Why Cameron’s funding for the NHS will be worse than Thatcher’s


9:42 am - February 18th 2011

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contribution by Richard blogger

The Conservative party went into the 2010 election with the slogan “I’ll cut the deficit, not the NHS”.

Labour knew that it was not possible to do the former without doing the latter, and because they didn’t give a straight answer about how they would change NHS funding, they lost their traditional NHS electoral advantage.

But how do the spending committments, only now coming to light, match up?

The House of Commons Library Standard Note SN/SG/724 gives tables of NHS spending from when the service was created.

These are “real terms” prices from 1974/75 to 2014/15, the last five years are the planned expenditure by the current government.

The actual data is plotted in blue. I have also fitted two trends to this data (the red dashed line). Although there is some variation, it is clear that from 1974 to 1998 there is a year-on-year increase (in real terms, around £1bn each year).

Technically the government has met the pledge of a “year-on-year real terms increase”. Since the amount of money going into the NHS will not decrease this means that NHS funding has not been “cut”.

However, this is not what the public interprets when they think about a cut in funding. To the public a cut is when the NHS is receiving less money than it needs.

This graph shows three approaches to the NHS funding.

The first is the Thatcher/Major approach that is roughly a £1bn real terms increase every year. We know from experience that this lead to long waiting times, poorly maintained hospitals and demoralised staff. The NHS was clearly not being funded appropriately, it was not receiving the funding it needed, even though there were a real terms increases.

The second is the Blair/Brown approach that is roughly a £4.8bn real terms increase every year. We know from experience that this lead to short waiting lists, new hospitals and well paid and well trained staff.

The third is the Cameron approach, which is a tiny real terms increase every year, (and if inflation rises, a real terms cut). We know that the Thatcher/Major approach produced bad outcomes, so the only conclusion we can make is that the Cameron approach will be devastating.

The difference between the green dashed line (Blair/Brown) and the blue line is the cut that the public will bear. The graph shows that if Cameron had taken the Thatcher/Major approach he would give more money to the NHS, and we know from experience that the NHS would suffer.

(To those people who will inevitably claim that the NHS was over-funded during the Blair/Brown years, tell me why you think that the Thatcher/Major approach is also too generous for Cameron.)

The fact that the NHS will get “increases” that make Thatcher/Major look generous means that the NHS is heading for a financial crisis.

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Reader comments


Yes and no. I think – and correct me if I’m wrong, Richard – but Labour was also preparing to restrict NHS funding post-election, so the green dotted line on your second table is at variance with what would actually have happened. Labour’s plan was to make a real terms funding cut – health wasn’t ‘ring fenced’ – although there was none of this White Paper nonsense (yet).

Your figures ignored the huge PFI issue – where the Labour government were able to show improvements in the NHS, only by dumping the cost onto the next government to sort out.

So, a portion of today’s spending is going on yesterdays improvements. It is therefore obvious that the budget will shrink in real terms – but only because the previous government screwed it up for todays users.

Unforgivable stupidity.

Anyhow, it is also generally accepted that tax payer funds were poorly spent during the Labour years, so taking just that situation, if you rip out the inefficiencies that built up, then you should easily be able to lower the spending without impacting on the quality of service.

Finally, an increasing percentage of NHS spending is going on what we might term “lifestyle issues” and the question might be asked whether the tax payer should be expected to apply expensive medical remedies to health issues which are a result of personal choice – not accidents of birth/genetics or sheer bad luck in life.

Cutting down on those lifestyle treatments could easily lower the NHS costs and also release more funds for essential medical treatments.

“However, this is not what the public interprets when they think about a cut in funding. To the public a cut is when the NHS is receiving less money than it needs.”

Then the public needs some urgent help with basic mathematics, (or could it be that some politicians consistently lie to the public about it and the poor benighted fools trust their dear leaders).

This also nicely illustrates why our healthcare system needs to be reformed. There is no end to the requirements of the NHS because it’s level of efficiency doesn’t increase even in line with people’s demands. We cannot go on forever increasing proportion of money we spend on healthcare.

