've posted links and infographics on this before but heres a report from last year, the NHS comes out pretty good...

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf
Title: Re: The end of the NHS.
Post by: monkoffunk on May 07, 2016, 07:56:50 am
A few days ago I posted this:

Quote from: BMA
The BMA believes patients should receive the same high quality of care every day.

The royal colleges have developed quality standards for the care of acutely ill patients that set out a clear aspiration of what should be achieved in all NHS hospitals. However, there are significant resource and ways-of-working implications that require close examination.

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

I think it's very interesting to see some evidence as to the cause of the weekend mortality effect and the debate as to whether services should be offered equally throughout the week.

Personally I have no problem with the same level of care and services being offered throughout the week. It does need to be funded and planned however, and spreading the current workforce of doctors out to provide less weekday cover, and more weekend cover is so far from the answer to this as to be absolutely laughable. To suggest that the same number of patients will be seen and we will all just chill a bit more during the working day is laughable.

Providing weekend care is expensive. It's expensive, not because our pay should be increased to work more weekends, but because you need more doctors to provide that care. You need to maintain safe, workable rotas that provide an adequate work life balance that will attract people to the profession and keep them in it, and in this country. I've already mentioned my 3/4 weekend A&E rota that almost broke me. Sure it gets a little better as you progress through the ranks but it's put me off A&E for life; no way will you see me back there. (I work in intensive care now BTW).

On cost, I'm sure you are aware this is much more than junior doctors. Elective care requires mostly consultant input and so of course we need more consultants to cover the weekends as well, and this still all pales in comparison to the rest of the rotas for other professions and infrastructure required.


On the weekend mortality figures. Is there any reason why death rates should go up? Truth is there is not a clear answer to this. It seems highly probable that patients presenting to A&E at weekends are more ill and therefore will have a higher death rate. Jeremy is doing his bit to smooth this out by scaring patients into delaying their presentation til Monday, which should have the effect of 1) reducing the weekend peak in morbidity and 2) increasing that individual patient's chance of death. Maybe not enough patients will be effected to change the stats but I'm sure we will see.

Are there reasons asides from patient characteristics? Obviously this debate is about elective work because emergency care is already equal?

Well no.

Quote from: BMA

The BMA believes that urgent and emergency services should be the priority for investment to bring the standard up to the very best, every day. Only when we have improved the quality of care for acutely ill patients can the debate start as to whether a weekday service can also be afforded at nights, weekends and bank holidays.

We absolutely do not have equal emergency cover 24 hours a day 7 days a week. We quite possibly don't need it (certain times of day on A&E tend to be more quiet than others), but we certainly don't have it. Certainly weekend cover could be improved. When I worked in A&E there were less of us at weekends. If you wanted to provide adequate and safe care for the patient in front of you this meant waiting times would be higher on average. Does this have an effect on mortality? It's small percentages and obviously emergencies were seen with the same level of urgency, with the waiting time passed on to the less urgent and non life threatening. But these percentages can add up.

Certainly providing emergency weekend cover for the medical wards as a medical FY1 you felt the pressure. During the week each team had an entourage of junior doctors at every grade. Just looking at the most junior lets say two FY1s on gastro, two on resp, three on elderly care, one on haem, one on cardio. Call it that, I think it was possibly more. And the weekend only one of us would cover every ward. You fight fires. During the week every patient was seen on a ward round. During the weekend you were seen if you became unwell. Did it feel safe? The worst weekend of my life so far (not just working life) was covering the medical wards, working two 13 hour shifts in a row after/before the normal working week. On the first day I didn't stop to even drink a sip of water in those 13 hours. A certain amount of that can be explained by inexperience, but a great deal came down to the huge pressure I was under to see multiple patients becoming unwell at the same time as well as a vast array of minor and often unnecessary jobs I was being asked to do. I didn't feel safe. I think it's impossible to pretend that ward patients are getting the same level of emergency care at weekend as during the week.

All of this bull about elective services is so misdirected. There isn't the funding or staffing to provide equal emergency cover at weekends, let alone elective work. You just can't do it by spreading out what you have, and robbing Peter to pay Paul. If we want a true 7 day NHS we need to pay for it. Frankly the last thing we need is Jeremy Hunt encouraging people to quit or emigrate. It's going to be hell for those of us left.
Title: Re: The end of the NHS.
Post by: GCW on May 07, 2016, 03:02:54 pm
When we talk about funding the seven days fully, my guess of £50 billion is probably low. Now remember the population of England is around 53 million. So every year it needs an additional £1,000,000 per head of population (I think, Jeremy and George never seem sure which billion they mean).

Can that be raised via increased taxation?
Title: Re: The end of the NHS.
Post by: GCW on May 09, 2016, 10:42:19 pm
You don't get me.
I'm not that interested in the death rate weekend thing - like someone said it might be explained by the types of cases admitted on weekends versus weekdays and remains to be cleared up without political involvement.

I'm interested in the 7 day elective care.

Quote from: http://www.pulsetoday.co.uk/hot-topics/seven-day-gp-access/hunt-to-push-ahead-with-routine-sunday-gp-appointments/20031804.article
Mr Hunt told MPs that the Government’s seven-day NHS secondary care agenda is ’not about elective care’ but about ’improving urgent and emergency care’.

 :lol:
Title: Re: The end of the NHS.
Post by: Lund on May 10, 2016, 12:08:19 pm

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?


What does this mean? Quite a confusing statement!

GCW was talking about a paper showing that increased availability of A&E and GP meant increased load - i.e. more people.  I was contending that the paper wasn't obviously relevant to the junior doctor, elective stuff discussion - because you can't just rock up to get an elective procedure: access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.
Title: Re: The end of the NHS.
Post by: GCW on May 10, 2016, 12:23:17 pm
Sorry, I've not had time to dig the other references out.
The increased availability of access to GP has been shown to increase referral number though, and thus increases elective care work.

access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.


Except for all inpatients, urgent admissions and A+E attendances which are usually dealt with by juniors.

Let's not forget that a "junior" is anyone from straight out of Uni to people in late 30s/ early 40s who will start a consultant post in August!!
Title: Re: The end of the NHS.
Post by: monkoffunk on May 11, 2016, 08:40:41 am

Isn't that about GPs and A&E - not "elective" junior doctor type stuff?


What does this mean? Quite a confusing statement!

GCW was talking about a paper showing that increased availability of A&E and GP meant increased load - i.e. more people.  I was contending that the paper wasn't obviously relevant to the junior doctor, elective stuff discussion - because you can't just rock up to get an elective procedure: access to junior doctors is protected by e.g. referrals by GPs.

It's not a major point.

I guess I was just confused as I wasn't sure if you were equating junior doctors with elective work, "elective junior doctor type stuff" doesn't make sense to me. Obviously junior doctors do elective work, but most complex elective work and clinics are still consultant lead. There are junior doctors who are GPs, and junior doctors in A+E. At night the most senior doctor in A+E will be a junior doctor.

