Coronavirus

[1andrew1]

Originally Posted by Damien

Because we've underfunded it for years compared to other similar countries: https://www.ft.com/content/f752a1ad-...9-4909974c6a2c

It's not a surprise that with that underinvestment we're also seeing much longer waiting lists since 2010: https://www.bbc.co.uk/news/health-60305502


And again this started before COVID hit. COVID made it worse for sure both the virus itself and the subsequent delayed treatment from the year lost but when you run a health service that can't meet the demand it already had, there is no capacity at all to deal with a crisis.

Look at that BBC article about cancer waiting times. The number of people urgently seen for cancer has dropped from 90% in 2010 to 80% by 2017 and now 70%!

The NHS has got measurably worse. I don't know why we're just accepting such declines.

Exactly.

People are accepting it because:

- Populism There's still a spill-over of populism. "If the NHS was more efficient with its money then there would be no problems." "We need more nurses and fewer admin staff. Once that's done, it will improve."
The we-can-have-our-cake-and-eat-it belief.

- Taxation People don't want to pay higher taxes in order to get a better service. More so with other costs rising. Apart from higher borrowing, that's what they will have to do. If you've got good private healthcare, you may be happier with the lower tax, lower NHS service trade-off.

- Party loyalty. Party loyalists will obviously defend their Party in almost all circumstances with an anecdotal, approach. "X party couldn't do any better." "Everyone's been complaining about the state of the NHS ever since I was a toddler."

Originally Posted by 1andrew1

Exactly.

People are accepting it because:

- Populism There's still a spill-over of populism. "If the NHS was more efficient with its money then there would be no problems." "We need more nurses and fewer admin staff. Once that's done, it will improve."
The we-can-have-our-cake-and-eat-it belief.

- Taxation People don't want to pay higher taxes in order to get a better service. More so with other costs rising. Apart from higher borrowing, that's what they will have to do. If you've got good private healthcare, you may be happier with the lower tax, lower NHS service trade-off.

- Party loyalty. Party loyalists will obviously defend their Party in almost all circumstances with an anecdotal, approach. "X party couldn't do any better." "Everyone's been complaining about the state of the NHS ever since I was a toddler."

Also, "is there a better way of funding/delivering healthcare free of charge at the point of need".

I don’t mean the farrago of nonsense that is the US Healthcare profit monster, I mean something like the French, German, or Australian models - we need to go back to basics and redesign the system and processes to ensure adequate funding and services.

[TheDaddy]

Originally Posted by Hugh

Also, "is there a better way of funding/delivering healthcare free of charge at the point of need".

I don’t mean the farrago of nonsense that is the US Healthcare profit monster, I mean something like the French, German, or Australian models - we need to go back to basics and redesign the system and processes to ensure adequate funding and services.

You might mean something like France or Germany but who are the tories inviting to get involved with our healthcare, American companies...

Originally Posted by Hugh

Also, "is there a better way of funding/delivering healthcare free of charge at the point of need".

I don’t mean the farrago of nonsense that is the US Healthcare profit monster, I mean something like the French, German, or Australian models - we need to go back to basics and redesign the system and processes to ensure adequate funding and services.

Yeah, it needs to be both. The NHS might well need reform and we can look to France or Germany as a reference point but if we're spending 20% less than France then we're not going to get their levels of care.

I would also want to see what would actually be gained from a European model. One advantage of our system is the simplicity of the service for a patient. There is no topping up of your medical insurance, no Carte Vitale to scan, and no paying your GP and then getting it reimbursed. The French system seems to have multiple options for insurance from the state or your workplace as well which seems confusing.

The main advantage seems to be all the other ways you end up paying for it from personal top-ups to workplaces explicitly paying for health insurance means it's politically easier to funnel more money into the system than when it comes out of general taxation.

[tweetiepooh]

But I know that there is huge wastage in the NHS like all large organisations and it's not those doing the work at fault.
People also want more from the service but less willing to pay more for it.
The NHS is doing tasks that should be done by other organisations or families - some social/discharge care could be done by families, in the case of older patients by their children. (Not all).


It is in a mess and has been for many decades but just injecting cash is not going to fix things. And it's not going to be fixed quickly, so what is the priority? Do you focus on prevention, caring for the most numerically, caring for the most critical clinically or something else? As with COVID stats it must be remembered that behind the figures are individuals.

Originally Posted by tweetiepooh

But I know that there is huge wastage in the NHS like all large organisations and it's not those doing the work at fault.
People also want more from the service but less willing to pay more for it.
The NHS is doing tasks that should be done by other organisations or families - some social/discharge care could be done by families, in the case of older patients by their children. (Not all).


