General News Discussion

[eFestivals]

I know you are closed minded on pretty much anything outside of your belief system but I am quite interested to see how it goes over the pond. Because it might result in something good. Of course the yanks keep watering down Obamas plans so its probably set to have limited impact.

oh, I don't doubt that it'll improve the health outcomes for many poorer people over there, but what won't come along with it is any cost saving - so the average health outcome might get to creep just above the average UK level, but the costs will increase even further than the twice-as-much as the NHS that it is currently.

[eFestivals]

For starters its now a degree only profession.

yep - and I suspect that fact is at the very heart of what went on at Stafford.

Wiping arses and the like - a big part of caring for people who are confined to bed - is very probably considered to be beneath those graduates, and something for others to now do (but who often didn't)

Considering the high numbers of older nurses who are working in the NHS

Hmmmm, are they? I mean are they working in hospitals as ward nurses? I suspect that the numbers are far smaller than you're thinking.

Ward nursing is often hard physical work, and it used to be the case that few older nurses were still working on wards in later life as that physical work was often beyond them (or beyond what they'd rather do). Older nurses tend to find less physical work away from the wards.

How many very caring people who would make fantastic nurses have been denied entry ?

that's a problem in just about all jobs now - the people getting the better jobs are from such a narrow educational background and have had what is regarded as 'best practice' drummed into them so much that they're often unable to think outside of the box for anything. We're wasting an awful lot of talent. Edited February 6, 2013 by eFestivals

[hot_ice]

I don't disagree with any of this.

There has been a huge cultural shift within the NHS and nursing. For starters its now a degree only profession. Considering the high numbers of older nurses who are working in the NHS working quite fine without degrees I challenge if this was all that clever. How many very caring people who would make fantastic nurses have been denied entry ?

Edited February 6, 2013 by hot_ice

[hot_ice]

not sure, haven't been a patient (or come to think of it visited) a hospital for over 12 years,

I guess with nurses all depends on what their role is actually suppose to be.. i think this has got lost in last 10 years,

[pink_triangle]

[eFestivals]

Will it has the potential to more than creep above the UK level. It could be a million time better... or worse... or the same. We don't know yet.

it won't be hugely better if it works perfectly.

But it won't work perfectly. Unlike the UK where there is a real sense of entitlement to healthcare, the culture of the USA will discourage people to take up the available state benefits.

It might cost a bit more, a bit less or the same...

healthcare in the USA costs on average (including those who get no healthcare at all within that) twice the amount as it does in the UK.

There's no chance of the costs of that coming down when healthcare is opened up to millions more people than who are able to have it now.

So the effects on costs are beyond any sensible question - they will increase even further away from the far cheaper costs in the UK due to the NHS.

But the important thing for me is which system offers the best service for the amount of money spent and if it is a universal offering.

again, it's beyond question. Private costs massively more.

Its hard to compare properly

it's difficult to put an exact figure on. It's not difficult to prove that costs would increase by a minimum of 10%.

we currently don't spend as much on the NHS as other countries.

we spend less and get lower health outcomes as a result, compared to some - yep.

If and when the UK population is fully up for voting itself a tax increase then it's a debate worth having. Until then it's just a waste of breath.

[eFestivals]

I think the problem with the general public though and tax is a lack of trust that the money would find its way to the NHS and not something else. Not sure how you overcome this though

that just gets to show just how thick the UK populatrion is.

We're not paying for the NHS as it is. We're making our children pay for it.

But hey, let's ringfence the money that won't be enough if it's ringfenced, that'll really sort the problems out.

[eFestivals]

Like I said I am not really bothered about the cost as much as I am bothered about making sure the service is fit for purpose!

ermmm.... really?

I reckon you'd care an awful lot if you were told that your NI was more-than doubling - cos that's what the yank system in the UK would have as it's very first effect.

We need a system that produces a good service, private, public or mixed and then stump up the cash so everyone has access to it.

Which we've got.

Like anything, sometimes things *will* go wrong. That doesn't change no matter who has ownership and no matter how it's funded.

[eFestivals]

Or maybe Neil they aren't that thick and can see the government doing stuff like that and then asking for more money as well....

You really do have an high opinion of yourself.

you've just said that the money should be ringfenced, and then when I point out that it's a factual impossibility unless healthcare is massively cut, that's me having a high opinion of myself?

You're priceless. I think that's the best stupid comeback ever from your stupidity hasving shone right thru.

[eFestivals]

Not if it was going towards health care....

Really? Even tho you paying over twice as much would result in no change to the quality of care you got?

Yeah, everyone just loves to pay double the price for the same thing.

[eFestivals]

That isn't a small failure. That is a disaster....

I agree. But it's no different to what would happen anyway under a different system.

The only difference might be the where and when and how, but not the fact of it happening.

The problem is the incompetents that are considered to be business heroes that end up in charge of any business at some point down the line. Nothing of that changes no matter what system operates.

If you show me Stafford and say that private care is the answer, I'll show you Winterbourne View or almost any private old folks home and say that it's not.

[eFestivals]

If we pay extra tax to fully cover a good NHS offering and ring fence it. How does that result in healthcare being cut ?

Are the voices speaking to you again ? Pop a pill or something!

oh, so you are amazingly keen to pay twice as much for nothing different. PMSL.

You can say that you are here as many times as you like. We all know that if that was proposed tomorrow you'd be the first to start a thread here to say how disgusting it was.

[eFestivals]

To suggest that within any system we should expect the level of failure we have seen here is just laughable.

so show me a system which doesn't have the same levels of failure - either within healthcare or outside of it.

