NHS Fiasco

[CirclipParticipant @circlip]

As an addition to Peter's post on NHS admin. and not to clog the Banks thread, when a few lumps appeared on my left shin, had to go through the performance of ringing the local Surgery for a telephone appointment for a doctor to ring me back for him then to decide I then needed a face to face appointment which was rather obvious at stage one but we have to jump through hoops to determine this. On observation, we then decide an Ultrasound is needed but will be informed when. Four weeks later, a letter bounced onto the mat, which had been written the week before, informing me that an ultrasound had been arranged for a week later, five in total from original Doctors appointment.

Now in the past, I've had out patient ultrasounds done at a local Hospital about two miles away BUT, this one to be carried out at a Health Centre (?) TEN miles away. Clocked in five minutes early to be told U/S machine had gone u/s and they were waiting for a replacement which would take between one to one and a half hours to arrive so did I want to go home and arrange another appointment? I opted to wait. An hour later I was called through and was stuck on a consulting couch. Despite having the relevant notes, we then had to determine WHERE the Technician had to zap. Five weeks ago they were THERE, so after the lubricant blather and waft around we then had a result which if there was a problem, my Doctor would inform me. Glancing round I determined the Ultrasound machine was in fact a laptop but rather than have a 'Spare' with the operatives, and we ALL know about Murphys law, a replacement has to be shipped in from miles away.

It seems that these operatives roam to various sites, as when I suggested why not take a spare, just in case, one said they weren't trusted to have the Password for the Health Centre they were at.

My initial thoughts were it could have been a thrombosis near my shin. Obviously wrong as my right leg is still working

Glad it wasn't something "Serious"

Regards Ian.

[CirclipParticipant @circlip]

[duncan webster 1Participant @duncanwebster1]

Believe it or not, we in the UK spend a lot less on NHS admin than comparable economies. Perhaps if we spent more we would get a better service. Medical people don't necessarily make good administrators.

[Ex contributorParticipant @mgnbuk]

Believe it or not, we in the UK spend a lot less on NHS admin than comparable economies. Perhaps if we spent more we would get a better service. Medical people don't necessarily make good administrators.

Yet NHS staffing figures show that only 53% of the workforce are clinically qualified & suggest that 2/3rds of the NHS budget goes on staffing costs. How many more non-clinical staff do we need to employ for "good administration" ?

My experience of NHS "adminstration" has been universally poor (and is getting worse) – be that from the GP practice or hospitals. When I have eventually managed to get past the "administration", my experience of the clinical & care side of the NHS has been universally good..

I suggest that less, but better, administration is what the NHS desperately needs, not more.

Nigel B.

[SamsarandaParticipant @samsaranda]

Similar experience early this year, had a large red painful area on my leg near to my ankle which was quite sore. Rang our local surgery, phone lines open at 08.30, engaged of course so kept ringing continuously till finally got through at 09.15 only to be told all appointments had gone, receptionist enquired what was the problem, I said that I suspected a blood clot in my leg, receptionist said hang on while I speak to the manager, came back on the line and said Doctor will phone me. Not long after the Doctor phoned and we discussed the issue and she said I need to see you come to the surgery at 11.00. I reported to the surgery and she examined and said that the problem was not a blood clot but she didn’t know what the problem was but suspected some ligament problems so she organised an x-ray and a referral for physio therapy. X-ray took 2 months to come through and the physio appointment took 6 months. Physio has decided to refer me to a Podiatrist for orthotics for a lifetime problem with my feet that is now giving problems, how long it will take for the referral to the Podiatrist is anybodys guess, a few months I expect. It’s no joke growing old as your body starts giving problems and the NHS is in crisis because of huge problems of mismanagement due to its use as a political tool.

I remember back to 1972 when my second daughter was taken ill whilst we were on holiday in Dorset it transpired that she had bacterial meningitis at the age of 21 months, it was the worst form of meningitis and after admission to hospital she was unconscious for 4 days and the prognosis was that she wasn’t expected to live but if she survived then she would undoubtedly be severely handicapped. She did survive and the only handicap that she suffered was epilepsy which fortunately by her teens she had outgrown. I am eternally grateful to the doctors and nurses at her hospital for the dedication and hard work that meant that she survived.