“The third is the Cameron approach, which is a tiny real terms increase every year, (and if inflation rises, a real terms cut). We know that the Thatcher/Major approach produced bad outcomes, so the only conclusion we can make is that the Cameron approach will be devastating.”

Please see today’s SMBC cartoon for the obvious reply to this point:

http://www.smbc-comics.com/index.php?db=comics&id=2159#comic

” it is also generally accepted that tax payer funds were poorly spent during the Labour years”

Tell that to the 90% of people who are satisfied with the NHS.

“So, a portion of today’s spending is going on yesterdays improvements.”

A portion of today’s NHS spending has always gone on yesterday’s improvements, ever since the creation of the NHS which was built on borrowed money.

“We cannot go on forever increasing proportion of money we spend on healthcare. ”

This is a point that really does need to be addressed. However I am not convinced that the conservative approach of GP comissioning will do this – it sounds to me like a recipe for lots of money ending up in the hands of skilled salesmen and medical reps. Plus it will be a lot harder for GPs to refuse to pay for homeopathy, faith healing and other woo as at a local level patients who believe in it will be an effective lobby group in the way they haven’t been able to for NICE.

I think a more effective way of reducing costs over the long term is in focusing on preventative medicine, promoting healthier lifestyles and reducing demand on the system.

Every political party who has acquired power in the last fifty years whether Labour or Conservative has been remarkable only in the breadth and depth of their lack of concern for the citizenship they were supposed to be working for, but were instead using to their own ends.

All of our politicians are criminals with legal backing. None of them are better than this, almost all of them are worse.

What your analysis leaves out are the big savings to be made by cutting bureaucracy that the government will be putting back into frontline care.

“However I am not convinced that the conservative approach of GP comissioning will do this”

It may, it may not. What we really need is some mechanism to allow different ideas to compete over time, that way we could find out which one was best. I’ve been banging my head against my sacred copy of Das Capital but I just can’t think of anything that could work.

“I think a more effective way of reducing costs over the long term is in focusing on preventative medicine, promoting healthier lifestyles and reducing demand on the system.”

If you could make this work without it ending up as top down, often counter productive and at best wasteful, nannying then bravo, I just don’t see how you could.

“What we really need is some mechanism to allow different ideas to compete over time,”

Well as health is a devolved matter, we have the potential for different ideas on how to do it in each of the 4 nations.

“Tell that to the 90% of people who are satisfied with the NHS.”

That people are satisfied with something does not mean that it cannot be made more efficient. Perhaps if the money had been better spent they would be even more satisfied.

If your in need of the NHS it’s always there, it may be a bit slow it may even be a bit of a hobby horse for Tories and new labour, if your ill disabled or sick, it’s the difference between life and death.

But the NHS rise in doing paid work has been noticed, for example I had a mild heart attack, if I had to wait for an appointment it would taken four months, if your willing to pay which most people do, they you can be seen within hours.

Many doctors will use this, some more then others, over the years of being disabled I’ve paid out thousand to be seen over and above people waiting on the NHS.

Then again with my mild heart attach I was seen the same day after paying £150, while waiting I had another attack while in hospital, it was being in hospital that saved me.

Swear to God, these NHS posts attract trolls like flies around shit.

‘We cannot go on forever increasing proportion of money we spend on healthcare.’

Given that we live in a country that is still subsidising banks by £30bn a year (or a third of the NHS budget), I find that argument somewhat absurd.

This graph shows three approaches to the NHS funding.

A (real-terms) reduction in the rate of increase is not a reduction in funding. To describe one as a ‘cut’ goes against just about everyone’s normal definition of cuts.

Certainly, the UK population has risen since the early 80s, life expectancy has increased, and the number of health conditions for which an effective treatment exists has increased. It’s not surprising therefore that the NHS’s necessary costs rise in real terms over time, even accounting for improvements in efficiency and treatment effectiveness. Nor is it in dispute that in the 80s it was significantly underfunded for what it needed to achieve.

