Many people would have been rather confused yesterday when they switched on the Today programme and heard that the health service is basically bankrupt. Apparently, the NHS needs another £10 billion from the taxpayer to survive in three years' time (put another way, just less than the cost of paying for the entire police service).
Listeners would have been forgiven for thinking: hang on, hasn't the NHS had a lot of extra money already? And they would be right. After a decade of historic spending increases, the NHS budget has more than doubled, from around £45 billion to £105 billion. The service has 41,800 more doctors and 84,700 more nurses. To say the NHS has never had more resources is an understatement: it is in a wonderland of extra money, on a scale that its leaders never expected. Quite amazing, then, that it is coming back to the taxpayer cap in hand.
The mystery deepened when Andrew Lansley, the Conservative health spokesman, appeared on the show at ten past seven. He said that there wouldn't be this problem under a Conservative government because they would spend more – in fact, they would spend more on health after inflation for ever, no matter what, not even if the recession worsened and tax revenues plummeted.
Hold on, said John Humphrys, isn't it the Conservative Party that has been saying that the country has run out of money? Wasn't it David Cameron who pointed out that this year's Budget forecast levels of government debt "not only higher than every government since World War Two, or even since World War One, but every government since the Bank of England was first founded, more than 300 years ago". Isn't it your party saying that you would do it differently – you would get a grip? Well, said Andrew Lansley, the next Conservative government would indeed get real on public spending – but the health budget would be immune.
In fact, there is a reason for the plight of the NHS (which is real). And there are some straightforward steps that we can take to give us complete confidence that the service will be here in five years' time, and to make it both better and less costly. But to do it we will need a new kind of political leadership, very different from that displayed by both the current Government and the Opposition.
The reason for the hole in the budget is that the NHS has spent its extra money in the wrong way. In another piece of evidence yesterday, the Office for National Statistics reported that NHS productivity had fallen by 4.3 per cent over the 10 years to 2007. In other words, the NHS actually destroyed some of the value of the money that it was given, just like a company making a loss. It has improved – in particular, very long waits for hospital treatment are now a memory – but those improvements could have been achieved at lower cost.
The reason is that the NHS just spent money on getting bigger, not smarter.
It wasn't supposed to be like this. Tony Blair said that investment would be accompanied by "reform" to get value for money. Today's ministers speak of three phases of NHS change: first, more money; second, value for money; third, a focus on "quality" (ie making the NHS more careful and thoughtful about how it treats patients).
But as Mike Farrar, the head of the NHS North West region, has gently pointed out, phase two was never achieved. The money went in but the talk of new ideas remained just talk.
In 2004, the Government said that by 2008 one NHS operation in six should be carried out by new organisations, paid by the NHS but separate from it. Rightly, it wanted to bring in new ideas and to ginger up the system. But as of today, fewer than one per cent of operations are carried out in this way. The NHS has fought off the competition, blown the budget and increased its costs. Too late, it is realising that it can't afford what it has become.
Fortunately we can put this right. The NHS already has the leaders and the ideas that can move the service on, and very quickly. On Tuesday this week, my own organisation – the independent think tank Reform – brought together 150 people inside and outside the service to get new ideas on the future of health. We heard about a London NHS hospital that now offers to put its overnight patients in a four-star hotel rather than a hospital bed – it saves £450 per night and patients are delighted.
We heard that in Denmark, medical records are online and secure, so that ambulances can immediately assess road accident victims and take them to the right hospital. We heard of new companies that treat NHS patients twice as well as the rest of the service (measured by complication rates after operations) at 20 per cent lower cost. Another private hospital group has had no MRSA or C.difficile at all in its 60 hospitals for several years.
These organisations and many, many others have the ideas to transform the NHS. What is lacking is the leadership – and this brings us back to politicians. Leadership doesn't mean ministers actually running the NHS – that has been part of the problem. It means politicians daring to make the case for change. It means explaining to the public (and to the service itself) that a better service will look and feel very different.
That service will have fewer big hospitals and many more smaller units, both general (like GP surgeries) and specialist (like stroke units). It will almost certainly have a smaller staff, in which the big pay rises go only to the best performers. It will be different in different places, as local leaders start spending local money better.
Put very simply, the NHS is a collection of organisations that buy healthcare on our behalf and then provide it in the form of operations, GP appointments and so on. We need to let new people take over these various organisations and run them better. And then we, as citizens, need to make greater effort to choose between them and put pressure on them.
And while the taxpayers' bill may fall, the amount spent on health overall will rise – because each of us will spend more of our own money on our health in various ways. In practice we will have new kinds of insurance policies that protect us against the costs of particular kinds of care. One company is already offering insurance for young women, for only tens of pounds per month, against the costs of the cancers that affect that age group. Such innovations will be the only way to cope with the rising demands on the service in future years, as people live longer – unless we want taxes to rise to the point where there is little reason to work or save.
At our conference, Mike O'Brien, the new health minister, said that he had been visiting his cousin in hospital on Sunday morning, a few hours before Gordon Brown had called him with his new job. He noted that while the actual medical care received by his cousin was excellent, what gets called the "patient experience" – the attitude of staff, the communication (or lack of it) with patients and relatives – was poor. That is the kind of honesty that needs to be amplified right across the political health debate.
It's true, the NHS is basically bankrupt and the taxpayer should spend less. It's true, the ideas are there to solve it. It's true, a better service will look and feel very different. All that remains is for our elected leaders is to explain this and to point the way. Tomorrow morning on the Today programme at 7am would be a great place to start.
