What would help the NHS?

[asthmatic camel]

From the outside looking in, it seems to me that the NHS is spectacularly good at wasting money. Apart from the ridiculous fees paid for agency staff, management doesn't appear to have a clue about allocation of resources. For example, our local hospital is currently constructing a new building, whilst the existing wards are often closed due to lack of demand or budget constraints, (probably the latter).

At the same hospital, the psychiatry department, already well-appointed, has been given an expensive cosmetic overhaul and renamed "Oasis", with a nice arty sign above the door. The waiting room in the cancer ward sports two televisions, one old-fashioned type and one vast, widescreen, LCD effort. Neither are ever switched on. And the heat! The terrible, terrible heat! I'm sure nobody who visits a hospital goes there for a sauna. Can't they turn the thermostat down a bit?

Given the size of the salaries NHS managers receive, their performance is hardly breathtaking, is it?

[Pebble]

Given the size of the salaries NHS managers receive, their performance is hardly breathtaking, is it?

NHS managers are more likely to have qualifications in management than managers in the private sector. Unlike the private sector, there is no single bottom-line that forgives incompetence in all other respects, there is a torrent of government directives to be worked through on a daily basis, to determine what must be adhered to, and that which can be safely ignored.
Old wards can be remarkably inefficient - for example one may just have the option of having the heat on or off, with little option for modification. Secondly, capital budgets may be available when day-to-day expenditure is actually more vital to the survival of the organisation. Those same capital budgets can be forced on the encumbents even if they don't want them - lumbnering them with public-private longterm costs that have been rejected at a local level etc.
The system has many faults, there are incompetent, demoralised managers - unsurprising in a system that cannot fail, but that is only one of many problems. Having said all that, the waste in private hospitals, makes anything I have seen in an NHS hospital look like chickenfeed.

[asthmatic camel]

Pebble, I accept that I don't really understand the intricacies of hospital management but, what do you think about the costs of employing agency staff? My sister in law works as a nurse and earns silly amounts of money working for an agency; far more than she would being directly employed by the NHS, but often working for them. The hourly rates charged by agencies are higher than plumbers demand, and that's saying something!

There must be a better way of managing this. For example, in the private sector, banks have a list of capable people who don't or can't work full time that they can call on when permanent staff are ill etc. There must be big reductions in cost available here.

[Pebble]

Pebble, I accept that I don't really understand the intricacies of hospital management but, what do you think about the costs of employing agency staff? My sister in law works as a nurse and earns silly amounts of money working for an agency; far more than she would being directly employed by the NHS, but often working for them. The hourly rates charged by agencies are higher than plumbers demand, and that's saying something!

There must be a better way of managing this. For example, in the private sector, banks have a list of capable people who don't or can't work full time that they can call on when permanent staff are ill etc. There must be big reductions in cost available here.

Staffing is as you say a bit of a nightmare, when jobs are scarce, then you can have a full staff compliment and individuals on 'bank' - that is prepared to do occassional shifts at short notice for the same cost as regular staff. The rapid expansion of nursing requirements over the past 10 years, means that many staff do not need the security of permenant employment and can reap the short-term financial benefits of working only via agencies. In addition, since staffing levels are 'kept to a minimum' when there are unforseen events (illness, admission of patients with very high needs, holiday entitlements created by unforseen extra work etc) there is no slack and people must be found immediately. These combine to ensure that many enviornments become dependent on agency staff at huge cost.
Problems like this can arise quite unexpectedly - one longterm sick, one handing in notice, one pregnant - and take months to put right.
100% efficiency has unforseen costs in a system that must be able to respond to unpredictible demands.

[asthmatic camel]

pebble, I regard anyone who's earning £100 a day as fairly well-paid. Agency nurses can expect a whopping £24 an hour just for basic care duties, specialists a good deal more. And that's after the agency has taken its considerable fee. So, for an eight hour day shift, doing nothing particularly special, a nurse gets £192. As I understand things, that's about twice as much as NHS staff nurses are paid and the agency fee isn't likely to be small.

How much would it cost the NHS to administer its own bank staff agency? I can't help feeling that there are significant savings to be made here. According to the conservatives, agency staff can cost as much as £146 per hour. That's just wrong.

[Pebble]

How much would it cost the NHS to administer its own bank staff agency? I can't help feeling that there are significant savings to be made here. According to the conservatives, agency staff can cost as much as £146 per hour. That's just wrong.

That is free market economics in operation, you pay what it is worth to you not what it costs. As explained above, the NHS does manage its own bank staff, but when jobs exceed supply - this is the result. There are potential savings if nearby Trusts worked together, but competition has reduced the attractiveness of this option. The fundamental problem is the huge expansion in nursing posts and roles without an adequate supply.
Look at it from the NHS perspective - is it cheaper to pay the ransom demanded, or the law suits that result from an understaffed ward, or the govt. penalty for failing to meet the targets.

[asthmatic camel]

pebble, I'm not convinced that agency nurses would stay in bed rather than earn £15 per hour for performing basic duties. Set a cap on the hourly rate available, and I'm damned sure we would still find people willing to fill short-term vacancies. Where else will they earn that amount?

[Tim the Mage]

pebble, I'm not convinced that agency nurses would stay in bed rather than earn £15 per hour for performing basic duties. Set a cap on the hourly rate available, and I'm damned sure we would still find people willing to fill short-term vacancies. Where else will they earn that amount?