However, we’re not going to drop back to Thatcherite NHS standards just because NHS funding only increases on an inflationary basis for a few years either.

That’s not to say we won’t drop back to Thatcherite NHS standards, but if we do it will be because of misallocation of funding, short-termist populist cutbacks to back-room admin staff whose employment actually saved the NHS money on average, cutbacks on the effective public health and preventative treatment campaigns, wastage on endless reorganisations, and other bad political decisions, not because the total funding level stopped increasing for a few years. (Keep it up for longer than a few years, and it would start to become a problem)

Another useful link: http://www.badscience.net/2011/02/andrew-lansley-and-his-imaginary-evidence/

15 major re-organisations in 30 years. Perhaps that is the main problem.

@ Richard Blogger

Would you care to put up a corresponding chart of productivity in the NHS?

I think I may have found the logical flaw here:

However, this is not what the public interprets when they think about a cut in funding. To the public a cut is when the NHS is receiving less money than it needs.

Um, no. I think you’ll find the public would consider that underfunding, not a cut. You see, whilst the public may not have degrees in economics (apart from those of the public with degrees in economics…) they are as a rule not stupid. And therefore they will be perfectly capable of seeing that a rise from £1000 to £1001 is not a cut.

Your entire argument is based round an assumption the public are too stupid to understand what a cut is, what underspending is and what a rise is. Seems somewhat unlikely to me, but maybe I only hang around a particularly intelligent section of the public?

Watchman

So you haven’t heard the phrases ‘real terms’ and purchasing power then?

Before the groans go up ‘well she would say that wouldn’t she’, please read on:

There is always money to be found quickly for a war [witness Iraq invasion] so forget the aching ‘need’ to cut NHS to plug the defecit. Just look at the facts.

No-one would say that the present system is perfect – but dismantling it is not the answer. We are still the envy of most of the rest of the world – and I say this having lived in a different country and experienced the sheer beaurocracy and inequality of the system there – where the richest got the best drugs and the poorest, well basically suffered… and that was in a country where health care insurance was compulsory but [a] one could ‘decide’ how much cover one wanted dependent on how much one could afford and [b] once on that cover the insurance company could not refuse to renew your cover/raise the premiums extortionately once you became too old or ill to be profitable. Nor could it refuse to cover a new arrival into the family if the new baby had an expensive medical problem. Both these things happen with private medical insurance in the UK.

Sure, there are reforms that may be made in the present system and some of those reforms may save money and some may cost money – swings and roundabouts. Some hospitals/doctors/nurses/physiotherapists/outpatients departments/etc etc may be better than others – but then some bus services/department stores/hotels/builders/car mechanics/etc etc may be better than others. What we should all be doing is not knocking the NHS but supporting it an discussing ways to improve it.

I made a comment in another place that Aneurin Bevan must be weeping in Heaven. I am not sure if he believed in Heaven but he is certainly in my Heaven and we have a duty to see that he is happy there. OK a bit sentimental, so if you like it better, Nye loved a drink so lets drink to the NHS!

20. alienfromzog

What your analysis leaves out are the big savings to be made by cutting bureaucracy that the government will be putting back into frontline care.

hahahahahahahahahahahahahahahahahahahaha

(sorry, but no one told me it was that easy.)

AFZ

Hardly worth having a debate with some of the morons who post here. They are the kind of people who will support whatever the Tories do, supported policies which caused the rapid corrosion of the NHS under Thatcher and will lie and lie again over the coming years as it happens again. They simply are not honest and rational partners in debate and are best ignored.

Peter Ward,

So you haven’t heard the phrases ‘real terms’ and purchasing power then?

Erm, yes. And I looked at the graphs and made sure they were corrected to 2009/10 spending levels before I posted.