Anyway we have an increasing workload, without more availability of GPs or A&E docs. Plenty of problems and people out there waiting to fill the gaps in any expanded services!
Title: Re: The end of the NHS.
Post by: GCW on May 11, 2016, 08:54:25 am
It just gets more ridiculous!!

Jeremy Hunt promises to push ahead with seven day, 8-8 GP opening.
Almost half of the Challenge Fund/GP Access pilots have already reduced opening hours, amid lacking patient demand and uncertainty over future funding.
NHSE state 7 day GP access plans should be ditched. (http://www.pulsetoday.co.uk/your-practice/practice-topics/access/pms-sunday-gp-opening-plans-should-be-ditched-suggests-official-evaluation/20030337.article)


Jeremy Hunt states juniors contract should be imposed due to weekend effect.
Studies published in Journal of Health Services Research and Policy and two in the Lancet suggest weekend effect is a fallacy.

Jeremy Hunt continues to promise a true 7 day NHS.
The Public Accounts Committee criticizes government plans, stating they are "completely uncosted" and contain"serious flaws".

Quote
In a highly critical report on NHS staffing levels, the influential Public Accounts Committee found that pressure on hospitals to save money was already leading to shortfalls on wards, and called for an urgent review of the size of the clinical workforce in England.




The militant buggers at the BMA once again state their polarised views.  :lol:

Quote
The BMA is clear that patients should have access to the same high quality of care, seven days a week, but if the Government wants more seven-day services, then it must finally answer the question asked by doctors, senior NHS leaders, medical royal colleges and now the Public Accounts Committee: how will it staff and fund them?



Jeremy Hunt's NHS plans for increasing staffing are clearly working too.

Quote
There are 300 vacancies for F1 training posts in England this year after they were oversubscribed in 2014 and 2015, which doctors’ leaders have blamed on the ongoing dispute over the junior doctor contracts.

Health Education England is advertising 300 places for Foundation Year training beginning in July, which were unfilled by graduates from English medical schools.

It's all good  :2thumbsup:
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 10:16:17 am
It just gets more ridiculous!!

Jeremy Hunt states juniors contract should be imposed due to weekend effect.
Studies published in Journal of Health Services Research and Policy and two in the Lancet suggest weekend effect is a fallacy.


It doesn't matter how many bold typeface headlines you create GCW, the weekend effect studies authors are contradicting each other and that says to me that none of them should be taken at face value or used for headline-grabbing spinning for political ends.


It sounds grand and convincing to the layperson, when 'Prof xyz of medical institution abc' is reported in the media saying his study shows 'the weekend effect doesn't exist'....
Until his counterpart, 'professor efg of 'medical institution jkl', completely contradicts him and says the study is flawed, and that his study shows 'the weekend effect does exist'... Which is what happened yesterday on R4 with the latest weekend mortality studies you just mentioned.


It's about money and power on both sides of the argument as well as patient safety.

Fairly balanced editorial here (http://www.theguardian.com/commentisfree/2016/may/09/the-guardian-view-on-statistics-and-nhs-reforms-jeremy-hunts-number-games)
Title: Re: The end of the NHS.
Post by: slackline on May 11, 2016, 10:21:32 am
Fairly balanced editorial here (http://www.theguardian.com/commentisfree/2016/may/09/the-guardian-view-on-statistics-and-nhs-reforms-jeremy-hunts-number-games)

I wouldn't hold out for the weekend elective service you're keen on though...

Quote
There is a real argument for improving the weekend service, but at a cash-strapped time when beneficial treatments are rationed, there is also an obligation to ask whether this is the best use of scarce resources.

Healthcare costs, you can't do "more with less".
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 10:25:40 am
I'm not holding out for anything.

It's more the tone of the debate on here that riles me.
Title: Re: The end of the NHS.
Post by: tomtom on May 11, 2016, 10:28:19 am
It's more the tone of the debate on here that riles me.

I didn't think it had been that bad?
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 10:36:19 am
It's very lopsided.
Title: Re: The end of the NHS.
Post by: slackline on May 11, 2016, 10:36:53 am
Last Friday you wrote...

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

...which suggested very strongly to me that you would like to see seven day healthcare (emergency and elective), even if you already know why it doesn't currently exist (I suggested this could be addressed by either going private* as you do for all the other weekend activities you listed or increasing taxes to cover the increased cost to the NHS).

I don't understand why or how being able to undergo elective treatment at the weekend would improve quality of life?

Having the treatment, regardless of when, improves quality of life.  There are laws governing sick-pay and so forth such that should you need to undergo treatment during the week and have to take time off from work your employers can not financially penalise you (this may not be so straight-forward for those who are self-employed, but presumably they put money by for such rainy days?). 

Title: Re: The end of the NHS.
Post by: Footwork on May 11, 2016, 10:44:52 am
http://www.mirror.co.uk/news/uk-news/jeremy-hunt-says-britains-care-7932080 (http://www.mirror.co.uk/news/uk-news/jeremy-hunt-says-britains-care-7932080)

The video at the top of the page.

Lets make money out of old people!
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 10:59:37 am
Last Friday you wrote...

I'm interested in the 7 day elective care.

Slackers - you can get your car fixed on Saturday, stock up on the week's supplies on Sunday, watch a film, relax with a pint in the pub, catch a plane or a train, go and do all sorts of activities on a weekend. Why the fuck shouldn't you, in principle, be able to sort out non-emergency healthcare issues on a weekend?
Of all the things it's possible to do on a weekend this would be the one that gives the greatest increase in quality of life for the general population who pay for their health service. But you don't think this is something worth aspiring to?

Other professionals such as lawyers, architects, engineers generally don't offer weekend service (or if they do it prohibitively expensive) and that's fine, they aren't central to one of the most important parts of quality of life - health. We don't have a national lawyer service or a national architect service.

Why isn't there 7 day elective care? Because it's too expensive... (or there isn't enough money, slightly different). Why is it too expensive?

...which suggested very strongly to me that you would like to see seven day healthcare (emergency and elective), even if you already know why it doesn't currently exist (I suggested this could be addressed by either going private* as you do for all the other weekend activities you listed or increasing taxes to cover the increased cost to the NHS).

I don't understand why or how being able to undergo elective treatment at the weekend would improve quality of life?

Having the treatment, regardless of when, improves quality of life.  There are laws governing sick-pay and so forth such that should you need to undergo treatment during the week and have to take time off from work your employers can not financially penalise you (this may not be so straight-forward for those who are self-employed, but presumably they put money by for such rainy days?).

I'm self-employed, I have been since 2002. I think you'll find there are lots of self-employed people who aren't well equipped for long rainy periods. In 2013 I paid ten thousand pounds on my health, on credit cards. Anf then missed 6 weeks of work, unpaid. How I wish I'd paid a less significant (but still significant) annual premium on health care and sickness cover. It isn't cheap though - I was being tight by not wanting to pay £800 per year for good health and wages cover. Many just don't have the means.