Would it not be easier to reduce reliance on agency nurses? I'm sure that this is fundamentally a game of budget ping pong - agency costs are a different budget from core staff costs so when the latter is spent up there's an escape valve and vice versa

[Tony Williams]

Incidentally, this is one outsider's view:

Having just survived a life-threatening medical experience, I can only express my thanks to the NHS: from the National NHS helpline, which determined that an ambulance was required; to the paramedics, who were knocking on the door within five minutes; to the multitude of medical staff who struggled to find the cause of my condition. The last used a variety of examination procedures including ECG, X-ray and full-body scan to identify the problem and start the treatment which saved my life.
With nine stitches in my head and eight units of blood in my body, I spent the next five days as an in-patient under observation. This gave me a chance to observe the everyday provision of services in the hospital.
I was impressed by the war on the MRSA super-bug, the attention to general cleaning, and the nurses and doctors who were cheerful and polite. The food would win no stars, but it was more than sufficient and I left hospital a kilo heavier. Having supervised the provision of hospital cleaning on various USAF bases in the UK, I feel qualified to make the above comments.
The American critics of the NHS know nothing of which they speak. Being an American living in Britain, I prefer the money-losing socialist NHS, which provides an adequate health service for 100% of the population using 8% of the GDP, to the American for-profit system which provides a more-than-adequate service for 80% of the population costing 16% of GDP.
The Obama healthcare reforms currently being attempted do not address all of the problems, but would be a start. If the opposition, who are a minority of Americans, fail to respect the wishes of the majority and succeed in stopping the reforms, it will be a tragedy.
George D Lewis, Northamptonshire
Published in The Independent, mid-March 2010

[Ryoden]

I work for the NHS and one of the potential savings that was mentioned earlier in this thread is already being moved into place (at least in our trust). A new pension, all new staff members go on it automatically but old staff are being encouraged to take it up, I havent had a chance to look at it in detail yet but I have been told (unnoficially) that it's not a final salary pension.

We are also going for foundation status again, which from my understanding makes us more likely to either do really well or fail spectacularly and shedding staff by the hundreds while the upper managment walk away with a golden parachute and a new job where they can try harder. hopefully if we do get it our management team will achieve the former.

[Matt]

The whole opt out thing is now a legal requirement or rather will be by 2012. Start a job and you'll be in the pension scheme by default. If your employer doens't have they own scheme then you'll be enrolled in "Nest"

You're just not going to find a new final salary (a.k.a. Defined Benefit) pension scheme. The ones that do exist are slowly being closed, first to new members and then to future accruals.

The new pension quality mark will let you know if your Defined Contribution scheme is "best of breed"

[spanner]

My first post. The ConDem budget has just been presented and the NHS is effectively a ring-fenced protected species. The NHS is also an ideological state apparatus. If it didn't exist it would have been invented solely as a device of government and the state to perpetuate themselves.

[Croydon Bob]

If it didn't exist it would have been invented solely as a device of government and the state to perpetuate themselves.

I don't really understand what you are trying to say. It's the sort of thing a conspiracy theorist might come out with.

The NHS was "invented" out of a long-held ideal that good healthcare should be available to everyone regardless of wealth. It didn't just "exist", it was created in 1948.

[Pebble]

My first post. The ConDem budget has just been presented and the NHS is effectively a ring-fenced protected species. The NHS is also an ideological state apparatus. If it didn't exist it would have been invented solely as a device of government and the state to perpetuate themselves.

As an ideal access to healthcare free at the point of care is not such a bad one. Most people do not really plan longterm, if they do, they plan for certanties but rarely adequately for possibilities. Insurance companies, despite making grandiose noises, provide inadequate cover for needs and work hard at extracting maximal income for minimal expenditure - hence the US healthcare system leads to more bankrupt people than any other outlays. When you consider these facts, what is wrong with universal healthcare?

The Liberals may have been conned, but not everyone has been.

[spanner]

The NHS is an institution, like the armed forces, Parliament, education, the legal establishment. Its function is to process nationwide illness and ideally to ameliorate this illness. As an apparatus, a system of applied medicine, it exists (how it came into that existence is beside the point).

It is by any standards an unwieldy project and imperfect, much like its consumers. However we approach this phenomenon as consumer or pundit or both we might be excused for believing that the NHS exerts a certain impact in our general society as a gigantic presence, in all areas of public and private being. Part of this 'experience' of the NHS can legitimately be philosophized, which is why I described it the way I did. It is ideological because that is what it has become since its inception. It is a bearer of ideology, an instrument of statecraft and policy, a cause to be argued over, funded by the state through taxation, a target in part or whole for privatisation, a high profile item on any government's hit list (or the converse as suits the political moment, hence my 'ring-fenced' comment).

I am conscious that I did not address the thread question in my post. In that I believe the NHS is self-perpetuating by virtue of its inner dynamic and its structures, then the issue of what might 'help' becomes contested as a project. Whatever ideas we came up with here there would be little or no application of these ideas to the reality of the NHS as a device of the state because it is the state as we experience its effect on us. To be sure I go in because I have a bout of pneumonia and leave pumped full of anti-biotics, eventually recover and have this feeling that the hospital is beneficial for me. It saves lives too. Or do I? If the experience was bad through weak diagnosis, poor nursing, grim food, etc, then my post-hospital feeling is not euphoric. However, did I have a choice to go elsewhere? Was there an alternative source of health care? If I wanted private treatment could I afford it or is such provision forever out of my grasp?

Now go back to the general concept of the state. Think about freedom of choice. Think about freedom per se. Then think about the NHS. No I am not a conspiracy theorist but I do see how the world turns and how structures can determine who we are and what happens to us to some extent. The NHS is part of this fabric of determination, in fact it is over-determined by virtue of the impact and intervention of other factors upon it, including my relative poverty, age, education and ignorance or otherwise as a consumer of the NHS. The NHS is not free standing. It is central to what constitutes the idea of the British state apparatus.