Richard’s post may be flawed in its assumptions about the public; it is not flawed in the comparative measures on the graphs, which are corrected for purchasing power (if you want to phrase it that way) by prices all being normalised to a common year.

Of course, it may be the medical purchasing power is decreasing at a greater rate than overall purchasing power, but that needs to be shown before it can be assumed.

And, incidentally, I bet most of the public (contra Richard’s implied expectations) know what real terms and purchasing power represent as well, even if they don’t know the actual terms.

“The second is the Blair/Brown approach that is roughly a £4.8bn real terms increase every year. We know from experience that this lead to short waiting lists, new hospitals and well paid and well trained staff.”

Perhaps I could inject a little basic mathematics here? Some compounding?

The NHS budget is around £100 billion, so Brown’s things was to raise this 5% in real terms each year. OK.

GDP for the entire country is £1,400 billion give or take. And trend growth is about 2%.

So, what happens in one century’s time?

Yes, the NHS budget is now £13 trillion and GDP is £10 trillion.

I think we can see there that we cannot simply grow the NHS budget by 5% each and every year. Not in the long term at least.

Now it is true that health care is a superior good (a technical term meaning that as we get richer we spend an increasing portion of our incomes on it). And the NHS does indeed have a higher inflation rate than the general one (partly because it’s the NHS, a centrally planned thing, and partly because it’s a service).

So, what are we going to do about it?

“Well as health is a devolved matter, we have the potential for different ideas on how to do it in each of the 4 nations.”

Oooh, yes, that’s a good idea. So, what is the result that we can see from the fact that it has been a devolved matter for some time?

Well, NHS England took a more market based approach than did NHS Wales or Scotland. And, get this, standards improved more in Enlgand at lower cost than in either Wales or Scotland.

So, it appears that the way out of our problem, that we cannot simply raise the NHS budget forever, is to use more markets.

How excellent, I look forward to seeing everybody get behind this idea then…..

“So, what is the result that we can see from the fact that it has been a devolved matter for some time? ”

Experimenting with different approaches under a devolved system – 1

UKIP policy on devolution – 0

😉

A more interesting question – and one I wish would be subject to a major public hearing is how much are we willing to spend to save a life or extend it by a few years?

£10? of course.

£10,000, easy to justify.

£3 million – hmmm.

£100 million – on just one person?

So where should the limit be placed?

The idea that spending on the NHS can – and should – always be in an upwards direction is one that needs debating, and yet few people seem willing to do so.

I see that countries such as India are able to deliver a private health care system for the middle-classes who can afford it – that delivers about 90% of the quality of the NHS, but at about half the cost, because their customers simply can’t afford to pay more than that.

They have to be cheaper – but also they don’t spend money on services that are nice to have, but in their customers opinion, wasteful of scarce resources.

So the question that would be interesting to know – are we getting value for money from that 50% of the NHS spending that delivers just 10% of the value added services?

Are we happy to pay that extra amount, or would we as a society be happier with a vastly cheaper health care, but one where more people are told that it is just not cost effective to spend tens of thousands of pounds on keeping them alive for just a few more months?

I think that would be a very interesting debate to have – and far more enlightening than the cuts vs spending debate that rarely takes into account what we get for what we spend.

26. alienfromzog

@23,

Tim,

Now it is true that health care is a superior good (a technical term meaning that as we get richer we spend an increasing portion of our incomes on it). And the NHS does indeed have a higher inflation rate than the general one (partly because it’s the NHS, a centrally planned thing, and partly because it’s a service).

You are right in pointing out the higher inflation rate in the NHS but are wrong on the reasons. Healthcare inflation is higher all over the developed world – especially in the US which is the lease planned system.

Well, NHS England took a more market based approach than did NHS Wales or Scotland. And, get this, standards improved more in Enlgand at lower cost than in either Wales or Scotland.

Post hoc ergo propter hoc.

The evidence is that a more market based approach in the mid 90’s resulted in lower quality of care*, so I wonder if the differences between England and other countries in the union might be due to something else?