People like you are focused (to the nth degree..) on the letter of the law and how things should be. The world isn't like that. A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy as it is for your public sector job.
Title: Re: The end of the NHS.
Post by: GCW on May 11, 2016, 10:59:57 am
I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

Sorry, I've tried to be as balanced as an unbalanced situation allows.  I'll shut up now.
Title: Re: The end of the NHS.
Post by: dunnyg on May 11, 2016, 11:01:18 am
Footwork - Dont feed the mirror ffs....
Title: Re: The end of the NHS.
Post by: lagerstarfish on May 11, 2016, 11:06:34 am
A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy as it is for your public sector job.

at this point some smart arse usually points out that people have a choice about working in the public sector or being self employed and that it is up to self employed people to factor stuff like medical costs into how much they charge their clients.

I realise that the world isn't like this, so won't say any such thing

what this does flag up (as mentioned before, by someone, I think) is the fact that the way NHS services are set up means that some people have to go outside the NHS for treatment, which helps to make it appear less valuable - if the NHS did provide a suitable service, it would be valued more by those people
Title: Re: The end of the NHS.
Post by: Footwork on May 11, 2016, 11:11:25 am
Footwork - Dont feed the mirror ffs....

I couldn't find the video alone to imbed!
Title: Re: The end of the NHS.
Post by: galpinos on May 11, 2016, 11:12:00 am
I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

What do you mean? People are passionate about it as a national institution, that people feel very strongly about, is falling apart and instead of fixing it, the government are pushing forward with an ill-defined manifesto promise (I still don't know what a 7 Day NHS is, the last comment I heard for the Health Secretary was that it wasn't about 7-day elective care so I'm at a loss as what the difference is to the service provided now).

There appears to be no clarity (or even debate) about the intended outcome of having junior doctors contract changed so that makes people worried.
Title: Re: The end of the NHS.
Post by: slackline on May 11, 2016, 11:19:09 am
I'm self-employed, I have been since 2002. I think you'll find there are lots of self-employed people who aren't well equipped for long rainy periods. In 2013 I paid ten thousand pounds on my health, on credit cards. Anf then missed 6 weeks of work, unpaid. How I wish I'd paid a less significant (but still significant) annual premium on health care and sickness cover. It isn't cheap though - I was being tight by not wanting to pay £800 per year for good health and wages cover. Many just don't have the means.

Personal choices and hindsight.  You and others presumably think about these things when choosing to go self-employed, to not do so might be considered careless (http://ukbouldering.com/board/index.php/topic,27001.msg520825.html#msg520825).

There are no doubt things that could be improved across society to the benefit of those who are employed and self-employed.  Personally I wouldn't mind paying more income tax if it were ring-fenced for health care.  I'm sure yourself and many others wouldn't object either (seems to be a slight undertone to what you write above).

People like you are focused (to the nth degree..) on the letter of the law and how things should be. The world isn't like that.

There is something wrong with having ideals/morals/ethics and seeking to achieve those?  Or should that be limited to the esoteric morals/ethics involved with climbing?

A lot of people would benefit from 8-8 availability and weekend availability because taking time off work isn't as easy

It would be convenient for everyone, but it costs money.  That is the bottom line with all of the discussion around 7-day services etc. and is unavoidable.

your public sector job.

No idea where you think I work but its not in the public sector.
Title: Re: The end of the NHS.
Post by: galpinos on May 11, 2016, 11:20:23 am
A lot of people would benefit from 8-8 availability and weekend availability

Is this what is being proposed? I honestly don't know, the manifesto promise was vague and there had been no clarification from the Department of Health.

If that is being proposed, should the public purse fund it? The NHS is underfunded at the moment but depsite this, has very good outcomes due to the efficiencies of the system. If we want to increase the availability of care, we need to fund it. Do you think this is where our taxes should go?
Title: Re: The end of the NHS.
Post by: Lund on May 11, 2016, 11:32:44 am
I don't think the discussion is totally lopsided - I think there's a lot of rational argument on both sides, some good and educational discussion - and clearly some people with different views.  Mostly it's OK, although it is a bit lopsided I think it's actually fine and a decent debate.  Hence I'm still here. 

P.S. GCW although you clearly have a clear opinion, I don't think that means you should stop posting.  It's never personal is it?

There are exceptions of course.  Slackline is foaming at the mouth, which is a bit annoying and I would much prefer it Slackers if you'd take your simplistic link-ridden posting off to a different topic as it's doing my head in.  I don't know what planet you're on, but it's not one of empathy, understanding, and compromise.  Stop slagging off other people's life choices for fuck's sake.  It's hardly immoral to want a public-funded seven-day healthcare service.
Title: Re: The end of the NHS.
Post by: GCW on May 11, 2016, 11:41:30 am
P.S. GCW although you clearly have a clear opinion, I don't think that means you should stop posting.  It's never personal is it?

I don't see much point in carrying on when resolution is impossible.

The sad thing is, I've had enough of all of this stuff and no longer really care. I half want it all to fall apart so people may appreciate what they used to have and abuse.

The only thing I don't get is who is going to do the work once it all falls apart shortly.
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 11:46:43 am
I'm not holding out for anything.

It's more the tone of the debate on here that riles me.

What do you mean? People are passionate about it as a national institution, that people feel very strongly about, is falling apart and instead of fixing it, the government are pushing forward with an ill-defined manifesto promise (I still don't know what a 7 Day NHS is, the last comment I heard for the Health Secretary was that it wasn't about 7-day elective care so I'm at a loss as what the difference is to the service provided now).

There appears to be no clarity (or even debate) about the intended outcome of having junior doctors contract changed so that makes people worried.

I agree there's a lack of clarity.

However my gut feeling is there's lack of clarity on both sides. For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth. It took the government to impose caps on agency fees; on the face of it (to a layman like me) the BMA, doctors and the people arguing about the NHS being underfunded didn't seem that proactive in reducing huge agency costs for their services. Underfunding? What about overspending?

Presumably there is some personal choice involved in working for agencies that charge the NHS the earth Slackers? Not to mention ethics morals and ideals?

The doctors contract debate can be viewed through different shades of optimism to pessimism, cynicism etc. In less cynical moments I can see how it could be attempting to impose some much needed cost control on a powerful group of expensive people. Quite naturally they don't like this. I don't fully buy the govs argument nor the BMA's. Clearly there's a power struggle, it doesn't strike me as all about patient safety.
Title: Re: The end of the NHS.
Post by: slackline on May 11, 2016, 11:47:47 am
Slackline is foaming at the mouth,

Far from it, but it bothers me that the need for funding is being completely ignored in these discussions where people are saying they want 7-day a week services.


I would much prefer it Slackers if you'd take your simplistic link-ridden posting off to a different topic as it's doing my head in.


You should probably employ the forums functionality to "Ignore" specific users as then you wouldn't have to read them.

Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 11:56:19 am
I don't know what planet you're on, but it's not one of empathy, understanding, and compromise.  Stop slagging off other people's life choices for fuck's sake.  It's hardly immoral to want a public-funded seven-day healthcare service.

This.
Title: Re: The end of the NHS.
Post by: lagerstarfish on May 11, 2016, 12:25:22 pm
The only thing I don't get is who is going to do the work once it all falls apart shortly.