Andrew Haldenby is director of the independent think tank Reform
(www.reform.co.uk)
Gee, communism doesn't work in medicine, either? What a shock. Oh, well, if you want to kill off a large segment of your population, Communism will still do the job for you.
Simon c
Sorry, no offence intended.
Yes, we need the private hospitals when dealing with non-urgent but painful conditions that require a long wait for NHS treatment.
The 'Farmer Giles' are better now, thanks.
now I'm off to KwikFit for spare tyre removal.
Living in America and having to recently experience the NHS for my mother I have a few observations.
The first is the NHS has most of the facilities a modern healthcare system requires, it also has at grass roots level dedicated staff.
Sadly management hasn't moved with the times.
For example over here if you need an MRI its available that day.. not 7 weeks later
If you have a CAT scan its read immediately not two weeks later.
If the budgets were adjusted to make management responsive and diagnostics a two shift program instead of 9-5 more like 7am-12am much of the problems would disappear
What is the point of having a sick patient scanned only to wait 7 days to find out what the matter is?
This tells me that a bunch of middle management needs to be fired immediately.
Lady Muck
on June 11, 2009
at 08:29 PM
You patronise me slightly but I'll let you off as you are witty in a non-Isabel way. I am more than aware I could have croaked in a private room at BUPA, and indeed have been found on the floor during a previous post-op stay - and that if I needed to go somewhere to live or die via intensive care they'd *blue-light* me off their hands.
Private care is for non-urgent things many people can afford to pay for outside the NHS - is this circling back to the argument that the latter is about A&E and a safety net for patients unable to pay? I'm not sure but I suspect something different to what we take for granted today will have to emerge.
110609-22:19
Simon Coulter 06.44
I agree that superficially the NHS isn't getting value for money compared to Private Health Insurance.
Perhaps the explanation might partially lie with the comments of Ann 09.27 who visited a hospital with a minor injury which required no medical attention, but still saw fit to complain about overstaffing !
I have worked in the NHS and note that the Consultants and Anaesthetists generally work in both Public & Private Hospitals so the quality of advice and top-end care at least is identical. The nursing staff are recruited from the NHS and may even work 'on the bank' at NHS hospitals. In time, their experience becomes outdated and to expedite careers, they may transfer back to the NHS !
There are many paradoxes. For example, in a Private hospital, a patient will have his own room, but if he falls out of bed in the night, he will not be discovered on the floor until the next nurses round. In an NHS ward his fall would normally be noticed immediately (probably by the other patients). If his condition deteriorates, he may have to be 'blue lighted' to the NHS hospital. If he dies, he will have to stay in the Private Hospital until morning (usually in his bed since there are no mortuaries).
in brief, Private Hospitals could not survive without NHS and unless you need urgent treatment for a non life-threatening condition or require your own room, you are probably best served in an NHS Hospital.
Of course, where the NHS exels is in the Emergency Treatment for life - threatening accidents, heart attacks etc. This is the expensive stuff Simon and you won't get it down the Nuffield !
Finally, look at the cost of the top end treatment, particularly ICU HDU & CCU. Our local ICU has 6-8 beds. Each patient has one nurse, 24-7. each nurse works 37 1/2 hrs pw plus holidays etc.
That is 5-6 nurses per patient, plus ward staff, plus doctors. A typical patient will be there 2-3 weeks. One third will die there. Once again' you don't get that down the Nuffield.
I am a renal patient on dialysis and couldn't wish for better healthcare. I believe the reason is that the Renal units appear to be more independent of the big hospital culture. The staff seem happy and they certainly care. My beef is with the Outpatient/Inpatient delays in most other departments (Renal is always on time) They just treat Patients as meat and their attitudes and cleanliness are abysmal.
The smaller the Hospital the better, and cleaner the care. Labour of course closed all our excellent local hospitals.Gerry Robinson showed what could be done in Rotheram but no politician took him up.
By the way, the headline NHS spend of �105Bn divided by a nominal 60M UK residents gives a fag-packet cost per head for our *free* health care of c. �1750.
That is considerably more p.a. than the sum for which I am getting full private health insurance cover, across all of Europe - at age 50+ from a UK provider.
My cover will get more expensive as I age - but for people younger than me - even with a couple of kids - an awful lot of family-wide health care could be provided via private insurance for a heck of a lot less than c. �7K p.a.
Is it time the NHS was more of a safety net and less a free-for-all? I strongly believe in free health care - but the costs of our system just don't seem to represent value for tax money to many groups in society.
110609-18:32
The NHS is not free. I pay 10s of thousands in NI and tax. And what do we get for it? Well, 1 in 46 of the population work for the NHS, so that's a lot of salary and pensions that have to be paid. Add on an unknown number of contractors as well.
1 in 46 of the population...and we still can't get a decent service. The bureacracy is over bearing and inefficient. The NHS wants to own us, our data, our bodies, and distribute information about us as it pleases.
I don't want my health details owned by the state, accessible to millions. I don't want to be messed around getting appointments to make appointments.
The staff generally look overweight, slovenly and often don't seem particularly knowledgeable. Nowadays they are only allowed to trot out the party line, of course. The NHS has become another one of the state surveillance devices, monitoring us from the cradle to the grave. Treatments are out of date, errors are rife, staff are patronising and rude, and if you refuse to give your ethnic origin they get stroppy.