AFZ

*Proper et al. (2002), University of Bristol:
http://www.efm.bris.ac.uk/ecsb/papers/deaths.pdf

“so I wonder if the differences between England and other countries in the union might be due to something else?”

Now we’re getting into the complexities and controversies around funding for the devolved regions, whether a needs based approach is used etc. I suspect the differences are partly due to lower funding – both historical and current – and the greater pressures we face. Basically we are fatter, more depressed and unhealthy in Wales than in England.

So much for the Tories protecting frontline services and guaranteeing the NHS will be safe in their hands!

29. the a&e charge nurse

I see finances have forced St Georges to shed 500 jobs with the loss of 100 beds and a cap on how many women can birth there (creating a major headache for local maternity services).
http://cohse-union.blogspot.com/2011/02/st-georges-hospital-cuts-500-posts.html

First we had Cameron’s pre-election pledge that there would be no more ‘top down’ changes to the NHS.
Then there was predictable guff about how ‘front line’ staff would not be cut.
http://www.guardian.co.uk/commentisfree/2010/dec/19/editorial-nhs-reform-andrew-lansley

The simple reality is the Dave & Andy cannot be trusted – not many people either inside or outside the NHS either asked for or want these damaging reforms (and for reforms read privatisation).
Here is a very good letter from a GP explaining to politicos why patient’s will be harmed once bed losses, staff cut backs (a la St Georges) and the increased effect of bogus markets really begins to bite.
http://www.taxresearch.org.uk/Blog/2011/02/07/dear-patient-the-letter-every-gp-should-be-sending/#comments

30. the a&e charge nurse

Perhaps I should have added – Kingston hospital in southwest London will lose 486 staff, almost 20% of its total workforce, over the next five years. In an email to staff, its chief executive, Kate Grimes, said two key government health policies had forced the decision and warned that its action would soon be repeated by others.

Doctors’ leaders warned that the loss of 986 jobs at the two London hospitals would prove to be “the tip of the iceberg”.
http://www.guardian.co.uk/society/2011/feb/17/nhs-hospitals-axeing-frontline-staff

The bottom line is David Cameron promised during the General Election Campaign to ring fence the National Health Service to gain votes. He should keep to that promise otherwise he is a Liar and gained votes under False Pretences and should be removed from office because in my personal opinion he would be guilty of making Fraudulent claims for gain.

Let us not forget that another General Election Campaign promise that David Cameron made was if you are Sick, Disabled, Old, Frail or Poor you would have nothing to fear if he came into Government and now the evidence shows that this was another General Election Campaign lie.

The list of Lie’s and broken promises is becoming longer and longer. We have been lied to and taken for a ride on an enormous scale and to me that makes this Government Fraudulent and unfit to serve this country.

If we were starting from scratch the NHS model would not be my preferred system. However, we have it as it is and although it is not the best in the world it probably provides the best value for money in the world. For what we spend we get more out of it than any other nation. Sure, others do better and they also spend more. Therefore, objections to the NHS can only be ideological as the costs arguments are spurious. Plotting trend charts is ridiculous. Circumstances, treatment needs, inflation and economic performance changes. Therefore, budgets can’t be fixed that way.

It is frankly absurd for the Conservatives to complain about bureaucracy when they were the ones who started the bureaucracy in the NHS with the internal market reforms. There were ‘ 510 senior NHS managers in 1986 and 13,308 in 1991. ‘ I was looking at an old James Le Fanu article from 1994 and he cites the example of ” St Richard’s Hospital in Chichester was managed by a staff of six in 1986; by November 1993 this had risen to 54. ” This is what happens when you bring ideology to something that is operating as a public good. All we get is more bureaucrats and the one thing we know about bureaucrats is they will replicate. So we went from 5% of the NHS going on administration to now three times that. Obviously the NHS needs motivated staff and pay is one factor. The problem with the last Labour government is too much of the additional funding was consumed in higher wages.