G4S

and when it turns out that they don't have the staff, the military will step in
Title: Re: The end of the NHS.
Post by: Johnny Brown on May 11, 2016, 12:34:21 pm
Quote
For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth

Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.
Title: Re: The end of the NHS.
Post by: tomtom on May 11, 2016, 12:49:44 pm
It's very lopsided.

You mean bias not tone then....
Title: Re: The end of the NHS.
Post by: galpinos on May 11, 2016, 12:50:36 pm
For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth. It took the government to impose caps on agency fees; on the face of it (to a layman like me) the BMA, doctors and the people arguing about the NHS being underfunded didn't seem that proactive in reducing huge agency costs for their services. Underfunding? What about overspending?

The funding model for the NHS is a bit bonkers and very convoluted. I've no idea how locum fees get set. My experience is limited as my wife works in a specialist hospital that struggles to get locums as few people have the relevant qualifications. My wife has done several locum shift but has never billed the hospital for them as she just sees it a covering when necessary. If fact, she is one of seven doctors working a ten person rota so they have to split the other three persons worth of work across the seven.

Presumably there is some personal choice involved in working for agencies that charge the NHS the earth Slackers? Not to mention ethics morals and ideals?

The doctors who are perpetual locums are often those which have failed to get a training post (the path to a Consultant position)

The doctors contract debate can be viewed through different shades of optimism to pessimism, cynicism etc. In less cynical moments I can see how it could be attempting to impose some much needed cost control on a powerful group of expensive people. Quite naturally they don't like this. I don't fully buy the govs argument nor the BMA's. Clearly there's a power struggle, it doesn't strike me as all about patient safety.

There has already been some cost control imposed. My wife was the first year of the most recent contract and was on £12k less than those who had started the ST post a year before her, doing the same job. Though in absolute monetary terms they are expensive, they are not on a cost per hour basis.

Regarding the BMA, lots of doctors aren't 100% behind them but have no other place to turn to get a cohesive "single voice" to get their points across. Unfortunately, I don't think the BMA have made a good job of getting the point across to the general public.
Title: Re: The end of the NHS.
Post by: galpinos on May 11, 2016, 12:54:28 pm
Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.

In theory yes, but there are some specialties that struggle to recruit (and will the financial incentives being reduced, will undoubtedly find it even harder) so have to fill the spots with locums. With the most recent intake of F1s (the most junior of junior doctors) being down and not all positions taken (they have previously be over-subscribed), there will be a requirement to fill the gaps with locums.
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 01:00:44 pm
Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.

Reduce agency involvement and impose fee caps on agencies. Or use own resources provided they compare well cost-wise..

Either way if overheads are too high they need controlling. You could also do that by trying to make the public - a pretty unhealthy expensive public - to be healthier of course!
Title: Re: The end of the NHS.
Post by: tomtom on May 11, 2016, 01:22:18 pm
Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.

Reduce agency involvement and impose fee caps on agencies. Or use own resources provided they compare well cost-wise..


Why do you think they've not done that Pete?
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 01:32:26 pm
I think 'they', the dreaded they, have imposed fee caps on expensive agencies haven't they?
Title: Re: The end of the NHS.
Post by: monkoffunk on May 11, 2016, 01:35:56 pm
Quote
For instance I can't help but find hypocritical the stance of some doctors who keep stating the NHS is underfunded (true) when I hear about the sky-high sums of money wasted every quarter paying doctors working for agencies that charge the NHS the earth

Presumably a 'properly-funded' NHS would be able to fill these positions from it's own resources and not require agencies. There is obviously a long history of the private sector profiteering from NHS contracts, so the answer would seem to be reduce their involvement? Cost overall would be higher but the standard of service should be better value.


Absolutely true. I know that cost cutting maneuvers in Bristol have lead to nurses being employed at the bare minimum to fill rotas. They take sick leave or quit (often due to poor treatment or better conditions in the private sector) and the gaps are filled with agency staff at high rates. Same is true of doctors.

And by the way they aren't asking for sky high rates, its just that the going rate, i.e. the value that say a senior registrar (a kind of junior doctor) has to the running of hospitals, is significantly higher than then the amount that doctors working training posts are actually paid. Also pales into comparison compared to the operational costs of the NHS. Some patients can require figures upwards of £100,000 individually per year as a conservative estimate, as one small example.
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 01:54:59 pm
And by the way they aren't asking for sky high rates, its just that the going rate, i.e. the value that say a senior registrar (a kind of junior doctor) has to the running of hospitals, is significantly higher than then the amount that doctors working training posts are actually paid

Really - including the profiteering middlemen agency's cut?
By definition isn't the 'going rate' for NHS staff what the NHS is prepared to pay them? The going rate for agency staff is what the NHS pays the profiteering middlemen agency.
Title: Re: The end of the NHS.
Post by: Johnny Brown on May 11, 2016, 02:52:45 pm
Well, no, it's what they have to pay in a competitive market to get staff of the required expertise and experience. Just like any other job.
Title: Re: The end of the NHS.
Post by: tomtom on May 11, 2016, 02:54:15 pm
And by the way they aren't asking for sky high rates, its just that the going rate, i.e. the value that say a senior registrar (a kind of junior doctor) has to the running of hospitals, is significantly higher than then the amount that doctors working training posts are actually paid

Really - including the profiteering middlemen agency's cut?
By definition isn't the 'going rate' for NHS staff what the NHS is prepared to pay them? The going rate for agency staff is what the NHS pays the profiteering middlemen agency.

Thats really just another form of outsourcing... as already happens with the cleaning, car parking, maintenance, buildings (PFI), catering, transport, care services etc... As I mentioned X posts ago look for the number of G4S or SERCO badges, uniforms, notices around in your local hospital...
Title: Re: The end of the NHS.
Post by: petejh on May 11, 2016, 05:10:29 pm
Well, no, it's what they have to pay in a competitive market to get staff of the required expertise and experience. Just like any other job.

Except the government has powers to impose fee caps.
Title: Re: The end of the NHS.
Post by: monkoffunk on May 11, 2016, 05:12:34 pm
Its supply and demand. Doctors want these training jobs and will work long hours, weekends and nights for less pay than they perhaps deserve (debatable) so as to have this training and career progression. Once you have a night shift without a medical registrar on call the dynamic changes. No one wants to work that shift as a one off. But if you don't cover it with registrar or higher then there would be a substantial risk of harm or death to patients. Therefore the value of a registrar is suddenly huge. The hospital simply has to cover that shift.
Title: Re: The end of the NHS.
Post by: monkoffunk on May 11, 2016, 05:13:32 pm
Except the government has powers to impose fee caps.

There is a policy doomed to failure. If they don't pay people to do the job then they won't.
Title: Re: The end of the NHS.
Post by: slackline on May 13, 2016, 08:25:46 pm
I don't know what planet you're on, but it's not one of empathy, understanding, and compromise.  Stop slagging off other people's life choices for fuck's sake.  It's hardly immoral to want a public-funded seven-day healthcare service.