I will never willingly use the NHS again, the whole experience is soul destroying.
Government will never fix the problems in the NHS because government IS the problem with the NHS.
when government is both the funder AND the provider then you have a nationalised industry. We all know the history of them.
To those that still believe, I say this.....you need the following 6 essentials to survive:
FOOD
DRINK
SHELTER
CLOTHING
HEATING &
HEALTH CARE
You're quite happy to pay for the first 5 so WHY THE HELL DON'T YOU PAY FOR THE SIXTH ?
If you are one of the millions that have been brainwashed into thinking that health care is somehow different then I say this....thank you, you selfish **** - it's because of you that our army doesn't have enough equipment, there are not enough police on the streets, there isn't enough jail space for our lovely criminals, our children are taught in classes of 30+, our pensioners live in poverty and our national transport infrastructure is the laughing stock of the developed world.
Your sacred cow is killing the rest of the farm....and it still takes forever to have your hip replaced.
It would laugh if it wasn't so ****ing SAD.
Those luddites who think the NHS can continue with successive governments throwing endless amounts of money at it, and an ageing population, are deluding themselves.
In less than five years, the cost for cancer drugs alone will be half the total NHS budget. Furthermore, those who deride a possible private option always refer to the US model; pay up or no treatment. Perhaps if they looked closer to home (France), they would see a 21st Century health service, where there is nobody begging a government quango (N.I.C.E.) for the drugs to keep them alive.
I'll tell you where are the extra � billions of taxpayers' money given to the NHS has gone - to excessive and overpaid management staff, pen-pushers, form fillers and endless tiers of management staff, many of whom are 'so good'at their jobs, that most of Britain's hospitals are riddled with infections like MRSA and C-diff!
As usual, nu labour has rewarded incompetence and utter failure handsomely; so much for their claim of being 'saviours of the NHS'.
So were are all of us,who are either retired or approaching retirement,supposed to find the cash to pay for health insurance? Unless your a government employee, your pension has probably been vastly reduced in value and the interest on any savings non-existant!
Once again we have all been 'let down' by our politicians, maybe it's time they were all sacked and made to find jobs they could actually do, perhaps collecting supermarket trolleys or stacking shelves!
Tony Blair said we have 24 hours to save the NHS, 12 years later it is still on life support.
True the budget has gone through the roof but it has been wasted, but dont blame the Doctors or Nurses its all the fault of government interference and control. Just look at where the money went, 12 billion on a computor system nobody but the government wanted, changing the management structure every other year, employed thousands more managers but cut 20,000 beds, paying 100,s of millions to rent hospitals that should have been built and owned by the government.
The only reason the NHS is in trouble is because of mis-management starting with this governments over bearing hand and lack of change, radically cut the management and red tape, let the Senior Doctors decide where the money needs to go and bring in the changes needed fast, unfortunately this government never had the guts to make the choices nessessery to get the NHS well again.
70% of diagnoses rely on pathology services which cost only around 3% of the hospital budget. After a crippling plague of managers (layers doubled), pathology is being further penalised by metastasizing CPA/UKAS/ISO quality management and accreditation which adds perhaps a third to costs. But it will assure "quality", whatever that is. Actually, it replaces quality with a "quality system" of paperwork that can be audited but assures little.
If accreditation were a medical treatment, would NICE find any evidence to recommend its use? If not, why is this relic of scientific management still being pursued?
Losing the over-management and compulsory quality cartel could increase the productivity of pathology departments by over a third.
Vote for change:
http://petitions.number10.gov.uk/PublicServices/
The NHS is similar to an African state in receipt of generous overseas financial aid. Sounds great except that little of the money finds its way to those most in need and much goes the way of those who should be sorting things out but aren�t.
Split the NHS into two -
A National Sickness Service, and
A National Lifestyle Sickness and Childbirth Service.
The first service, all taxpayers will pay towards, the second a mix of private insurance and U.P.T (Unhealthy product added tax) chargeable on all unhealthy consumables - and we KNOW what they are!
Obviously there will be grey areas but it should not be beyond the wit of man to develop sound guidelines.
All things can be unhealthy in excess (even exercise) but the beauty of the system is, the more you use, the more you pay, the more children you have, the more you pay.
What could be fairer than encouraging a healthier, less crowded nation by the freedom of choice to PAY as you GO?
I`m sure the overburdened middle income taxpayer would then feel less aggrieved about the obvious abuses to this cherished system.
Andrew Haldenby's article was selective in its choice of information and misleading in its interpretations.
Of course the NHS could save a lot money, but the solutions offered in this article were poorly thought out.
For instance, the use of a computer system to get people to the right hospital as in Denmark. We are already wasting over �12 billion on our computer system, which will not work, because the government wanted to show something impressive to the electorate.
Then he extolls the private hospitals, their lack of hospital based infections, and their cheaper costs. Well, if you only admit well people for easy surgery, people who don't need antibiotic treatment, then you will not get C diff or MRSA.
The idea that private hospitals can provide cheaper treatment is so stupid that it barely deserves an answer, but here goes. First, they are almost always more expensive for almost every procedure than the equivalent NHS service so it is hard to see where he gets his figures. Then if one adds in the cost of training doctors, nurses and all the ancillary staff, the cost of all the back-up services for acute medicine which the private hospitals don't have ( therefore they can exactly tailor their beds to their throughput ), the long term care of patients unable to be discharged from NHS beds, the mental health services, then we can see that the NHS has to provide far more than the private providers - and usually for less money.
