How to "save" the NHS

TractorStats

War Hero
The problem there is that the contracts were structured in such a way that made it impossible for other companies to tender, and also that the duties and responsibilities implicit in the contracts have been consistently badly specified and poorly managed. And ultimately the same failing companies were selected for the work because they knew how to tick the right bureaucratic boxes, rather than on proven/provable ability to actually do the tasks that were required.
Absolutely nailed it there. The useless public sector mindset just hands out a tender that embeds the 'useless public sector mindset' in the form of a contract. It happens time and again and the same old useless outcome still happens with a minor reduction in cost and the private sector contractor walks off with a profit by reducing the quality of delivered food service. Patients are very unhappy but public sector manager takes the credit for cost reduction and directors of private sector contractor count their bonuses.
 
You'd think so, wouldn't you. But as I said, how have the messages that 'smoking kills' '7 units of alcohol a week', and 'don't fill your children with fat, salt and sugar' actually worked?

Because from where I sit, they haven't. And they are costing more every week.
Michael Moseley had an interesting series (still on All4 I believe), about junk food and the marketing behind it etc. May be of interest in to some of the why certain things/messages don't cut through and stick.
 

Grownup_Rafbrat

ADC
Kit Reviewer
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If they are failing companies, why aren't they simply refusing to take these contracts they know they can't honour and fulfil?
No contract company ever admitted it couldn't fulfil a contract.

In fact responses to tender invitations rarely show true staffing need, equipment need or running cost. Army Recruitment being the worst example.
 
If they are failing companies, why aren't they simply refusing to take these contracts they know they can't honour and fulfil?

Failing from the point of view of the end-user, in terms of what we/they hope to see as results from many large projects, not from the viewpoint of the bods told to get a service out-sourced or the companies 'winning' the process.
 
But you blamed the public sector when it’s private, so are you now going to blame the private sector?

The private sector will, quite rightly, work to the contract. If there is leeway for them to improve their position by reduce the implied tasks down to the shorter list of specified tasks, then they can hardly be blamed for improving the results for their share-holders. The whole procurement process seems to be managed by those a few rungs lower in effectiveness, than those making the bids. In turn, this situation is a choice made by politicians (via CS) in one form or another, and who elects politicians??? They must be daft . . .
 

TractorStats

War Hero
I've worked in the Ambulance Service in Glasgow for 6 years and I have to say that everything we are struggling with in our local services was predicted and already taking effect before I started.

I'm only a lowly clinician so I can only speak of what I encounter on a daily basis and as much as I'd love to have solutions for the problems, some are well above my pay grade but I can touch on some popular points from my point of view and I suspect some of the madness is reflected elsewhere in the system.

I'll leave it there as a wee snapshot of things as I could go on but as I said much is above my paygrade and I don't have the statistics to back anything up. Fwiw for those who have been failed by the Ambulance Service and lost loved ones please understand we share your anger and as I said, we've been warning about it for years but the ones who make the noise don't get into the positions to change anything and suggestions are usually forgotten or aren't heard unless they come from management or an outsourced data company.
I just want you to know that I carefully read all that, mostly with my head in my hands, and that while I don't agree with the 'clap for carers, angels, tik tok hero nonsense' most sensible people know that 90% of the front line staff are doing an absolute bang up job every day. The other 10% need their backsides kicking like every organisation. Meanwhile 90% of the management is stuffed full of the jobs for the boys clipboard waving types swinging the lead and taking the absolute **** in many cases and would not be missed. The other 10% of management need promoting. I spend a lot of time in hospitals as an outpatient so I just quietly put up with it and try not to make the jobs of front line staff any harder.
 
Failing from the point of view of the end-user, in terms of what we/they hope to see as results from many large projects, not from the viewpoint of the bods told to get a service out-sourced or the companies 'winning' the process.
True, though sorting out the NHS is with goal of making it better for the end user in many areas. If companies are failing in that regard, then are they really the answer to the problems or will we be simply replacing one system under immense strain and coming up short, with another that will also come up short.

Either way health and lives are genuinely at stake.
 
I refer you for a cough, you have an x Ray and it’s not cancer that’s great.
I don’t refer you, you’ve got lung cancer, you go to hospital, you need surgery, you need treatment and it costs lots but you still die.
I refer you, it’s caught early, you’re treated and survive, what to do?
If all a GP can do is refer me elsewhere, they may as well be automated.
We'll all die of something, preventing one potential cause won't stop the others, unless the NHS constantly monitors every patient.
 

Mbongwe

War Hero
If all a GP can do is refer me elsewhere, they may as well be automated.
We'll all die of something, preventing one potential cause won't stop the others, unless the NHS constantly monitors every patient.
You seem to be saying that unless the NHS implements a system in which no-one ever dies, there's no point trying to prevent anyone dying?
 