This.

You two couldn't be further off the mark if you tried.

Its precisely because I have "empathy, understanding and compromise" that I think the current proposals for seven-day services are dangerous.  They are dangerous because there is zero additional money being provided to cover the expansion in service provision, which is dangerous in the short-term for immediate patient safety and long-term because of the potential demise of free-at-the-point of contact medical care regardless of your financial means to pay for it (i.e. the demise of the NHS as it was originally conceived).


I never once said it was immoral to want a publicly funded seven day service, in fact I agreed, and wrote that it is a worthy goal.  But living in the real world (understanding and compromise) I realise that it is not achievable without additional funding.  Pete you have mentioned that the NHS employs expensive agency staff, but aside from the valid reason JB gave, have you paused to consider why?  Its because they're sick of the shit working conditions (longer and longer hours, and more and more bureaucracy), but they can actually do the job they want rather than paper work for less hassle by working for an agency.  What you describe is a symptom of the drive to run the NHS into the ground, not a cause of it.

You both seem to have completely missed the human aspect of the health service, the staff working there are humans, they have wants, families and lives outside of work.  But no, lets not show empathy, understanding and compromise towards those people, lets bang our single-issue drum whilst missing the bigger picture and continue to rant that "I want to have my health seen to at my convenience", and push these people to breaking point such that they quit the profession and more work is out-sourced to agencies.

Pointing out that something was a choice is not the same as slagging off that choice....

@Lund : You don't seem to have liked my "Deal with it" comment and think I lack empathy, understanding and compromise as a consequence.  Well I, and everyone else I know who have kids, do whatever they can to care for and bring their children up as best they can.  Work is important, but if my child is ill and needs my attention, or my wife is ill and can't do her share of caring then, as important as work is, the child takes priority.  So you have my empathy and understanding with regards to taking time off work in light of having children because I do it too.  But you sound like a child yourself whining that they want something NOW when you go on about how its inconvenient for you not to have access to your health service at the weekends and as a consequence have to take time off of work.

@petejh : You don't seem to have taken kindly to the fact I said that its individual choice to be self-employed and went on to say there are lots of self-employed people who aren't well equipped for long rainy periods, but that you splashed out £10k on credit to have your health problem dealt with privately but that with hindsight you regretted not taking insurance, and went on to point out that not everyone can afford insurance up front.  Well those people who aren't well equipped for long rainy periods will, under the current system, at least have their health taken care of free of charge but currently I, and many others who are capable of forming our own opinions rather than listening to spin, believe that to be under threat.  It would be a travesty if we moved away from the current system because firstly healthcare is expensive, secondly it would increase in cost (companies have to turn a profit, look at costs in the US), thirdly the inequality that exists would mean that many simply can't afford it.  So you and every other self-employed person out there also have my empathy and understanding because I want to see the NHS continue in its current form and not discriminate against you and others worse off than you.

I know a few medics (a climbing partner whos a clinical psychologist and two GPs through friends), there are GCW, monkoffunk, webbo and other doctors posting in this thread, all of whom have insight into an increasingly broken system giving their opinion, which yes, might be biased, but its because they no doubt feel as I do, that the NHS in its current form is worth saving.  The compromise is that because you can't have a seven day service without more money you have to stick with the current five-day service until more money comes along.  Neither of you have seriously addressed how a seven day service would be funded, instead sticking to "how you think things should be" (an accusation you levelled at me Pete).


All that said, I'm done with discussing anything serious on this forum.  You've both employed a classic Sloper tactic of being myopic and purposefully ignoring the larger picture and consequences of various courses of action (you even stated this was your aim at the outset Lund, kind of like a declaration of trolling) yet big issues like this and many others simply can not be boiled down to a single issue as you have both attempted to do, and I can't be bothered wasting time having such discussions. 

@Lund Nor do I have any time for you or the vitriol you have directed towards me.  You are a hypocrite to complain that my posts are "link ridden" as you do exactly the same, further back posting right after me and asking me what I made of a paper and linking to it.  I took the time to read it and comment on it (the effect size was tiny) and provided you with a means of reading it in full yourself, but you chose to ignore that, and simply posted a link to another paper that supported your view point a few posts later. 

P.S. Pete - Its perfectly natural that differences of opinion on a piece of work arise (viz. your comment about "Prof xyz of medical institution abc" being contradicted by "professor efg of medical institution jkl").   That is science.  You do a piece of work, put it out there and others review it,  criticise it and then improve on it.  Go to conferences and at the end of almost every talk when questions are asked you can almost guarantee someone will ask "Did you consider the impact of A, B and C?".  Thats how science progresses and we can either take these at face value, read the methods and judge for ourselves the appropriateness of the methods employed and the conclusions that can be drawn or you can trust an expert (after checking who funded the work and whether there are any conflicts of interest) because these are the people who you should listen to, even if they disagree, eventually with more work a consensus will be reached.  The only people who quote statistics you shouldn't listen to are politicians who twist facts to whatever whim takes their fancy.  I always got the impression you understood this.
Title: Re: The end of the NHS.
Post by: webbo on May 13, 2016, 08:37:31 pm
 :bow:
Title: Re: The end of the NHS.
Post by: tomtom on May 13, 2016, 08:41:20 pm
Well said Slackline.
Title: Re: The end of the NHS.
Post by: a dense loner on May 13, 2016, 09:59:25 pm
What did he say?
Title: Re: The end of the NHS.
Post by: webbo on May 13, 2016, 10:14:59 pm
Don't fuck with me or the NHS.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on May 13, 2016, 10:28:08 pm
Well said Slackline.

+1

Wrote something almost witty, then deleted it all.

This shit ain't funny.
Title: Re: The end of the NHS.
Post by: Will Hunt on May 15, 2016, 08:27:00 am
A tour de force of reasoning.
Title: Re: The end of the NHS.
Post by: Offwidth on May 15, 2016, 09:37:13 am
Comes across more as frustration based rant to me.  I want slackers to continue discussing, links n all. The situation with the NHS is horribly complex and buried under masses of spin, so its understandable some people don't get it at all let alone most in detail. If we want to keep the NHS its important to keep up our side of the information war and stay honest in this.
Title: Re: The end of the NHS.
Post by: Oldmanmatt on May 17, 2016, 02:16:51 pm
This has been reported on the BBC site, but I've gone with a more reliable source.

 http://newsthump.com/2016/05/17/trained-chimps-should-fill-in-for-doctors-say-nhs-bosses/


Sent from my iPhone using Tapatalk
Title: Re: The end of the NHS.
Post by: Offwidth on May 19, 2016, 08:32:15 am
Channel 4 news last night had a good summary, JH under pressure (from 4:45) and a very mature interview with a Junior Doc.

https://www.youtube.com/watch?v=fEKIGzW_eLc
Title: Re: The end of the NHS.
Post by: highrepute on May 19, 2016, 11:25:28 pm
Great post by slackline there, thanks for putting the effort in.