http://www.jameslefanu.com/articles/politics-the-shortest-way-to-ruin-a-health-service

@1. Chaminda

Yes and no. I think – and correct me if I’m wrong, Richard – but Labour was also preparing to restrict NHS funding post-election, so the green dotted line on your second table is at variance with what would actually have happened. Labour’s plan was to make a real terms funding cut – health wasn’t ‘ring fenced’

No. As I addressed in this blog post Labour made no pledges one way or the other. The nearest that we have is Darling’s March 2010 budget (which Labour said they would implement after the election if they were re-elected) which said:

6.13 In the 2009 Pre-Budget Report the Government made a clear commitment to protect key frontline public service priorities in 2011-12 and 2012-13 and announced that:
NHS frontline spending – the 95 per cent of near-cash funding that supports
patient care – will rise in line with inflation;

That is, for those two financial years there would be flat funding – exactly what the Tories are implementing now.

The Tories pledge to have “year-on-year real terms increases” in the NHS has already been shown to be a small real terms cut (because inflation is now projected to be higher than when the spending plans were made last year). Under Labour, at worst, we would have the same funding that the Tories are inflicting, and at best (once they realised the damage that flat funding will cause) give higher funding for the two following years. The Tories plan flat funding for four years.

@2. IanVisits

Your figures ignored the huge PFI issue – where the Labour government were able to show improvements in the NHS, only by dumping the cost onto the next government to sort out.

Sigh. The figures I gave include all NHS spend. It includes servicing PFI. That is PFI from the Major years, Blair/Brown years and Cameron’s years. So I have not “ignored it”.

So, a portion of today’s spending is going on yesterdays improvements. It is therefore obvious that the budget will shrink in real terms – but only because the previous government screwed it up for todays users.

Huh? huh? huh?

Given that we needed new hospitals (and if you say that we didn’t then you are showing total idiocy), the government had two options: PFI or public sector borrowing. And guess what? In both cases a proportion of today’s spending will go on today’s hospitals that you built yesterday by borrowing the money.

While I have my own issues with PFI (namely the fact that it did not transfer risk to the private sector) your rant is baseless.

@16. Tyler

Would you care to put up a corresponding chart of productivity in the NHS?

As you well know, we have had these conversations before on this site. The ONS figures on NHS productivity (tediously repeated by the Tories) is flawed because it only covers 80% of NHS activity (missing out areas where there have been improvements in productivity), and does not cover agency staff.

York University have recently provided more accurate values and they say:

[There were] year-on-year increases in the number of patients treated meant that output growth averaged more than 3.8% per year up to 2003/4. The net effect, though, was slightly negative productivity growth between 1998/9 and 2003/4.

This has since changed. NHS output has continued to rise, but at the faster rate of 5.7% a year. … Since 2004/5 growth in inputs has been matched or slightly exceeded by growth in outputs, so recent NHS productivity growth has been slightly positive.

So basically, there were small drops in productivity until 2003/04 and after then there have been small increases year-on-year in productivity. There is a graph in the report (Centre for Health Economics Research Paper 57).

@23.

The NHS budget is around £100 billion, so Brown’s things was to raise this 5% in real terms each year. OK.

No. As I showed, this was the policy from 1997. And guess what? The public had voted specifically to increase the NHS budget to the European average (in proportion of GDP). There was a mandate to increase NHS funding.

So, what happens in one century’s time?

Of course you cannot increase it relentlessly. This post gives a graph of the NHS spending as a proportion of GDP. We are currently at arounf 8%, but if we want the French system that so many right wingers lust after, we will have to spend 11%, well off the top of the graph.

I suggest that we put a cap, say 10% of GDP and at that level we will still have a better NHS than we have now. But to get there, we cannot have Cameron’s flat funding.