It is in a mess and has been for many decades but just injecting cash is not going to fix things. And it's not going to be fixed quickly, so what is the priority? Do you focus on prevention, caring for the most numerically, caring for the most critical clinically or something else? As with COVID stats it must be remembered that behind the figures are individuals.

From above

Populism There's still a spill-over of populism. "If the NHS was more efficient with its money then there would be no problems." "We need more nurses and fewer admin staff. Once that's done, it will improve."
The we-can-have-our-cake-and-eat-it belief.

Do you have any evidence to back up your assertion "I know that there is huge wastage in the NHS like all large organisations"?

You may believe it, but can you *verify it (considering there have been so many initiatives/reorganisations in the last 20 years)? There is wasted effort in any large organisation (by the very nature of the beast), but "huge waste" is an unquantifiable and emotive sound bite.

https://keepournhspublic.com/factche...onal%20funding.

In one international comparison, the NHS scored 4th out of 11 rich countries when their health systems were compared for administrative efficiency[1].

However, while there are some areas of waste in the NHS they do not negate the need for additional funding.

Here’s an interesting article from a couple of years ago..

How much money does the NHS waste? http://www.bbc.co.uk/news/health-37715399


*anecdata doesn’t count…

Fax machines.

A single example, but an indicator of wider cultural resistance to new and more efficient ways of working. As recently as 5 years ago the NHS was reckoned to be the single biggest purchaser of fax machines in the entire world. It took a government directive in 2019 to forcibly stop the purchase of new (!) fax machines in England and several hundred are still in operation.

The delightfully unreformed Welsh version of the Labour Party is still allowing their purchase and use in NHS Wales.

https://www.walesonline.co.uk/news/h...g-fax-22899228

[tweetiepooh]

I used to work for the NHS first in Chem Path and then IT. I saw and experienced some of the inefficiencies though to be fair when you are dealing with very large organisations some of those are needed to allow for proper governance.
I needed to buy a new PC and it took a lot of work to get the unit that did what I needed to. The standard PC would have been more expensive and less powerful.

[ianch99]

Originally Posted by Damien

The NHS has got measurably worse. I don't know why we're just accepting such declines.

This is the point I am highlighting. I don't understand why so many are content to see this.

Originally Posted by tweetiepooh

I used to work for the NHS first in Chem Path and then IT. I saw and experienced some of the inefficiencies though to be fair when you are dealing with very large organisations some of those are needed to allow for proper governance.
I needed to buy a new PC and it took a lot of work to get the unit that did what I needed to. The standard PC would have been more expensive and less powerful.

But that’s been the default in most large organisations (well, the ones I’ve worked in) - standard IT equipment/builds are simpler and easier to maintain (so it would be more inefficient if a large amount of non-standard builds were available by default).

We got round that issue by having a number of standard builds (general office work, IT developers, marketing, etc.) - I know this is how it currently works in NHS Digital, as I have a couple of ex-colleagues who work there.

[Pierre]

Originally Posted by Damien

Because we've underfunded it for years compared to other similar countries: https://www.ft.com/content/f752a1ad-...9-4909974c6a2c




It's not a surprise that with that underinvestment we're also seeing much longer waiting lists since 2010: https://www.bbc.co.uk/news/health-60305502



And again this started before COVID hit. COVID made it worse for sure both the virus itself and the subsequent delayed treatment from the year lost but when you run a health service that can't meet the demand it already had, there is no capacity at all to deal with a crisis.

Look at that BBC article about cancer waiting times. The number of people urgently seen for cancer has dropped from 90% in 2010 to 80% by 2017 and now 70%!

The NHS has got measurably worse. I don't know why we're just accepting such declines.

Is that "spending" or "funding"?

other countries may well "spend" more, but it is not all "funded" by taxation. like the nhs is.

---------- Post added at 14:27 ---------- Previous post was at 14:26 ----------

Originally Posted by TheDaddy

You might mean something like France or Germany but who are the tories inviting to get involved with our healthcare, American companies...

of course you plenty of examples

---------- Post added at 14:32 ---------- Previous post was at 14:27 ----------

Originally Posted by Damien

Yeah, it needs to be both. The NHS might well need reform and we can look to France or Germany as a reference point but if we're spending 20% less than France then we're not going to get their levels of care.

You need to bottom out the spending /funding definition. France and Germany may spend more because they have some sort insurance element to fund it as well as from taxation.