Regarding the 7 day NHS. They trialed 7 day at the fracture clinic my partner worked at and they couldn't fill the weekend appointments. Turns out people got better things to do at weekend! My understanding is other trials showed similar results. The problem being the main users of the NHS, the 10% who take up 90% of the costs can and want to go in the week. And the generally well people who want weekend services rarely have to utilise them as they are generally well.

If there was really a demand for routine services at the weekend then this would have been filled by the market cashing in on high demand.
Title: Re: The end of the NHS.
Post by: monkoffunk on May 20, 2016, 12:45:25 pm
Slightly concerned that not rostering junior doctors two weekends in a row hasn't been thought through. I think it's a good thing, but not thought out. ED rotas you end up working up to three in a row. So trusts need to either employ more doctors or put less on at weekends. Without more funding they will do that latter. Paradoxically this contract might mean fewer doctors on ED at weekends. Further cracks in a broken system.
Title: Re: The end of the NHS.
Post by: Offwidth on July 27, 2016, 11:01:22 am
Some more news

https://www.theguardian.com/society/2016/jul/27/hospitals-overtime-payments-soar-freedom-of-information-request
Title: Re: The end of the NHS.
Post by: slackline on November 29, 2016, 11:20:00 am
Assisted Conception is free to a point* on the NHS, after that you have to pay for it.  A recent paper in the BMJ demonstrates the pernicious consequences of unregulated private treatments being sold to patients with little evidence to support their efficacy...

Heneghan et al. (2016) Lack of evidence for interventions offered in UK fertility centres BMJ : 355:i6925 (http://www.bmj.com/content/355/bmj.i6295)

Someone I share an office with is working on a study assessing the efficacy of the one promising adjunct intervention (endometrial scratch).


Looking at the US system I can only really envisage this spreading to other areas of care and pointlessly inflating the cost of healthcare in an already under-funded and strained system.






* The point varies between Clinical Commissioning Groups, some places you get one pop at IVF, others two.
Title: Re: The end of the NHS.
Post by: slackline on January 26, 2017, 02:54:09 pm
Protect the NHS from Brexit trade deals (primarily with the US) (https://actions.sumofus.org/a/protect-the-nhs-from-brexit-trade-deals/)
Title: Re: The end of the NHS.
Post by: Offwidth on February 08, 2017, 05:16:06 pm
More shit news:

https://www.theguardian.com/education/2017/feb/02/nursing-degree-applications-slump-after-nhs-bursaries-abolished

Title: Re: The end of the NHS.
Post by: tomtom on February 08, 2017, 09:30:15 pm
Sadly not at all surprising. Apparently here has been a halving of applications for nursing positions from non U.K. People since Brexit...
Title: Re: The end of the NHS.
Post by: webbo on February 08, 2017, 09:47:38 pm
Some of the best and most experienced nurses in the NHS have recently retired which also adds to the shortage. :dance1:
Title: Re: The end of the NHS.
Post by: mrjonathanr on June 20, 2017, 09:24:21 pm
This does not make encouraging reading:

https://www.theguardian.com/society/2017/jun/20/leak-shows-devastating-impact-of-planned-nhs-cuts-in-london (https://www.theguardian.com/society/2017/jun/20/leak-shows-devastating-impact-of-planned-nhs-cuts-in-london)
Title: Re: The end of the NHS.
Post by: SamT on June 21, 2017, 09:18:26 am
Some of the best and most experienced nurses in the NHS have recently retired which also adds to the shortage. :dance1:

My other half works 'behind the scenes' in a Lab for the NHS.  This is totally the case here, older, i.e. anyone over 50, with vast experience are just retiring early/quitting left right and center before they have mental breakdowns  They're being replaced particularly well if at all, leaving a raft of younger, less experienced staff who are now even more overworked/stressed, without the comfort blanket of older staff to lean on, but who are just about young enough to cope with the stress/long hours..  :no:
Title: Re: The end of the NHS.
Post by: mrjonathanr on July 02, 2017, 08:11:04 am
Posted in Guardian comments. I wonder if any knowledgeable posters could comment on the accuracy of the detai lin the letter below?

Quote
I'd like to ask everyone who's keen to protect the NHS's survival to read through the following letter. If they agree with it, please could they send the letter (email or print) to their own MP?

This letter was drafted by a KONP member (KONP is one of many groups working to protect the NHS), not by me. I think it's a superb letter.

Dear (MP name),

You will be aware that the state of the NHS continues to cause grave public concern .
The 44 Sustainability and Transformation Partnerships (STPs) are required to deliver a £22bn reduction in the NHS annual budget by 2020/21 - even though the UK already spends significantly less healthcare than comparable countries like France or Germany.

The Sustainability and Transformation Plans have been drafted in secret. They lack public support or any firm clinical evidence base. The swingeing cuts will be achieved through ‘new models of care’ that involve:
● closure of A&Es, beds, hospitals and local services despite lack of capacity
● rapid and unprecedented sell-off of NHS sites to plug funding gaps (as set out in the Naylor Review), resulting in lengthy, inconvenient and potentially unsafe journeys for patients and relatives and loss of sites for new NHS provision
● downgrading professional staff : replacing qualified doctors with 2-year trained Physician Associates; replacing nurses and other professional staff with unqualified care assistants,
● ‘care nearer home’ meaning impossible new demands on social care services that are already stretched to breaking point and family carers (predominantly women) caring for very sick people at home
● appointments conducted via Skype despite known difficulties this will create for many older and vulnerable patients
● health apps and remote monitoring used as a replacement for face-to-face engagement

We are horrified that the STPs are being imposed primarily as cost-cutting measures, in the absence of any reliable evidence-base to support clinical effectiveness, and without consultation with clinicians or with patients or local communities to determine acceptability.

This devastating STP programme flies in the face of the NHS’ proud tradition of evidence-based medicine to meet patients’ needs.

The latest phase of the programme is the creation of ‘ Accountable Care Systems’ , modelled on the US healthcare market, and we believe this is the intended future for the NHS.

We seek
● an immediate halt to the STP programme pending local review including full consultation and involvement of patients and community organisations.
● funding to bring the NHS into line with that of similar EU economies.
● a new NHS Bill that will end the NHS market and privatisation and will reinstate a publicly funded, publicly provided and publicly accountable NHS.
We look forward to hearing what action you, our elected representative, will take to support these aims.
Yours sincerely...
[\quote]
Title: Re: The end of the NHS.
Post by: powderpuff on July 02, 2017, 08:49:01 am
Posted in Guardian comments. I wonder if any knowledgeable posters could comment on the accuracy of the detai lin the letter below?

Quote
I'd like to ask everyone who's keen to protect the NHS's survival to read through the following letter. If they agree with it, please could they send the letter (email or print) to their own MP?

This letter was drafted by a KONP member (KONP is one of many groups working to protect the NHS), not by me. I think it's a superb letter.

Dear (MP name),

You will be aware that the state of the NHS continues to cause grave public concern .
The 44 Sustainability and Transformation Partnerships (STPs) are required to deliver a £22bn reduction in the NHS annual budget by 2020/21 - even though the UK already spends significantly less healthcare than comparable countries like France or Germany.