Two relevant news reports which have been missed in the discussion here:

First, try this interview in the FT of David Nicholson in December 2009:

“The National Health Service can make the £15bn to £20bn of savings needed during the next three years without damaging the quantity or quality of care – indeed while even improving the latter – according to David Nicholson, the NHS chief executive.” [December 2009]
http://www.ft.com/cms/s/0/6fba7dfe-e683-11de-98b1-00144feab49a.html

Second, try this recent assessment by the National Audit Office in its report on: Management of NHS hospital productivity

“Hospital productivity has fallen over the last ten years. There have been significant increases in  funding and hospitals have used this to deliver against national priorities, but they need to provide more leadership, management and clinical engagement to optimise the use of additional resources and deliver value for money.”
http://www.nao.org.uk/publications/1011/nhs_hospital_productivity.aspx

38. Arthur Seaton

Get this – the BMA are now seriously considering industrial action. That’s right – GPs on strike – un-fucking-precedented.

http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4128590&c=2

The forest u-turn is just the start. If the BMA action goes ahead, we really have got the fuckers on the run………

For info:

– Comparative national spending on healthcare: this chart shows spending on healthcare in 2008 as a percentage of national GDP for OECD countries:
http://www.oecd.org/dataoecd/45/55/38979836.pdf

The US comes out top in spending but few believe healthcare there for the average citizen is better than that in most west European countries. Evidently the quality of healthcare services for the average citizen depends on more factors than just spending.

– As for trends in UK public spending on the NHS:

“The NHS inparticular has experienced substantial growth, with average annualised real increases of 3.2 per cent under the Conservative governments from 1979 to 1997, and 6.3 per cent under Labour from 1997 to 2008.” [IFS Survey of Public Spending – p.15]
http://www.ifs.org.uk/bns/bn43.pdf

The sad thing is being satisfied with something does not mean it’s being run well, for example in my hospital for every nurse that works in the hospital they have four managers. For every manager they have two secretaries.

Go down to speak to somebody within the local health center you have to go through at least three people who are pen pushers to get to the nurse to be seen by the doctor all doing the same thing passing paper.

41. alienfromzog

@40, Fred

The sad thing is being satisfied with something does not mean it’s being run well, for example in my hospital for every nurse that works in the hospital they have four managers. For every manager they have two secretaries.

Really?
Nurses make up 30% of NHS staff. Managers make up less than 4%.

The hospital trust I work in employs around 7000 staff (it’s a big trust). Around half of these are nurses ~3500. In a smaller hospital, they may well be employing ~500-1000 nurses to cover all the shifts on all the wards 24 hours a day as well as outpatients, A&E etc.

So are you trying to tell me that your hospital employs 1000 nurses, 4000 managers and 8000 secretaries?

In which case, I’m really pleased. Because if we close your hospital we will have made the massive savings the NHS is being made to make, in a stroke!

AFZ

@38

I wouldn’t get to excited. Below is one of the reader responses to the article you linked to:

“This is utter Luddite stupidity and will play straight into the Government’s hands. This is exactly the head-in-the-sand posturing that we heard from the BMA about GP Fundholding. We have spent the last 13 years or so griping,quite rightly, about the incompetency of PCTs and Trusts. We are now being given an opportunity to do it our way, to actually have the power to enact radical change as our patients’ advocates, and what do these numpties want to do? Go on strike!!! Give me strength!
If you withdraw your labour not only will you lose public sympathy in less time than it takes to say: “I need antibiotics NOW”, but you will throw the door wide open to Any Willing Provider before you can say “Branson”.

43. Chaise Guevara

@ Fred

“Go down to speak to somebody within the local health center you have to go through at least three people who are pen pushers to get to the nurse to be seen by the doctor all doing the same thing passing paper.”

…and your point is?

Why does everyone buy into the “paperwork iz evilz” racket? It’s bizarre, especially as many of the same people are outraged when organizations like the NHS make administative errors. It’s like we’ve developed a social phobia of the written word or something.

FWIW my own impression based on personal experience is that routine, low-level administration is the least satisfactory aspect of the NHS.