Productivity in the NHS fallen? If that means that each patient now has more time with the doctor or nurse, surely that can't be a bad thing. The private patient always says that the private hospital is better because the doctors and nurses spend more time with them.
Could it be that the productivity has decreased because there is now an army of administrators and managers whose roles are to prepare the NHS for privatisation and creating the health market. All these people reduce productivity because they do not treat patients yet increase staff. A district general hospital used to have a manager, a secretary, a matron and a technical manager in administration. Now, all the old wards have been taken over by these administrators who contribute nothing to the treatment of the patient. They are there to provide statistics for government and not patient care. Perhaps your author might like to ask the average district general hospital how much of its total budget is spent on people who are not front-line staff.
Look also at the cost of Private Finance Initiatives. We are now getting the bills for these. Gordon Brown chose this method of finance because it did not appear on his government spending plans. Yet they are costing the NHS three times as much as the conventional cost of hospitals. Surely these are an example of how much more it costs the taxpayer when private companies are introduced to the Health Service.
Finally, if we look at the country where most of these ideas come from - America. The healthcare providers there have expanded as far as they can there because there is no more money to pay any more. These are the people who have the government's ear when it comes to NHS privatisation. In parts of America, the cost per patient for just hospital treatment per year is $15,000 per annum. The average is over $7,000. Yet the NHS which treats almost the whole population costs less than �1,500 per person - a third of the cost. Why does anyone even start to think these providers will be cheaper here?
To save the NHS we should ditch the internal market, get rid of 95% of the administrators, renegotiate all the PFIs and stop any more starting, scrap the NHS IT programme and give every patient a smartcard for which they will be responsible which has their medical data, stop further outside consultancies, introduce a no-fault, rapid compensation scheme to get rid of the legal vultures picking at the NHS. Use the money for equipment and front-line staff and we would have an NHS to be proud of
Oh dear, if you are the best that a 'think tank' has to offer, not a bit of wonder the government flounders around in a desert of ideas. I am a doctor who also thinks the NHS cannot survive, but frankly any sensible person could see what rot you are talking. You don't get it do you? It is people like you that are part of the problem. Like every health minister before you, YOU KNOW NOTHING!!!!!
There are a numbers of misleading statements in your article. I will restrict my number of arguments, despite that fact that virtually every sentence you write is rubbish.
Firstly, you talk about productivity. Doctors were working an average of 80 hours a week at the beginning of this period. Europe made this illegal, so doctors were forced by law to work fewer hours. As a result, each doctor sees fewer patients, but the commensurate number of doctors was not increased to take account for this, hence the 'drop' in productivity. Just as the Belfast streets were safer to walk when the IRA were around, it was cheaper for an exhausted, exploited doctor to treat more patients 10 years ago. Time moves on though. The dangerous exploitation of doctors was rendered illegal.
Secondly, you quote these farcical numbers for the increase in doctors. Most of these rises are down to the change from a full-time male dominated profession, to a part-time female dominated profession, as well as doctors rented for a few shifts from overseas before they are flown back. You MUST know this, so are either trying to pull a fast one on your readers, or are stupid. You must have heard of the phrase 'whole time equivalents' in your think tank, surely? IF you have, why did you try to give the impression there has been massive staff expansion when there hasn't?
Next, the comments about competing providers providing cheaper services than the NHS with fewer complications. This is also downright stupid and if your boss is reading this, they should have you on 'special measures'. The Independent Treatment Centres you refer to are designed to cherry pick the lowest risk patients. Let us take an analogy, to make it simple for you. If I wanted to set up a mechanic's garage that had high success rates for fixing cars at low cost, I would set up a Honda Civic garage and only accept cars made in the last 3 years. My costs would be low, allowing me to have a nice shiny waiting area, my technology would be new and reliable and it would take no time at all to fix these cars, with high customer satisfaction. If, however, I decided I would only take cars made by British Leyland, where the owner insisted that they will never buy a new car and demand that their British Leyland car runs to Honda Civic standards, how much do you think it would cost to fix these and how often would they break down afterwards?
C Difficile. This organism thrives in debilitated patients who have received multiple courses of antibiotics. How many of those do you see in private hospitals? You don't need three week-long courses of IV antibiotics to get your hernia done. You need to compare like with like Andrew. Is that so hard for a 'think tank' to think of?
Next, I want to come back again to the productivity farce. Given that the majority of NHS beds are filled up with acute admissions (sick people - I know Gerry and you lot don't think about them much because they are annoyingly difficult to 'pathway') and the number of beds continues to fall whilst the population ages and becomes more complex, where are we supposed to treat these patients? We don't. We kick them out earlier because we have no choice - discharge patients early or stack them up on the ramp of A&E. To continue my garage analogy, reducing the number of beds year on year is like passing a law that only British Leyland cars are allowed on the road and at the same time reducing the number of mechanic's premises.