My daughter is currently employed by the Home Office and her department looks after unaccompanied refugee children that arrive on our shores, no shortage of those so kept very busy. In respect of her treatment that she received as a child I couldn’t fault the NHS, she spent a month in hospital recovering from the meningitis and was then transferred to a hospital near our home. I believed then in 1972 and still believe now that if you need an emergency admission to hospital there is no finer health service in the world, the problems that currently afflict our health service are all related to mismanagement and inappropriate funding, the medical profession does itself no favours because of outdated attitudes of a number of consultants who would not be out of place in a feudal system in the Middle Ages with their pompous attitudes of how important they perceive themselves to be, fortunately their numbers are decreasing with time as they die off.

My granddaughter is a senior sister in our local hospital, she is always complaining about the problems facing the NHS, one wonders how bad it has to get before radical changes are put in place. In contrast to the NHS if I take my cat to our vet with a problem and a blood test is required then the results are available within two hours, blood test through our doctors surgery take a week for results to be available, I realise that with the vet I pay for the service but even in the NHS everything is costed and allocated to budgets so no real difference.

OK so rant over now. Dave W

[duncan webster 1Participant @duncanwebster1]

But that will include cleaners, porters, maintainence, kitchen staff etc etc. The report I read quoted 2% of budget spent on admin, which is extremely low. Germany and France were up to 10%

[KWILParticipant @kwil]

To get through the "administration" at my local surgery, you have to survive the "Receptionist" who transfers whatever you have told her to a further person who triages you and determines whether you really want/need to see a doctor.

This person was not at all helpful and when I refused his advice got all upset and recorded on my file, "does he have the capacity to decide?" I was however referred to a GP who called me in and after 30 mins consultation (collecting all the data and the necessary paperwork) caused me to be admitted to hospital via the Emergency Department.

Administrators Bah Humbug!!

[Ian HewsonParticipant @ianhewson99641]

Had my psa blood test on Wednesday at 9-00, results through and checked by doctor, on my phone by email 8-00 Thursday.

Ian

[Tony Pratt 1Participant @tonypratt1]

I think we can all agree the NHS is not fit for purpose, why, well everyone will have an opinion and as for solutions only God will know the answer. Most people myself included dread getting ill as it’s a lottery whether you will receive timely attention.

Tony

[Martin KyteParticipant @martinkyte99762]

The thread title implies something negative about the NHS but then goes on to complain about GP’s and the way they organise themselves. GP’s are a strange group as the are self employed although many are contracted to the NHS and organise themselves into partnerships providing services to the local community and receive NHS money for doing so. How they organise the delivery I think is up to the practice and its managers. There will be over site to ensure the NHS is getting value for money and safe working practices but after that they could be regarded as semiautonomous.

Regards Martin

[SillyOldDufferModerator @sillyoldduffer]

Posted by mgnbuk on 10/12/2022 12:15:06:

Believe it or not, we in the UK spend a lot less on NHS admin than comparable economies. Perhaps if we spent more we would get a better service. Medical people don't necessarily make good administrators.

… I suggest that less, but better, administration is what the NHS desperately needs, not more.

Nigel B.

Good idea Nigel, let's put you in charge. What exactly can be done do to achieve 'less, but better, administration'?

Serious question. Dead easy to enjoy a rant, and we live in an echo chamber full of people happy to join the chorus, all of them convinced there's an easy answer, even though no-one has an actual costed plan. Unfortunately solving problems like this is much, much, harder than enjoying a good whinge!

Good news if the problem really is a need to reduce administration because the NHS currently has over 100,000 vacancies. Here's an uncomfortable thought though, could it be the shortage of administrators that's doing the damage, not that there are too many of them? Of maybe cutting the country off from the European labour market might have something to do with it? Another uncomfortable question, what is it about the NHS that puts potential employees off? Could it be low pay, hard work, anti-social hours and ungrateful customers?

Too many of us think that somebody else is to blame, and 'they' need sorting out! It's always assumed we personally don't have any responsibility for the state of affairs. Absolutely not! Of course it's always some other group, and they are all idiots. But before throwing rocks, bear in mind the NHS problem developed during our watch. As none of this is new, I suggest the 'they' who messed up were 'us'.

