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[pscocoa]

My father died in Tameside Hospital in March this year and he had been in several times in recent years as had my mother who is now in a nursing home.

I do not know what to say really when I read the clams about the neglect and putting targets before people etc. They used an example of a patient who was allergic to penicillin being given penicillin - and yet this happened to my mother in law 2 years ago in Truro Hospital and the effect of that was terrible skin damage and other things which may have accelerated her demise in July last year. Truro is not on the black list as just announced.

At Tameside I have seen very good caring things but also had to deal robustly with the areas where they declare a pateint medically fit and start to arrange to send them home - when they are not fit. I was fortunate to be able to more than fight my parents corner in this respect but can well imagine problems in those cases where no proactive family member is on hand.

With my father he had recovered from death's door on several occasions in past few years but when he went finally it was nevertheless a surprise in some ways but he was in a bad way all round and it was a blessing he went when he did.

I wonder how I would fare (or how long) as CEO of a hospital trust instead of CEO in private sector where I am today? You are trying to deliver against massive expectations and yet you have all sorts of bureaucracies and reporting and targets to deal with as well - way beyond accountability to shareholders within a financial investment model.

http://uk.news.yahoo.com/report-slams-high-death-rate-nhs-hospital-200852635.html#8RsH80B

[Varche]

I have long thought the NHS has lost its way. Inefficiency and bad practice is institutionalised.

It is full of people who go home each day and say to their partner. "I worked really hard today" . They probably did but were they working smartly? Mostly not. To give just one example. The person rescheduling appointments for whatever reason. Shouldn't even need that job(s).

Mrs V's aunt had her cataract operation rescheduled 4 times. What does the surgeon and team do during the missed, cancelled operation? The fourth time they wanted to cancel because her warfarin level might be too high. Fair enough except with help from Mrs V the local doctor adjusted her level and tested twice before the day of the op. Each time (as a registered blind) she had to make her own way 70 miles to the hospital and 70 back.

A root and branch change would help but lets be honest that isn't going to happen.

[Rods2]

This is where the French system is so much better. You choose where you want treatment from about 50% public and 50% private hospital mix. They then get paid for the treatment provided. Now the French system has a means tested contribution system, but I can't see why the same model can't be used with free at the point of access.

It means that bad hospitals get no patients and earn no money. There is nothing like the prospect of going bust and losing your job to motivate management and employees to make sure it doesn't happen. This is why for a similar cost to ours of about 7% of GDP they have much better statistical outcomes including cancer survival rates. I have several friends that have retired to France and the say the difference between the NHS and the French health system is chalk and cheese. One is first world and the other isn't.

Political and vested interests will make sure such a successful system is never adopted here, we have to settle for our third world NHS (National Homicide Service, from so many reports we are now receiving) and first world costs. Without the establishment of patient treatment and payment from a national health fund, it won't matter how many five year tractor plans they have to reform the NHS, the Soviets showed us the results will always be the same where it uses the same sort of Stanalist system. Einstein summed it up well: "Insanity is doing the same thing again and again and expecting a different result".

Like the Dilbert cartoon, the NHS and other public services exist primarily as an end to those that run them. This year our public services are costing £715,000,000,000 yes almost 3/4 of a trillion pounds. This is £11,500 for every person in the UK. Do you think you get good value for money? I certainly don't.

Countries like Denmark, Sweden and Switzerland have high Government spending on public services, the difference is that their systems seem to work well. We have the worst of all worlds with high taxes and spending and very poor services.

The NHS is very error prone where most hospitals still use written notes. Not only is computerization more efficient, but it is proven that good computer systems reduce errors. Like using a barcode system for drugs, which is scanned before it is administered to make sure it is the right patient and they have not known allergies to that particular drug or class of drugs.

[Rog]

I have very close links with the NHS, it is my biggest customer. But I also have a family and all the same health issues that everyone has. Overall I consider myself to be in a good position to make informed comments.

We all know that there is no quick-fix or instant solution for the NHS.

One of the biggest problems is that the government (any colour you like) relies on it's information from NHS managers. A manager at the top gets info from the one below and on downwards through the food chain. Each and every manager has to protect his/her own position, look good, and avoid any flack. The result is that the info getting to the top is flawed, and in some cases downright lies. I am not in favour of privatising the NHS but in a private commercial company, if such mis-information got to the top and someone up there finds out, someone gets fired. Not in the NHS.

What we end up with is a jobsworth culture from top to bottom. Even nurses who see the elderly and nervous Mr Jones as just the last in the queue before the shift finishes and it's go home time. The result is sloppy work. Not everwhere of course, but frequently.

So what about money ? Everyone loves to blame the woes of the NHS on "The Cuts". Sorry I just don't wear it. The amount of money I see wasted is phenomenal. There were recent reports of pharma companies overcharging and working fiddles. Crooked companies ? yes of course, but only because the system permitted it. I routinely see loads of cash almost thrown away in a huge number of different ways.

I must stop, I could go on-and-on-and-on. It just makes me mad. 

I sell medical stuff. When I am at a hospital I often ask myself "Would I be happy for a close member of my family to be treated in this department ?". Most of the time the answer is Yes, but unfortunately there are frequent "No's".

 

[RobG]

The amount of money I see wasted is phenomenal.