Next, Mike O'Brien. To have a minister in this government criticise his medical team for communication is downright farcical. Where does he think those doctors and nurses are when they are not 'communicating'? Sitting on the terrace drinking coffee planning to knife the Chief Exec in the back to protect their jobs, like his ilk are? No. They are in meeting after meeting with HIS STOOGES. Justifying why the length of stay of vulnerable, frail old people is 'an outrageous' 5 days and trying not to have another 4 beds closed on his ward to fund the new chief executive's 'patient interaction lounge' advised by CityConsultingInc. last week (that idea only cost us 1 million quid as well - bargain). No, if they aren't losing the will to live trying to explain common sense to bean counters like you, your doctors are doing outreach clinics in lovely cottage hospitals to bring care 'closer to the patient'. i.e. they are in their care driving across cities and the countryside, rather than talking to patients and relatives in that den of iniquity - the hospital (that place where tests and treatments can be performed). What, they aren't at outreach clinics today? Well, they must be working on 'patient pathways', because that is now an end in O'Brien's NHS, not a means or maybe they are in A&E, trying to fight the growing tide of ill-health in today's ageing population, with fewer useful staff and fewer beds while constantly being hassled an army of clipboard carriers policing O'Brien's four hour wait.
The only bit I agree with is that the NHS should spend less. They should spend less on the opinions of idiots like you. There is a consultant in every hospital department who knows how to improve their service. If she or he was given the power to instantly dismiss any useless government stooge they interact with and redirect those resources to patient care, the NHS would improve IMMEASURABLY overnight, without the need for shareholder's dividends, like those that will cripple the NHS for decades to come due to PFI (I seem to recall you lot advising us to build hospitals on the credit card 15 years ago, which was a great idea wasn't it?)
And as for Denmark's secure records, presumably then you support our 14 billion pound government computer system. A system that will be riddled with security leaks (of course it will be, humans have access to it - the HOME OFFICE couldn't even stop leaks with the help of MI5!!!!), cost an absolute fortune for marginal clinical benefit and is EXACTLY the sort of foolery advised by the management consultants that we pay BILLIONS to.
It really is just common sense.
More doctors doctoring. More nurses nursing. More beds to put them in. It is AS SIMPLE AS THAT. The problem with that plan is: no consultants, no think tanks, no big speeches, no 'ideas', no productivity measuring, no targets and an entire industry of idiotic think tanks full of people who haven't done and honest day's work in health care are put out of business.
A truly customer-serving, cost-saving, resource maximising ethos just has to be very difficult, if not impossible, to achieve in any enterprise operating as a near monopoly - or at least as the most dominant player by far - in a marketplace.
But I may stand to be proved very wrong indeed...
New Labour's methods of finding solutions are to throw other peoples money at any problem and believe it will go away. Hence the shambolic financial waste they are responsible for. Tony Blair's promised reforms are, like him, pure wind without a semblance of substance. The two 'B's are quite a pair are they not.The NHS has become a huge guzzling monolithic giant incapable of reacting credibly to the everyday needs of the people
NuLab shovelled money at the NHS... the money was there because of a golden legacy left by Kenneth Clark. It was easy for NuLab to do that.
Not nearly so easy for the necessary reforms which NuLab patently failed to implement.
More pro-privatisation propaganda from 'Reform'
Haldenby says he has heard of "
new companies that treat NHS patients twice as well as the rest of the service (measured by complication rates after operations) at 20 per cent lower cost. "
The reality is that private health companies are ripping off the NHS- and the British taxpayer off- to the tune of �1bn.
PRIVATE health companies have milked the NHS for �1billion for operations and treatments that were never carried out.
The findings, gathered through Freedom of Information requests, have led to calls for an inquiry into flagship Independent Sector Treatment Centres.
Last night new Health Secretary Andy Burnham faced demands to disclose the Government�s deals.
The ISTCs were launched five years ago to allow private companies to help reduce NHS waiting lists.
Allyson Pollock, a finance expert who undertook the research, found some were under-used due to problems and other were unpopular because of their location.
She said: �There is nothing efficient about the NHS paying for thousands of operations that have not been carried out and the private sector pocketing the money.�
http://dailyexpress.co.uk/posts/view/105911/Scandal-of-NHS-1bn-loss.
I agree that this country needs to introduce a private type of health scheme, as this must have been so before the NHS. Since it was set up surgery has also become more expensive and complicated. People also come here from another country wanting free treatment.It would also encourage people to take care of there own health more (the more they disregard their health be it with smoking, alcohol or drugs etc) the more it costs them or increases their insurance. However some children are born with a health problem and they are not going to be able to work let alone be able to pay for an insurance, and this should be weighed up, and not given second rate care as a result of how they have been born (they cannot help it, but their parents may have been able to). I also think to that a Doctor would be liable for his own mistakes covered by his own insurance, and that too many mistakes made he would become uninsurable and unimplorable. The smaller the surgeries and hospitals also cut down infections (less sick people congregate together). The larger the hospials have become, the more infections there are, and the more visitors go in and out the greater the risk of bringing infections back out of a hospital, and this causes a circle all the time. The young have been encouraged to go on the pill, and now infections there are going back to the dark ages with antibiotic use not able to cope. The food and farming industry also come into peoples health.
Gordon Brown supplied the NHS with great sums of money but did not keep track of what was going to happen. In any Government organisation when a great pool of money is allocated the managers of that money start to dole it out and what happens, salaries go up, offices get decorated, managers 'need' more staff etc and what is left goes to the front lines services. This is what has clearly happened in the NHS. I would imagine that the money was split in three ways - two thirds to management - and the rest to the health workers. The answere to the problem of funding is to cull all the middle management and staff leaving the hospitals to take care of themselves - which they will do.
We've all got anecdotal NHS horror stories. I had trouble with my neck, saw my GP and was given a form to get an X-Ray at my local hospital. I duly took time off work in London and attended the X-Ray department in Crawley - where I was seen by a receptionist who took the GP's form - and gave me an appointment to come back in two weeks!