The Sustainability and Transformation Plans have been drafted in secret. They lack public support or any firm clinical evidence base. The swingeing cuts will be achieved through ‘new models of care’ that involve:
● closure of A&Es, beds, hospitals and local services despite lack of capacity
● rapid and unprecedented sell-off of NHS sites to plug funding gaps (as set out in the Naylor Review), resulting in lengthy, inconvenient and potentially unsafe journeys for patients and relatives and loss of sites for new NHS provision
● downgrading professional staff : replacing qualified doctors with 2-year trained Physician Associates; replacing nurses and other professional staff with unqualified care assistants,
● ‘care nearer home’ meaning impossible new demands on social care services that are already stretched to breaking point and family carers (predominantly women) caring for very sick people at home
● appointments conducted via Skype despite known difficulties this will create for many older and vulnerable patients
● health apps and remote monitoring used as a replacement for face-to-face engagement

We are horrified that the STPs are being imposed primarily as cost-cutting measures, in the absence of any reliable evidence-base to support clinical effectiveness, and without consultation with clinicians or with patients or local communities to determine acceptability.

This devastating STP programme flies in the face of the NHS’ proud tradition of evidence-based medicine to meet patients’ needs.

The latest phase of the programme is the creation of ‘ Accountable Care Systems’ , modelled on the US healthcare market, and we believe this is the intended future for the NHS.

We seek
● an immediate halt to the STP programme pending local review including full consultation and involvement of patients and community organisations.
● funding to bring the NHS into line with that of similar EU economies.
● a new NHS Bill that will end the NHS market and privatisation and will reinstate a publicly funded, publicly provided and publicly accountable NHS.
We look forward to hearing what action you, our elected representative, will take to support these aims.
Yours sincerely...
[\quote]
Just emailed my local MP ☺
Title: Re: The end of the NHS.
Post by: mrjonathanr on July 02, 2017, 09:14:22 am

The ACS are a new concept to me. Kings fund explains this:
https://www.kingsfund.org.uk/topics/integrated-care/accountable-care-organisations-explained

Quote
The relational challenges centre on the need to develop trust between the organisations and leaders involved as well as an ability to collaborate in a legal context that was designed to promote competition. 

Sounds like quite serious organisational change. It seems to me that news of what is occurring within the NHS is not that well publicised.
Title: Re: The end of the NHS.
Post by: Offwidth on July 03, 2017, 10:28:01 am
Latest bad news:

https://www.theguardian.com/society/2017/jul/03/more-nurses-and-midwives-leaving-uk-profession-than-joining-figures-reveal

Also Roy Lilley did a concerned comment piece on the likely new chair of NHSI; an extract:

"The time is right to get back to one head-office; straddling primary and secondary care.  Commissioning is all-but finished.  Providing, service level agreements, ACOs, population-based, capitated budgets... they're the future. Time to dump NHSE and NHSI and have NHSA... NHS All-together.

However, if the gossip is right and it usually is, it looks like we are set for more of the same.  Perhaps I should say, the worst of the same. A key appointment will be the chair of NHSI.  For months everyone's known it will be Dido Harding, aka; Baroness Harding of Winscombe.  You may not have heard of her?  If you had a Talk-Talk phone you will.  She came spectacularly unstuck with a data breech. Having been accused, by the press, of naivety, she left saying she;  '... wanted to focus more on her public service activities.'  Jerusalem, jam and the NHS.  She probably knew then, she had a job in the bag. She's worked at McKinsey, Thomas Cook, Woolworths, Tesco, Sainsbury's, Car-Phone Warehouse, British Land and Cheltenham Racecourse... a great pedigree.

But there's a problem... She's a conservative life-peer, went to uni with David Cameron and The Tinkerman and married a conservative MP.  For the role of chair of an independent regulator... totally unsuitable. No one seems to have had much of a say in her appointment and it will be a test for the chair of the Health Select Committee to say no.  NHS do not elect their bosses and they should.  Staff should have a say. In the public sector favouritism, cronyism and nepotism undermine confidence and the common good.  No one I've spoken to sees Dido as an independent regulator.  The fear; everything confided in her will go straight back to mates at DH. In the US there would probably be a law against this appointment. 

The NHSI chair will have influence... that can be the invisible poison that pollutes public life. As the Talk-Talk advert used to say; 'This stuff matters'. Dido, the NHS matters.  It matters that public life is not an extension of mates, alumni and the Carlton Club.  Transparency matters; it matters that appointments look like a fit-up.  It matters they look tribal. In my view this appointment is contrary to the Nolan Principles, undermines public confidence in the recruitment process, is naive, lacks judgement and waves two fingers at the NHS. Appointment by whisper. This appointment undermines the purpose, tone and texture of good government. It matters that this is a bad, bad, bad appointment, that will play badly in the NHS, she will become the story and it matters that the NHS is the story.

Dido, 'This stuff matters', do the right thing; give it a miss."
Title: Re: The end of the NHS.
Post by: Offwidth on January 19, 2018, 12:51:28 pm
When do we think someone is going to do something about the nursing crisis? Brexit consequencies, the demographic pension bulge, supercharged by austerity and a shortage of required training numbers were all fairly predictable. The reality is turning out even worse than the "doom mongers" predicted from two years back.

The latest on the DH press office response to this from Roy Lilley:

"Honesty

News and Comment from Roy Lilley

I don't know why I let them upset me but they do.  They irritate me beyond belief.  I've tried everything.  Deep breaths, counting to ten, think-calming-thoughts, relaxation, calamine tea... but they still drive me BARMY! I'm talking about the Department of Health Press Office. Why don't we dump them?  We could have one of those press-button, dial yer-own-answer, premium phone lines; dial-a-quote.

Press one for; 'The NHS has had more money than any time in the history of coinage... there is more money than ever before'.

Press two for; 'The NHS is expected to provide more care, better care... whatever... there will be more care in the NHS than ever before.'

Press three for; 'The NHS has commissioned a report on this and it will be published when it is published and it will address these issues, or not... there are more reports in the NHS than ever before.'

Press four; 'Although you may think today is Thursday, actually, because yesterday was Wednesday and tomorrow is Friday, does not guarantee you have got the day of the week correct.  There are more days in the week than every before....'

... and there is the latest.  Infuriating.  But first some context from the BBC;

The NHS is "haemorrhaging" nurses with one in 10 now leaving the NHS in England each year. More than 33,000 walked away last year, piling pressure on understaffed hospitals and community services.... a rise of 20% since 2012-13... there are now more leavers than joiners. In up-sum: more than 10% of the nursing workforce have left the NHS in each of the past three years; leavers would be enough to staff more than 20 average-sized hospital trusts; more than half of those who walked away in the last year were under the age of 40. Leavers outnumbered joiners by 3,000 last year.

The DH press office; what did they say?  Brace yer-self... here it is;

'There are 11,700 more nurses on our wards since 2010...'