The USA spends loads on health care but funds little of it from taxation, everybody needs some sort of insurance. (generally, there is help for some people).

[pip08456]

Originally Posted by Chris

Fax machines.

A single example, but an indicator of wider cultural resistance to new and more efficient ways of working. As recently as 5 years ago the NHS was reckoned to be the single biggest purchaser of fax machines in the entire world. It took a government directive in 2019 to forcibly stop the purchase of new (!) fax machines in England and several hundred are still in operation.

The delightfully unreformed Welsh version of the Labour Party is still allowing their purchase and use in NHS Wales.

https://www.walesonline.co.uk/news/h...g-fax-22899228

They'll not be able to use them soon.

For 20 years, the fax machine’s beeping, static-strewn screech was the sound of the future. But the pace of technology is pitiless: like carrier pigeons, portable cassette players and videocassette recorders, the fax machine is finally an official relic of the past.

The death sentence was handed down on Tuesday in the form of Ofcom’s announcement that it was minded to back the government’s decision to remove the requirement for fax services under the Universal Service Order (USO) legislation. These are the rules that ensure phone services are available to people across the UK at an affordable price.

As ubiquitous as fax machines were in the 1980s and 90s, their obsolescence comes amid the industry-led migration from the public switched telephone network to all-internet protocol (IP) telephony, which means that fax machines will no longer work in the same way.

Ofcom’s move comes after the government amended the Electronic Communications (Universal Service) Order 2003 to remove facsimile services from the USO from 1 October 2022.

https://www.theguardian.com/technolo...-office-staple

Originally Posted by Pierre

Is that "spending" or "funding"?

other countries may well "spend" more, but it is not all "funded" by taxation. like the nhs is.

You need to bottom out the spending /funding definition. France and Germany may spend more because they have some sort insurance element to fund it as well as from taxation.

It's spending. Let's use France as I looked into that a while back and I think it's not all funded by direct taxation but ultimately it's enforced insurance that operates like a tax, similar to national insurance. So the majority of people have compulsory deductions from their pay checks as does their employer.

The weirdest thing they do is a top-up scheme you can pay more for that means optical and dental (and a few other things) are covered as well.

I prefer our system as it's simpler and I think it's possible to fall through the gaps in the French one even though in theory those out of work should be covered by a state-provided insurer.

But when we say 'insurance' we're not talking about private insurance like in the United States, it's compulsory and backed by the Government. I think it's what the Americans call 'single-payer'.

[tweetiepooh]

Originally Posted by Hugh

But that’s been the default in most large organisations (well, the ones I’ve worked in) - standard IT equipment/builds are simpler and easier to maintain (so it would be more inefficient if a large amount of non-standard builds were available by default).

We got round that issue by having a number of standard builds (general office work, IT developers, marketing, etc.) - I know this is how it currently works in NHS Digital, as I have a couple of ex-colleagues who work there.

It's easier now that hardware is cheap enough to over spec the basic so most users can use that standard and the exceptions can be dealt with.


Then the standard was way below what I needed and to get what I needed from the standard supplier was hugely more expensive with much longer wait times.


I am aware that IT systems are more complex and integrated than when I was trying to get the right serial library to get a PC to talk with a bit of lab equipment but I look at how projects like the NHS national network is reported and I just wonder.


One of the issue I had with the integration above is that the equipment had no idea of a patient as an entitity. It knew about an inpatient or an outpatient but not just a patient that may have both inpatient and outpatient tests. (The nature of the hospital I worked out meant some patients were admitted for extended periods and the consultants would see them as part of their outpatient clinics so a patient could be in and out at the same time, logically possible). This incompatibility is what gets sited as one of the big issues.


But when I was doing patient systems the NHS had a huge set of manuals about how data was "formatted" and how different data sets were related. It may not be possible to force this on the different NHS units but you should be able to specify that in how they communicate. e.g. you will receive queries in this form and you will reply in this form, how you achieve that is not important. That way you specify the communication but not how any one platform manages it. This is probably too simplified in these days where there is a lot more done with computers.


Other inefficiencies included getting rid of bad staff, not those who commit some form of malpractice but those who know how to work the system to their benefit. Insisting on following procedures/protocols that while important could be short circuited in some cases to get the job done faster. (Not all cases, not all the time, not just to avoid paperwork/documentation.)



I'd hope demarcation is mostly gone. Obviously some jobs must be done by the appropriate persons but sometimes if something needs doing and you can do it, just do it.

I think we are in danger of wandering away from the topic of this thread..