I was so annoyed at this completely bureaucratic waste of time I went straight back to my surgery got the same X-Ray request details and was seen at the local BUPA hospital an hour later, and had a diagnosis and the start of treatment the same day.
You don't have to be a brain surgeon to know what is wrong with the NHS. The buildings may have been upgraded (though I think you will find a reduced number of bed spaces all the same) - but the people working within them have not.
Mum was a nurse, working in a multi-grade team - always under pressure - but able to assist, wash, talk to, feed and toilet patients as much as each individual needed. There were auxiliaries, state enrolled and state registered nurses, as well as ward aides and proper cleaners. The buildings were late Victorian or Edwardian - but spotless, airy with high ceilings, and a good space between beds - and there was always time made to deep clean beds and tables between patients - and to take wards and operating theatres out of service for their periodic deep clean. Most of this has vanished today - and with this have returned infection issues relating to hygiene standards.
The point being made here is that the issues for the NHS were never about 19th C buildings being replaced by airport lounges (with pay car parks) and the like - but about the ethos of the staff, the mix and tasking.
That has all gone terribly wrong, despite vast amounts of new money, new buildings and so on. There is no step change in what is delivered - and the length of waiting lists for non-urgent procedures was never the burning NHS issue.
Value for money is lacking - and though this is a service free at every point of contact to all who come - it is paid for by the taxpayer. We can't afford to feather-bed the NHS when times are hard. It is not lean and efficient - nor even top of European league tables in much either.
The NHS is one of the three largest employers in the world. Ours is a small country � alarm bells should be ringing � because others provide a better service for a lot less money.
110609-10:12
Historically - When the NHS 'bleats' that it has run out of money - It is given more.
That regrettably is the situation - So no highly paid Administration has really been made to exercise it's skills to create economies, and make anything efficient.
Perhaps for a change it could be made to.
Yes ! I know such a statement will raise lots of cries - "What about the poor patients ? ? Indeed - But ! That is the whinge -made by these very inefficient Managers to frighten the system into giving them yet more money
It's long past time the bluff was called.
Don Eccleston: Well done a few words of wisdom at last.
For all those who condone Private Medical Insurance I would advise caution.
Whilst in the military I was in the States and met up with an old American friend. The news that he was in financial difficulty because his child was ill astounded me. He then went on to explain the American Health Insurance System. What a horror.
Fact:
It is vastly expensive.
The Insurance companies choose cost rather than quality of care.
Insurers choose who they want, and frequently turn away the "risk" element.
Treatment is stopped once a cap is reached, unless you pay yourself.
Since the Americans signed over the "state" run health care and medical service to the private sector spending has soared, quality of service has dropped, choice of hospital is not allowed, waiting times have increased and medicines have been severely restricted.
We have a very good health service but what Andrew has failed, or the Government have refused to acknowlege, is that the UK is now the target of choice for "health tourists" who are aware our hospitals will not turn anyone away, and unfortunately, a running system for charge back is not in place. Added to this is the vast rise in patients coming to the UK from Europe and around the world which the Government had not accounted for when funds were allocated.
Not only does this put a strain on the medical front line staff, trying to diagnose their problem, there is also the problem of providing interpretors, instructions for taking the medication, allocation of special resources for medical or religious reasons (which may include disposal of used medical items through to special dietary requirements), and perhaps finally, the frustration of the patients themselves annoyed with what they see as a delay.
GPs work on a different contract to hospital doctors, nurses are paid different to agency nurses, and due to the Government insistance that patients can choose a hospital of their choice, expenses have taken a leap.
The NHS it has to be admitted, is very, very top heavy with so called specialist managers. This IS purely the fault of the Government due to their obsession of meeting targets, reporting figures, implementing non sensical guidelines and promoting political rhetoric on behalf of their "Political Masters".
Keep politics and politicians out of the NHS and it will run a lot smoother.
'no free market has a conscience'
Don Eccleston
on June 11, 2009
at 08:37 AM
So its 'conscience' that gets food into supermarkets and the nation's bellies?
This is rather like the Creationist's argument that random activity cannot design an effective system. Quite the opposite!
fraser kelly medical and occupational health care manager
on June 11, 2009
at 05:59 AM
Why after reading your post dear do I imagine a five year old with a gun.
Countries that historically adopted the NHS model have moved significantly, in some way or in many ways, away from it. These days no country adopts the NHS model - at least in the form as we in the UK know it. Why is that?
Not suprised at all. Anecdotal I know, but I think my experience is not out of the norm.
I took my 9 year old daughter to the nurse for a bruised thumb. The thumb was clearly not broken, just required a bandage. The nurse left the thumb unbandaged, just recommended an x-ray, "just to be sure".
Against my better judgement, the next day, we went to an NHS drop in centre. The triage nurse didn't seem to know what she was doing, just put me on the list for an x-ray despite me saying that the thumb was clearly not broken, surely it just required a bit of support. Four hours later, I officially complained that not only was this a dreadful wait for what was a bruised thumb that just required a bandage, but I, my daughter and others in a lot more pain were expected to wait whilst the x-ray lady took AN HOUR'S lunch. Who takes an hour's lunch nowadays? I pointed out that there were FOUR receptionists at the desk, more than there were nurses. I was told that this was good, that I would be truly unhappy if I couldn't be immediately seen by a receptionist when I arrived. My response, I'm afraid was less than polite.