Reach for the calculator;

11,700 in 7 years = 1,671 nurses a year

There are roughly 157 trusts;

1,671 new nurses divided by 157 Trusts

= 11 new nurses per Trust.

Less than one new nurse a month...

Does the Press Wallah think we are all stupid.  Can't add up?  Is this careless or Machiavellian?  Dissembling, misleading an attempt at being smart.  Is this good ethical press management?

As the BBC say;

'They (the DH Press office) have picked 2010 and nurses on wards.  If you look at the entire nursing workforce, the numbers have only risen by 1%... demand across health care has gone up between ten and twenty percent...'

It is the role of the DH press office, funded by the taxpayer, to be truthful, accurate, objective and impartial.  They are accountable to us all.  They are not accountable to Tory Central Office; to gift wrap, polish or present the facts sunny-side up.  We want stripped pine facts. And the facts are nursing is a great profession, a wonderful vocation but a rotten job.
It's a rotten job because the DH have got the numbers wrong, training wrong, funding wrong, safe staffing wrong.  On any measure they are on the wrong side of right. Three days a week twelve hours a day, understaffed wards, getting through a shift with fingers crossed there isn't a disaster.  It's not a job it's torture. Car-parking charges, child care, flat-line pay increases, patients in the corridors.  No breaks. To make ends meet a couple of shifts in a care home.  Exhausting.

All the nurses I have met love nursing.  None of them leave a job they love.  They leave management, bureaucracy, bullying, anxiety, rehearsing for CQC inspections, daft policy and unnecessary pressure. What's not to like about working for an agency; work the shifts you want, where you want, no management hassle.  I'm surprised the whole of the workforce isn't agency.

Organisations get the workforce they deserve.  Nothing changes anything faster and quicker than honesty.

The Health Select Committee report on nursing next week.

Contact Roy - please use this e-address  roy.lilley@nhsmanagers.net  "
Title: Re: The end of the NHS.
Post by: Oldmanmatt on January 19, 2018, 01:14:23 pm
Jeremy has got this!
Using advanced technology, like spread sheets (not sure what I was using, circa 1999. MS Project must have been far inferior); staff are ensuring safe staffing.
Because Red is good right? The Chinese think it’s lucky, so it must be, because they’re good at business and controlling their population.
This does not in anyway indicate a chronic staff shortage that not merely strays, but leaps like a startled Gazelle with a firework up it’s arse, into dangerous territory daily...
No, not at all.

(https://image.ibb.co/nmLdDb/15_AADE37_58_FC_4_F71_8_D80_B59314_AF5_F6_E.jpg)
Title: Re: The end of the NHS.
Post by: Jim on January 20, 2018, 01:07:21 pm
someone has obviously shown him how conditional formatting works
Title: Re: The end of the NHS.
Post by: mrjonathanr on September 20, 2023, 09:29:22 pm
I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE
Title: Re: The end of the NHS.
Post by: stone on September 21, 2023, 09:32:15 am
I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE

Yesterday one of the leaders of the consultants' strike was on BBCRadio4 Today. He said that their demand was for the pay review body to be genuinely independent rather than being constrained under government directed
affordability limits as is now the case. That seemed to make a lot of sense to me as an achievable "way back" to having a decent NHS.
If we want an NHS (which I do), we have to (and should) pay the staff. It won't save us any money if we end up reverting to a private system.
 
Whenever there is grumbling about paying people who do well paid jobs such as doctors, train drivers or whatever, I remind myself that a huge slice of our national income (50%ish) goes to share and bond holders and landlords etc. The political choice we have made was to increase that share from the 30%ish that it was a few decades ago. That's the choice I question.
Title: Re: The end of the NHS.
Post by: Offwidth on September 21, 2023, 04:38:39 pm
I get Roy Linley’s regular bulletin. (thanks Offwidth for advertising it). Very down to earth,an  interesting if slightly disturbing read at times, from a well informed perspective.

I’ve never read a message from him like this one. Worrying.
https://myemail.constantcontact.com/No-way-back.html?soid=1102665899193&aid=NFCkOLV0AaE

I think Roy is really good on constructive NHS management issues and is incredibly well informed but he has always had a blind spot on trade unions. His analysis is very simplistic on the BMA failures on pay,  given such failures are shared by every major trade union and are mainly down to an increasingly difficult legal environment for industrial action in times of austerity. He does at least recognise the NHS workforce planning (and motivation to remain working in the NHS) is falling apart but somehow refuses to link that to one of the key ideological drives causing medical staff to strike, despite deep care for their patients: most genuinely think they are trying to save the NHS.
Title: Re: The end of the NHS.
Post by: spidermonkey09 on September 21, 2023, 04:55:23 pm
Well informed he may be, and that email was an "interesting" read, but am I alone in finding the rhetorical style of it intensely irritating? So many ellipses, unnecessary bold type, repetition. Really annoying.

Pretty unimpressed by his inference that the GMC should threaten strikers with deregistration. That sort of rhetoric belongs in the Mail. Also pretty tedious is the inference that doctors are bad people for going on strike, coupled with the predictable recourse to the 'do no harm' line. The delusion that doctors are all Florence Nightingales is nonsense. It is a job, nothing more nothing less, for many, and they are striking accordingly (with a gigantic mandate as well). He should consider why 13,000 doctors trained in the UK have left (his reference), and then consider again why they are striking.
Title: Re: The end of the NHS.
Post by: stone on September 21, 2023, 06:00:36 pm
Pretty unimpressed by his inference that the GMC should threaten strikers with deregistration. That sort of rhetoric belongs in the Mail. Also pretty tedious is the inference that doctors are bad people for going on strike, coupled with the predictable recourse to the 'do no harm' line. The delusion that doctors are all Florence Nightingales is nonsense. It is a job, nothing more nothing less, for many, and they are striking accordingly (with a gigantic mandate as well). He should consider why 13,000 doctors trained in the UK have left (his reference), and then consider again why they are striking.
Especially since the key demand by the consultants is for genuine independence for the pay review body -ie taking their pay out of the realm of being something they need to strike for.
Title: Re: The end of the NHS.
Post by: webbo on September 21, 2023, 07:50:41 pm
 The delusion that all doctors are Florence Nightingales is nonsense.
You have your professions a bit muddled there. ;)
Title: Re: The end of the NHS.
Post by: spidermonkey09 on September 21, 2023, 11:08:44 pm
Ha I realised that after I posted it but hopefully the gist came across!
Title: Re: The end of the NHS.
Post by: monkoffunk on September 22, 2023, 06:09:59 pm
Yeah wow, what a mad suggestion.

I don’t believe the 35% will stand, and the BMA would have to put an offer of less than that to its members. I suspect members might vote in favour of significantly less. But the government do have to negotiate something.
Title: Re: The end of the NHS.
Post by: spidermonkey09 on September 22, 2023, 06:41:31 pm
I think they'd be happy to vote for anything in double figures really. I don't think anyone seriously thinks they'll get 35% but it's an opening gambit. The government appear to have forgotten how negotiation works and are just taking their ball home.  :slap:
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