Dave

 

Edited By SillyOldDuffer on 10/12/2022 16:34:07

[Michael CallaghanParticipant @michaelcallaghan68621]

My wife is an NHS manager, and I have had a lot of dealings with her go workers over the years. And a more totally useless set of people you would have a hard job to find. The problem is that useless management is looking to employ people with the same mindset as they have. They are mainly almost unaccountable in what they do in a given week, and many like my wife hold a rubber stamped position which means in simple terms, it’s cheaper to keep them in post then sack them.
if I was in power I would have teams of experienced professionals targeting every hospital, and sacking staff including management that are not doing the job.
the vacancies within the NHS are due to two reasons. The first being senior management not allowing the vacancies to be filled, and two the almost lack of young people with the educational skills to fill many of the vacancies. An example only last month was a main hospital x-ray department which as 20 vacancies. Reasons being . Older staff leaving and then returning to the same job working for an agency. The staff member not only gets their pension, but also an higher rate of pay without working the hours they don’t want to. Again, the total lack of young people with the educational skills for the job. The smartest young people who do train up, leave once trained for better conditions in Australia etc. The whole system within the NHS is one of waste, a bit like most large government departments I would think

[Martin KyteParticipant @martinkyte99762]

Moving on from pointing out that GP surgeries are effectively the semi-privatised part of the NHS, hospital staff do actually enjoy the freedom to innovate and reorganise the way things work (sounds a bit like administration really).

To give you an example, my wife has been under the care of the diabetic foot clinic at our NHS teaching hospital for a number of years. In the early days one of the clinics nurses gave me an email address that I could send pictures of my wife’s foot to if we started to have problems and then if they were concerned they could get her seen that day, on the basis of early intervention equals faster healing. We saw the very same nurse yesterday (she is now in charge) and talked about this practice. She said we were the first to do it and they rolled it out to other patients. At that time they had to load all the photo’s manually onto patient records at the end of the day. Now the clinic has its own email address and we among others routinely send pictures so they can keep an eye on progress between visits allowing for less visits.

regards Martin

[Peter G. ShawParticipant @peterg-shaw75338]

As the Peter Shaw from the other thread, I'm now coming back on this, more appropriate thread.

Unfortunately, over the years I have come across quite a number of incompetant people, both "doers" and "admin" types. I've also come across some very competant people in both categories, indeed in my early days I put in a travel claim only to get it rejected. On querying why, it turned out that it was actually HMRC rules I was breaking, and in all fairness to the admin type, she explained it very well. So yes, as a "doer" myself I have made mistakes.

But, in my current situation, the admin person who rejected my request for a parking permit was quite arrogant about it, and that I did not like. There really is no excuse for rudeness. In the second instance, it was the delay in starting treatment that I really did not like, the fact that she was also telling me that I had to travel excess miles was, if you like, the icing on the cake. When all said and done, it's my life, my longevity, they are dealing with. Of course, I do not know if her (in)action has caused my life to shorten, but there will always be that nagging thought now.

I must admit that the second lady above seemed very pleasant over the 'phone, indeed the vast majority do, but there will always be that nagging doubt about speed.

Martin Kyle,

Near the beginning of the Covid lockdown, I had some eye trouble and was asked to photograph both eyes and submit the photos by email to the surgery. Not exactly easy to photograph ones own eyes, but I managed it, and ended up on a suitable drug, can't remember what it was. Since then I have used that email system a few times. It works well, provided I can get a good steady photo of whatever it was – and that's not as easy as it sounds.

I've even had to photograph my feet and submit those photos to my podiatrist – non-NHS, but very, very good. But again, try holding you camera steady when pointing down at your feet – I don't find it easy, but at least with a digital camera I can try, try, and try again until I get a satisfactory photo without blurring and shake.

KWIL,

During the Covid thingy, I developed a rash on a rather personal part of my body. I lied to the receptionist, and when I finally managed to speak (telephone) to the GP, I explained why. The GP, female, was actually quite understanding about it. It turned out that in fact I was reacting against the ointment being used, it did actually work, but I needed to reduce the time I was exposed to it.

And with that, it's goodnight from me,

Peter G. Shaw

[CirclipParticipant @circlip]

To anyone misinterpreting my initial posting as having a go at the Indians (NON racist remark) on the shop floor, read again. The service tendered by the medical staff, on the three occasions I've had to be admitted into Hospital can only be described as exemplary. Two were for non invasive treatment that a local GP could not have issued medication to cure but on one of these encounters it was discovered that I was going to need an urgent operation to insert a new piece of pipework (Triple A). On observation in recovery, It became blindingly obvious the amount of waste being generated.