My impression was that my daughter's bruised thumb was simply an excuse to keep three nurses, an x-ray lady and a gaggle of receptionists in a job. That's just one patient, one very minor injury. Sorry, but the NHS is like any other public sector, too many non-jobs and people creating their own empires and systems designed to support these inefficiencies rather than the best needs of the patient. According to the NHS, four health professionals needed to individually attend to a bruised thumb. Dreadful. Not surprised at all they are in debt despite all the money they've been given.
That week, my daughter came with me to my physiotherapist. He offered to check her thumb, confirmed it was clearly not broken and showed me how to use a plaster to create a support for it. Says it all really.
"Another private hospital group has had no MRSA or C.difficile at all in its 60 hospitals for several years."
Well of course we could eliminate these from the NHS just as easily - make sure they only take elective cases from good backgrounds who wash properly (like their visitors) and who are screened before admission. Unfortunately the NHS has to take sick people regardless.
Simplistic? - maybe - but no more so than comparing an elective Private Facility with an Acute Hospital that has no choice over who and what they take in.
I notice the author also skates over the Private Hospitals where the opposite has been the case - but because they aren't covered by the inspection systems in the NHS they don't have to tell anyone - and trust me they're out there.
But I suppose it wouldn't support the agenda if a good investigative reporter went and dished the (literal) dirt on the Pivate Hospital scene?
I recently met a doctor's secretary (Mrs A) who had asked a Polish girl working at the practice why so many Poles want to come here. She cited several reasons, then ended "and of course for the free medicine". Mrs A replied " You don't get free medicine if you are working" The girl said "yes we do" Mrs A asked how come? The girl said " we just tick the box on the prescription".
Does no-one check these claims? Extrapolate this across the EU migrant workers (and others) spectrum and no wonder the NHS is losing money.
And clearly, neither Reform nor the Conservatives have any clear proposals how to break up the state monopoly which is the central problem of the NHS.
The purchaser/provider split was not sufficient to bring real competition into the NHS. It needs to be followed up by allowing PCTs- the fundholders for their catchment population- to compete with one another for patients: allow them to charge flat rate monthly top-up fees, and their members to migrate between them and non-statutory healthcare providers, which would continue getting capitation funds as now from the Treasury. The Treasury could even give personal tax allowances to offset the subscriptions.
That way a real, not just internal market, will produce the benefits of competition in both price and performance, and circumvent the Treasury's stranglehold on resources and methods, allowing patients satisfaction to trump the interests of Whitehall and NHS box-tickers.
Rest assured that privatization of health insurance will not resolve the issues currently faced by the NHS. But responsibility, sound ethics and planning will. And it is these same three factors that no market based system of health insurance or health care or pharmaceuticals can provide since, by definition and construction, no free market has a conscience. Thus, the suggestion to rely on the market to discern reasonable standards-of-health-care is, on it's very face, unconscionable and unreasonable. For proof, all one need do is look at the horror of health insurance conducting itself anathema to reasonable health care interventions in the United States: if you are well-off, you get care, but if you are not, you do not. Thus, in the United States, where free-markets trump any reasonable and appropriate conceptualization of the universal status of health care for anyone, irrespective of that patient's socio-economic status, has never been attempted and has long since passed. And, so, you might foolishly believe that humanity is better off while under the auspices of a free market as stylized and run amok by American interest in privatized health insurers' profits over and above standard medical protocols that will deny usual care to patients irrespective of socio-economic status? If you erroneously think that the American's free market regulated conceptualization is better than care provided by the NHS or that privatization of health insurance is due any consideration, consider that treatments for disease in the United States are proportional to the wealth these of these same patients or their privatized health insurance backing. Note, further, that privatized health insurers, under the guise adjectives of 'effective' instead and in fact unethically and unreasonably shift onto those who should have been covered by those insurance policies sold by these same privatized insurers costs that the privatized insurers should have covered but do not. Free markets only work when the 'customer' has choices. With that in mind, how often have you seen a physician tell a heart attack victim to make a rational decision regarding the type, time, quality, and location of the care that victim/patient obviously needs? Should the decision to treat the hypothetical heart attack victim rest, then, in and on a market having neither conscience nor humanity nor caring a whit about that victim/patient's outcome?
Rest assured that privatization of health insurance will not resolve the issues currently faced by the NHS. But responsibility, sound ethics and planning will. And it is these same three factors that no market based system of health insurance or health care or pharmaceuticals can provide since no free market has a conscience, by definition. For example, all one need do is look at the horror of health insurance conducting itself anathema to reasonable health care interventions in the United States: if you are well-off, you get care, but if you are not, you do not. Thus, in the United States, where free-markets trump any reasonable and appropriate conceptualization of universality of humanity, the Americans' privatized health insurers' attempts to bend standard medical protocols and to deny usual care to patients irrespective of socio-economic status are proportional to the wealth these same privatized health insurers unethically and unreasonably shift onto those who should have been covered by those insurance policies sold by these same privatized insurers. Free markets only work when the 'customer' has choices. With that in mind, how often have you seen a physician tell a heart attack victim to make a rational decision regarding the type, time, quality, and location of the care the victim/patient obviously needs? Should the decision to treat this hypothetical heart attack victim rest, then, in a market having neither a conscience nor caring a whit about the patient's outcome?