There were recent reports of pharma companies overcharging and working fiddles

I routinely see loads of cash almost thrown away in a huge number of different ways.

the NHS, it is my biggest customer.

I sell medical stuff.

I assume that your pricing policy is a "fair" one then Rog, and not "what the market will stand" (or what the NHS will pay)

[Rog]

The amount of money I see wasted is phenomenal.

There were recent reports of pharma companies overcharging and working fiddles

I routinely see loads of cash almost thrown away in a huge number of different ways.

the NHS, it is my biggest customer.

I sell medical stuff.

I assume that your pricing policy is a "fair" one then Rog, and not "what the market will stand" (or what the NHS will pay)

HaHa !  Yes of course, point taken.      

Actually, yes I do think I'm fair and ethical. But I have one customer that orders exactly the same item several times a week with each separate order incurring delivery charges and processing cost at both ends.

A recent customer spent over £3,000 on an optional extra for some equipment although I told the purchasing department that it was not required. It really was not required, but a box got ticked and the stuff is sitting in a cupboard unused.

In the last couple of years hospitals having been striving to buy "Robotic Surgical Systems". They cost in well excess of £1m, cost hundreds of thousands a year to run before it is even used, the surgery takes longer, the benefits are highly questionable, the per procedure cost is huge, and probably in a few years time they will be out of date or discredited in some way. Managers like them as they are something to shout about "look what we've got".

I could go on . . . . . Yes I do have a vested interest, but I am also a tax payer.

 

[RobG]

HaHa !  Yes of course, point taken.

Glad you took it as a non-hostile comment Rog

[Rog]

HaHa !  Yes of course, point taken.

Glad you took it as a non-hostile comment Rog

But of course  however I'll be around to beat you up later 

[Rods2]

The amount of money I see wasted is phenomenal.

There were recent reports of pharma companies overcharging and working fiddles

I routinely see loads of cash almost thrown away in a huge number of different ways.

the NHS, it is my biggest customer.

I sell medical stuff.

I assume that your pricing policy is a "fair" one then Rog, and not "what the market will stand" (or what the NHS will pay)

All businesses try to price their products to maximise profits. This is profit per unit v amount sold at this price. This is never an easy calculation with the two extremes being stack them high and sell them cheap, relying on small profits from large volumes to exclusive expensive labels charging premium prices and making large profits on small volumes to keep them exclusive. The former are brands like Primark, Aldi and Kia, the latter Burberry, Rolex, Ferrari etc.

Any term with the word "Fair" in it is meanless as it is subject to your frame of reference. A free market price is what I'm prepared to sell to you at and what you are prepared to pay or vice versa. The element here is the ceiling and floor prices for each side and their respective negotiating skills. Now I would hope an organisation the size of the NHS would have professional buying departments. If the NHS is being ripped off then heads should roll here. One of the problems you have with supplying goods and services to the public sector is the amount of hoops and hurdles you have to go through just to be an approved supplier. By its very nature this costs money to conform to which is passed onto the customer and it limits competition which is also likely to push up prices.

[Rog]

Any term with the word "Fair" in it is meanless as it is subject to your frame of reference. A free market price is what I'm prepared to sell to you at and what you are prepared to pay or vice versa. The element here is the ceiling and floor prices for each side and their respective negotiating skills. Now I would hope an organisation the size of the NHS would have professional buying departments. If the NHS is being ripped off then heads should roll here. One of the problems you have with supplying goods and services to the public sector is the amount of hoops and hurdles you have to go through just to be an approved supplier. By its very nature this costs money to conform to which is passed onto the customer and it limits competition which is also likely to push up prices.

Actually, that really is part of my point. They do, and for the most part they are staffed by incompetants or spotty 17 years old with zero experience. The big trick these days is to try and outscource procurement therefore relieving them of any responsibility whatsoever. There is a big organisation called NHS supply chain that promises NHS buyers lower prices and simpler procurement. Although they use the NHS logo, it is run by DHL, which in turn is owned by Deutch Post, yes folks the highly profitable German Post Office ! NHSSC buy from us, and then resell to the NHS making a profit. Hmmmmmm, now that must be cheaper surely ?

[albitz]

Your comments (particularily in your first post) are very interesting Rog,and confirm several things I was already pretty sure off.
Colchester hospital is on the list of 14 which the Govt. are looking at.
some of the treatment my family have received in that hospital in recent times has been utterly appalling. Including potentially fatal errors.Imo many of its staff (including especially nurses and doctors)should only be employed in a hospital if they are picking up fag butts in the car park.

[Varche]

It would be a brave government to implement root and branch changes as opposed to tinkering. I am afraid the waste ,inefficiency and malpractice will just continue. We do not (in Britain) have brave governments, though this one is trying its best on welfare. They all hope for a return of the "good times" where spending can just continue to balloon OR the next election.

[D]

Rods2: France spends more per GDP on healthcare than the UK. From memory it was 10% vs 7%. The number of various specialists in France per 1000 population is much higher than the UK. We seem to use GPs as a quick fix for everything. As an example, the waiting list for a patient to be slotted into a colleague's specialist Rheumatology clinic is 7 months. But the clinical commissioning groups want the GPs to handle this specialist care. But patients want to see a specialist for their difficult to control Rheumatoid arthritis, not a generalist. But that isnt what the govt. want. Who do you think will win? Not the common man, I can assure you.