I’ve already posted elsewhere about being asked to sign a surgery consent form which specified the wrong operation, and about the lamentable failings of the NHS Choose and Book system for arranging hospital appointments – at a hospital appointment just last Thurday, I was told the hospital avoided using it.

I can readily cite several further examples from personal experience of flawed basic administration such as the request in August 2007 to return to the hospital pathology department to provide another blood sample as insufficient was taken at my “recent” test, which was in the previous April. It took the pathology department from April to August to recognise that they had taken insufficient blood for all the tests requested by my GP.

Another recent example was a letter booking an appointment for a post-surgery review at a named ward which had ceased to exist years before because the premises had been converted to another purpose. Understandably, none of the signposts on the hospital site referred to the named ward and several hospital staff whom I asked initially for directions couldn’t offer guidance.

In some contexts, flawed administration can have potentially disastrous consequences.

45. Chaise Guevara

@ Bob B

“FWIW my own impression based on personal experience is that routine, low-level administration is the least satisfactory aspect of the NHS.

In some contexts, flawed administration can have potentially disastrous consequences.”

Sure. But that means we need to improve admin, not bewail its existence. I know bureaucracy is a dirty word in most parts, but you can’t run a complicated human system like the NHS without it. You’d have no checking of potential employees’ expertise, no medical records, no way of booking appointments…

The problem is, of course, that the benefits of so-called red tape are far more indirect than those of, say, a bottle of antibiotics. So we take it for granted while complaining that it costs money, and politicians can use it as an easy target when they talk about saving billions of pounds by cutting “waste”.

“I know bureaucracy is a dirty word in most parts, but you can’t run a complicated human system like the NHS without it.”

The problem is that the NHS is a particularly complicated system and a very large one. You therefore hit the twin problems that you genuinely need a lot of bureaucracy to run it and that it will tend to multiply unnecessarily over time, (as with all very large organisations).

If you want less bureaucracy then the obvious solution is to change the system rather than tinker round the edges.

47. Chaise Guevara

@ 46 Falco

“If you want less bureaucracy then the obvious solution is to change the system rather than tinker round the edges.”

Firstly, I’m not sure that you do want less bureaucracy. Pointless or harmful red tape should of course be identified and removed, but that doesn’t mean having less bureaucracy is a positive goal in and of itself.

Secondly, what’s your basis for saying that it’s better to change the system than “tinker round the edges”? If you got rid of the NHS you’d have to replace it with something else, and there’s no reason to assume that the new system would be any less bureaucratic or wasteful. Also, the process of changing the system would presumably be very expensive in terms of both financial and human cost. That doesn’t mean that you shouldn’t do it, but you would need to have the benefits worked out and costed beforehand.

@ Chaise Guevara

“But that means we need to improve admin, not bewail its existence. I know bureaucracy is a dirty word in most parts, but you can’t run a complicated human system like the NHS without it. You’d have no checking of potential employees’ expertise, no medical records, no way of booking appointments…”

I agree with that. More importantly, healthcare professionals that I’ve talked with about this say that they don’t have enough admin support.

My impression is that this is a complex issue to resolve in London and the South East regions.

Low level NHS admin can be very boring work (IMO) and I suspect hospitals usually have a problem attracting and retaining admin staff because local (usually buoyant) job markets can offer more attractive opportunities to women – and it’s almost always women in these posts.

I seriously doubt that abolishing the low level admin posts is going to yield positive results for patients and thinning out the number of higher level posts will simply reduce promotion prospects, thereby rendering the lower posts even less attractive. One possible option is to require nursing and clinical staff to do some admin work as well – and also to rotate nursing staff between wards and work experience so they are not stuck in one kind of job. I’m no expert in hospital HR management but don’t believe that there’s a silver bullet.

The evidence is that hiving off and centralising appointments booking in Milton Keynes hasn’t worked – and that’s not just my view based on personal experience. It’s very evident local healthcare professionals have little confidence in the system even if GPs regard Choose and Book as a very convenient option for arranging hospital referrals for their patients.


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