I have recently learned that my brother, who died of myeloma last year in Birmingham, was not offered a new thalidomide-type drug because of cost.
The NHS is terminally-sick. Scrap it completely and replace it with the excellent French model before it's too late.
We can well understand Cameron's warm feeling for the NHS due to his tragic family experience, but he should not let this influence his judgement as it appears to do.
I would be very surprised if competent management could not bring about savings and increased efficiency far in excess of the 10% being talked about currently. 20 years ago when I still lived in the UK, I had a dinner guest who felt that she could offer something to our local hospital but soon left in disgust as she was unable to make anyone do anything to stamp out rampant corruption and inefficiency. The lady in question had valuable international experience in private industry but was unable to 'adapt' to the mental attitude necessary to feel comfortable in an NHS environment.
We have the most expensive healthcare system in the world, which is also one of the least efficient. Why is it some sacred cow that cannot be given root and branch reform? Why do people think it's "free"? Why can we not have a sensible study of systems that work really well in mainland Europe and switch to one of them?
More money, less beds, and big problems such as C-diff and MRSA, why? Simply because the money is not spent properly. Too many advisers and consultants (not medical), too much waste, too many "pen-pushers," and not enough consultants, doctors and nurses. Is there anything more absurd than cutting the number of nurses directly and then employing agency nurses, which are vastly more expensive.
The NHS IT project appears to be going nowhere fast with a huge overspend. PFI (and its relatives) is not the way forward either, as the costs are in the long run huge.
Why is it that government enters into contracts that allow a company to extract more money when they run over the contracted amount? Is the NHS (and other government departments too) with the vast sums spent on advisers and consultants (non medical) incapable of drawing up a "water-tight" contract? It certainly seems to be the case.
With taxpayers money always available, and little or no accountability, the NHS can continue to spend wastefully. Until there is real accountability by making firms pay for their errors when things run over the contracted price, and NHS management face termination of their overly protected employment, nothing will change.
In short, the NHS must face the harsh reality of delivering services to the taxpayer like any other major company in the UK, instead of enjoying its profligate protectionism.
is the british nhs the 2nd biggest employer in the world (after the indian railway system)?
i've heard that gps pay is that good many need only work part-time
Buying health care from third party corporate organisations is one problem; they are in business for one reason only - to make a profit. Another is the army of pen-pushers and managers who think they can run the NHS from calculations made on a spreadsheet.
No reference to why the productivity dropped [it has started to rise again since 2007 by the way]. How do you quantify the massive drop in waiting lists, or the rebuilding of crumbling infrastructure or the absolute need to retain staff who were leaving in droves? Quality improvements dont show up in balance sheets!
If the tax payer is to pay less and services are to continue to improve it will be because of the personal contributions to private medicine that the middle classes are forced to shell out in times to come. This is one massive risk that Cameron needs to be much more honest and open about. The slapping down of Andrew Lansley is a very worrying sign of bad things to come.
We have lived abroad, in various countries, for nearly sixteen years and are used to paying for and choosing our health care providers, through health insurance. Here in Brazil, almost every street corner and shopping centre has a doctor of some kind; if you need any kind of test, there is a variety of providers to choose from - and the results are yours, to take home and have reviewed by whoever you want. They don't belong to some huge, bureaucratic organisation.
If you don't like the doctor, can't get an appointment, or prefer a different hospital, you can go somewhere else - tomorrow, and without getting permission, referrals etc.
Universal, comprehensive health insurance is the way forward, perhaps subsidised in part by the government (and with basic insurance premiums paid in full for those on very low incomes).
The government has no business to provide or manage health care - only to ensure that it is available and accessible to everyone. The whos, hows, whys, wheres and whens should be entirely up to the individual.
Why should buying healthcare be different from buying anything else? We need to get over the idea that it should be free for all at the point of delivery - getting a bill concentrates the mind, even when you know the insurer will pay. Here in Rio, a thriving city in the developing world, 50% of the population have private health insurance, compared to under 10% in the UK. Why? It should be the first item on the family budget.
Your comments about "new types of health insurance" are all very well but, until the insurance companies are prohibited from cherry-picking customers (refusing to cover pre-existing conditions), private health insurance will remain a niche that only the wealthy can afford to occupy.
almost right.
end NHS.
introduce compulsary insurance schems
call it medishield,medicare and specialised ones for elderly-elderhsield and eldercare.
they do primary and secondry care respectively.
ministry of health runs dept of quality and auditing,with depts for inovation and compliance.
current NHS hospitals can stay as restructured-ie they charge like everyone else.but with subsidies for the poor.
then lower tax by about 10 p in the pound as you reap economies from not actually micro manageing health care anymore.
the isea of getting rid of the managers who still think they are in the peoples republic of la la land is also sound.
let real health care managers take over.
and get politicos right out of it.
moh brief is simple-to facilitate appropriatte levels of affordable healthcare for the citizens of the UK.
Reform's proposals sound very rational, and well researched. I wonder what the hope of any sensible policy ever being implemented in regards to the NHS is though? And what about the over-inflated Management tier? They seem to be highly effective at raising their own salaries, creating additional, superfluous, junior management posts to make themselves feel grand and nothing else.
"Leadership doesn't mean ministers actually running the NHS � that has been part of the problem." Bravo.
It would help if Ministers or MPs did not run anything. MPs are the problem with this entire country, especially labour ones.
brown is almost right on one thing, we do need political change, but a drastic change, an MP cull. Starting with him being thrown out immediately.