Sadly, if a thousand billion was 'Invested' into the NHS they would still be screaming for more.

Regards Ian.

[Tony Pratt 1Participant @tonypratt1]

Posted by Circlip on 11/12/2022 12:58:01:

To anyone misinterpreting my initial posting as having a go at the Indians (NON racist remark) on the shop floor, read again. The service tendered by the medical staff, on the three occasions I've had to be admitted into Hospital can only be described as exemplary. Two were for non invasive treatment that a local GP could not have issued medication to cure but on one of these encounters it was discovered that I was going to need an urgent operation to insert a new piece of pipework (Triple A). On observation in recovery, It became blindingly obvious the amount of waste being generated.

Sadly, if a thousand billion was 'Invested' into the NHS they would still be screaming for more.

Regards Ian.

Sadly Ian you have hit the nail squarely on the head!

Tony

[HopperParticipant @hopper]

If you want something messed up, put the government in charge of it.

[Harry WilkesParticipant @harrywilkes58467]

Diagnosed with prostate cancer in 2021 had the choice of QE Birmingham or New Cross Wolverhampton elected the QE sorted by the end cataracts needed treatment August this year got referred to a private hospital working for the NHS both eyes done by November so cant knock the NHS

H

[Mike PooleParticipant @mikepoole82104]

When I was a lad our GP worked from a surgery at his house, I am pretty sure you didn’t need an appointment as he saw everyone who turned up at his surgery session. When I was 17 I had a day of feeling slightly odd followed by a rough night with an abdominal pain. My mother rang the doctor at around 8am and he called round about 9am, he suspected appendicitis but was not certain and would call back later, he returned at lunch time and sent me straight to hospital, my mother took me by car and I think I was on my way to the operating theatre within 30min of arriving. Woke up later that afternoon with mum and dad stood round my bed. I just don’t get why we have to wait weeks to see a GP. If a waiting list is getting longer then they do not have enough staff, if it is static then they need to clear the backlog and keep on top of things if they start to slip. The appointment system must self defeating if once the list is full any extra patients are put off until tomorrow and so the slide starts. Our old doctors system probably meant he had some long days but his backlog was non existent as he never let it develop, I expect he got an early finish on odd occasions. He was widely regarded in the village as a good doctor and had been my mother and fathers doctor since they were youngsters. The village named a street after him. It will be funny having a street called “anon. Zoom call” these days.

Mike

[Peter Cook 6Participant @petercook6]

Posted by Hopper on 11/12/2022 13:20:42:

If you want something messed up, put the government in charge of it.

Or better still have the government privatise it in the least useful way (e.g. Rail, Water, Energy etc.)

Mike – in defence of GP's. A friend who chairs the local surgery's patient liaison committee told me recently that the surgery is getting three times as many requests for appointments than they did in the year pre-covid. Why – they are not sure. The local population might be up 10% but not 3X, so people are requesting many more appointments.

I wonder if it's anything to do with the relentless barrage of media cover of any and all aliments – all of which recommend that if you have the slightest symptoms you should see a doctor.  I wonder how many surgeries are currently buried in children with coughs and/or sore throats which would have been treated at home – but now need to be seen because of the publicity surrounding Strep-A. 

Edited By Peter Cook 6 on 11/12/2022 15:07:30

[brickyParticipant @bricky]

The goverment should stop the stupid idea of nurses having to obtain huge debts to do a job that should be like most of the people on the forum who had a traditional training on the job with day release for the technical side.who wants to take a job that does not pay enough to pay off the debts incurred at university.There is little wonder we are short of nurses and technicians in other deparments who now also have to have a university degree.My son started as a nuclear medicine technician on the job with day release and an exam at the end he is now a clinical scientist deputy manager of a nuclear medical department.What is wrong with the govenment that can't see the obvious solution to the recruitment problem.

Frank

[Peter G. ShawParticipant @peterg-shaw75338]

Frank,

I quite agree. It simply is not necessary to have a degree for much of what goes on. And certainly not of the "Meeja Studies" types.