It might be different now, but 18 years ago I needed a crutch to assist getting about for a fortnight after getting run over. I spent almost two days on the phone trying to hand them back (you got prescribed a pair regardless), only to find there was no returns system for them, or any mobility assistance device.
All such devices are not accepted back as the NHS fears it will be sued if anything goes wrong so they get dumped or exported.
 
A very informative post. Thank you for writing it.

Accountants and physiotherapists can make good managers I'm sure but IMHO have no place in leading a blue light organisation where they fail to take on board the troops ideas or concerns.

IME, anybody from any discipline can make a good manager, provided they have the right attitude, some intelligence and a willingness to learn some of the basics of what their troops are doing. I've encountered a couple of very switched-on cookies who had fine arts degrees yet were very capable engineering project managers (I'm a physicist by education, so if you ever tell anyone I said that, I'll have to execute you and your audience. Sorry about that).

Another thing I noticed very early on in my engineering career is that some bad managers have had little supervisory background and little management training. In some cases, it wouldn't have made much difference, but in most other cases I'm sure it would.

Response times-

My experiences have been that the paramedics have turned up pretty quick and started diagnosis/treatment immediately. However, delays can certainly occur at the receiving end. I've lucky to only have had one protracted wait in a corridor with the paramedics.

chronic conditions that a person has been having for a week and done sod all about.

I've done that. However, 'sod all' means thinking "It's just a bug/back pain/whatever, it'll pass in a couple of days like they usually do", and it's only by day 4,5,6 that the thought "Hmm, this isn't right. In fact, it feels almost like it's wrong, but I'll give it another day" pops into the head.

Then the back pain morphs into a couple of paras kicking your kidneys apart, and the bug turns out be a kidney infection/whatever which has finally taken the hill your body has been staunchly defending for the past few days. Oddly, even my acute events happen on a Friday afternoon.
 
You seem to be saying that unless the NHS implements a system in which no-one ever dies, there's no point trying to prevent anyone dying?
Not at all. But generally anyone over 60 already knows they're counting down anyway, the actual cause is irrelevent to most.
And realistically, how much do you want to spend on extending the lives of the no longer productive?
 
Not at all. But generally anyone over 60 already knows they're counting down anyway, the actual cause is irrelevent to most.
And realistically, how much do you want to spend on extending the lives of the no longer productive?
That's a very mercenary use of words for anyone over 60
 
That's a very mercenary use of words for anyone over 60
It's also an open question on the economics of healthcare. My late father died just shy of his102nd birthday, in hospiral and being treated, but realistically that bedspace could have bern used for someone with a longer projected lifespan?
It may be draconian, or fascist, or whatever label you care to use, but it's a decision someone in authority needs to make.
 
Absolutely nailed it there. The useless public sector mindset just hands out a tender that embeds the 'useless public sector mindset' in the form of a contract. It happens time and again and the same old useless outcome still happens with a minor reduction in cost and the private sector contractor walks off with a profit by reducing the quality of delivered food service. Patients are very unhappy but public sector manager takes the credit for cost reduction and directors of private sector contractor count their bonuses.
Capita ^ in a nutshell.

Except when they screw up they walk away virtually unscathed via small print that locks their contribution within a severance penalty, along with contractual non-censuring of the partnership failings.



 

Mbongwe

War Hero
Not at all. But generally anyone over 60 already knows they're counting down anyway, the actual cause is irrelevent to most.
And realistically, how much do you want to spend on extending the lives of the no longer productive?
From the day you're born, you're know you're counting down to death, whether that be 60 years or 100.

What puzzles me about your point is the notion of where you think we should give up on preventing poor / worsening health.
 
It's also an open question on the economics of healthcare. My late father died just shy of his102nd birthday, in hospiral and being treated, but realistically that bedspace could have bern used for someone with a longer projected lifespan?
It may be draconian, or fascist, or whatever label you care to use, but it's a decision someone in authority needs to make.

Did he cut you out of his will or something?

My late father died just shy of his102nd birthday, in hospiral and being treated, but realistically that bedspace could have bern used for someone with a longer projected lifespan?

If we're going to be draconian about, refuse treatment to those who refuse to adopt healthier lifestyle after being treated for pieabetes and lager liver. I know of people in their 80s and 90s who are still productive or were so until the end. Some 103-yr old might just live long enough to finish the definitive guide to That Rifle, and I can't imagine a better use of a blocked bed ... especially against some of the mouth breathers whose lives you want to extend.

Anyway, give me a few pictures of Commander Ivanova and I'll soon show you who can be productive. :twisted:
 
Homeless don't want food. They want money for their addictions.
If you gave them at out of date sandwich and the got ill, probably not from the said sandwich, they would try to sue the NHS
@Micawber why the dumb?
 

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