When I look back at my career, such as it was, I had three "O" levels and a C&G Full Technological Certificate. And yet, through an amount of self-study, I did some low-level electronic design, was involved in some prototype telecom engineering, and produced a routing plan which when the manager who requested it, saw it, he said "I like it. Do it!" Not bad for someone with my low level of formal education and no degree in sight.

Having said that, I have three children: my daughter, six 'O' levels worked for HMRC ending up as a VAT Inspector: elder son gained a MPhys 2:2, taugh for a few years and now runs his own business: my younger son should never have gone to university – he gained a third Bsc in Physics and hasn't used it.

Peter G. Shaw

[Mike PooleParticipant @mikepoole82104]

I think there is quite a hierarchy of nursing staff, not all are qualified to the highest level. The term nurse is applied probably incorrectly to all the staff who provide a patients requirements. The person who washes you and changes the bedding is probably at the lower end and the person who sets up and monitors the equipment that keeps an eye on you and deals with drips and medication is probably at a higher level. There used to be quite a variety of uniforms and hats that went with the individual roles but it seems hard to tell these days, fortunately since I parted with my appendix at 17 I have not spent a night in hospital, a very painful kidney stone sorted itself out within a couple of hours of arriving at a triage unit at about 3am, no shortage of staff at that time of night, it was like a Grand Prix pit stop with people on every side, luckily the night surgery doctor managed to bypass A&E and sent me to a triage unit in the relevant department who didn’t seem to have much on at that time of night, full marks to him for sorting that out.

Mike

Edited By Mike Poole on 11/12/2022 22:45:12

[Kiwi BlokeParticipant @kiwibloke62605]

The provision of healthcare is horribly expensive, with no obvious limit, given continuing scientific advances, greater demand, and no evidence that people are really interested in making much effort to preserve their health. No government can afford to fund something like the NHS 'adequately', because the money will always be used up. Likewise, no government would ever want to be seen to be rationing healthcare. Therefore Something Must Be Done!

Mrs Thatcher was apparently horrified to discover that the NHS effectively ran as a 'black box', into which vast amounts of money poured, but no-one really knew where it went. The workings of the black box were mysterious to those outside. And so the NHS was made into a pseudo-business, with 'purchasers' and 'providers', in the hope that the government's money could be tracked a bit more easily. Also, any rationing now became something that could be blamed on the purchasers, and the purchasers could beat up the providers for being inefficient. Divide and rule!

In order to operate this massive pseudo-business (the NHS was Europe's biggest employer at the time), a huge number of 'managers' and administrators was required. Many of these were pulled from health-delivery positions (nurses, occupational therapists, and so-on), exacerbating clinical staffing problems. They, at least, had some understanding of how things worked. Others were brought in from industry and who-knows-where, and rapidly demonstrated that they didn't understand the nature of the beast. Health care doesn't work like a typical business pyramid, where those nearest the top (the higher management) control the money flow. Instead, (and this is of course a gross simplification) people like doctors could, at a stroke, initiate horribly expensive treatment, arrange expensive tests and occasionally make ghastly and expensive mistakes. And they practiced with scant regard for (financial) cost.

And so the proportion of people employed by the NHS, who were not directly delivering health care, ballooned. The NHS, pre-Thatcher spent far less than other health care systems on 'administration. Post-Thatcher, the non-deliverers syphoned off enormous amounts of money as salaries, new, plush office space, etc., but the NHS's funding did not increase to cover this. Bureaucracy is expensive, and, in a system like this, where the 'shop floor' workers really take the decisions which summate to enormous amounts of money, outwith the control of the paper-pushers, bureaucracy just gets in the way. As an example, a 'business case' is required to justify the purchase of any significant item of medical equipment. Just demonstrating a medical need won't do. Who are the experts in the NHS? Who have the power? Why are the clinical staff so unhappy?

The essential problem is that the government can't won't fund the monster that has been created. IIRC, in the late '90s, the cost of a new district hospital was (optimistically) considered to be around 50 million pounds – about the cost of one of the RAF's Harriers.

[roy entwistleParticipant @royentwistle24699]

I am at present trying to phone my local hospital. I rang at 9.05am, I was told that I was 3rd in line. I'm still on the phone and have just been told by automated voice that I am now 15th in line. Tried on line and can only find the same phone number.

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