The end.

[eFestivals]

I am not an expert in health care on the international stage. But neither are you. Unless of course you claim to be in contact with a team of experts at the UN down your local pub (the ones giving out nuclear secrets )

But can I imagine a health care system that doesn't allow people to die because they didn't receive the most basic element of human humanity and didn't leave them sat in their own filth.

Yeah I can see that. And because you can't please stay well away from anything important.

when you've invented a world of only-perfect human beings, get back to me.

Meanwhile, you're the man who thinks scamming someone is good business practice, don't forget.

Edited February 6, 2013 by eFestivals

[abdoujaparov]

For certain! and Neil just made a point about people being prepared to pay more tax as well.

Personally happy to pay more tax myself for a better health system.

I think the problem with the general public though and tax is a lack of trust that the money would find its way to the NHS and not something else. Not sure how you overcome this though

[eFestivals]

I think that we deserve a significantly better health service for what we already spend. It's glib just to argue that if you want a better service you must pay more.

you don't think it's glib to expect the impossible, then?

The NHS is inefficient, bureaucratic and subject to irrational political whims.

yet it's more efficient and less bureaucratic and subject to less policy whims than the private alternatives.

I absolutely believe in universal healthcare, free at the point of use, but the NHS as an organisation has jut become too big and unwieldy to be anything other than a money pit.

and yet the facts of healthcare done in other ways gets to show that's simply not true.

That's not me saying that we should stoip striving to try and improve things, but such striving needs to keep within the bounds of the possible and not the impossible.

It's striving for the impossible that has led to so many fuck-ups - such as with Stafford.

[abdoujaparov]

you don't think it's glib to expect the impossible, then?

yet it's more efficient and less bureaucratic and subject to less policy whims than the private alternatives.

and yet the facts of healthcare done in other ways gets to show that's simply not true.

That's not me saying that we should stoip striving to try and improve things, but such striving needs to keep within the bounds of the possible and not the impossible.

It's striving for the impossible that has led to so many fuck-ups - such as with Stafford.

[pink_triangle]

What, so it's impossible to get a more efficient service, with better outcomes, for the same money?

[abdoujaparov]

Its possible to run any service more efficiently and I havent worked in a single NHS organisation that hasnt tried to achieve this. The trouble is the easy savings to make are generally the ones that dont save enough money and if you want to make a significant savings you have to look at things eg staffing which will effect patient care. In the long term you cant achieve better outcomes with the same money as in an again population demands on the service will always significantly increase. The NHS cant just say because of an aging population we wont see people born after this date, untill enough people die to free up services to see more. The NHS has to be open to everyone and in an aging populationi you cant achieve that through pay freezes/cuts. People try to compare the NHS to any other businesses and while it can learn from other businesses it cant operate under the same rules.

[eFestivals]

What, so it's impossible to get a more efficient service, with better outcomes, for the same money? I will bow to your clearly superior knowledge of the economics of healthcare, but I think you're wrong.

as I said, it's possible to strive for realistic improvements. As I also said, it's not realistic to strive for the impossible.

The improvements that can be made for the same money are marginal. The facts of different systems elsewhere in the world show beyond all doubt that this is the case.

All I would say is that there are areas of public service where private sector providers have delivered better services for less money than the public sector alternative.

really? Where?

It's certainly not been the case in the NHS, that's beyond all doubt whatsoever.

It's also not been the case with every single privatisation which has happened, nor with any conmtracted out service at local levels or national levels.

There have been some money savings for the taxpayer in some instances, granted, but they have not been for everything else remaining equal. Cheaper cleaning has always equalled worse cleaning and staff paid less - which has then impacted back into other stuff, including often a bigger loss in tax revenue than what has been saved.

I'm not sure how it's impossible to make a demonstrably inefficient system deliver better value for money. I could give you a dozen examples from the last week alone. They may be isolated and only evident at my local hospital, but I doubt it

Your examples is stuff like staff having the tea break they're perfectly allowed when you'd rather they'd be unnecessarily fussing over your missus.

And if it's not only that, it needs remembering that healthcare is not a production line where the work is always reasonably spread across the working day. There needs to be slack at times so that there's the resources available when it's needed - and at those times those staff won't get a tea-break or lunchbreak at all.

At the same time, I'm also aware that there's an awful lot of wasted time. For example, I've experienced five different people who have come and checked that my name, address & DoB is what I told them ten minutes earlier.

However, I suspect that it's not merely the waste of time that it appears to be. Cos if you take the time to notice, plenty of patients want to believe they're being left to die if there's not someone fussing around them at least once every hour, and so what I experienced is probably a reaction to the stupidity and selfishness of so many patients who want to think that their own ailment is the most urgent one in the hospital. It's probably more efficient to unnecessarily fuss than it is to work in the most efficient manner.

There's also stuff like the working practices of doctors, which is not really anything to do with or about the NHS - the doctors drive their own conditions of work. The communication and arrogance of doctors is often astounding (such as one telling me I was a liar for saying what he was looking at was a mole - who had to sheepishly apologise for his error afterwards; like I didn't know I'd had a mole since birth on my face ). Or his junior who stated with a straight face that nothing could possibly go wrong with his work prior to doing it, again to give a sheepish apology afterwards.

To me, those errors scream gross stupidity and arrogance, but I'm only on one side of the situation. I suspect that despite how they came across to me there's a more-than-payback in other areas of their work.

But whatever it was, they'll be nothing much different by doctors everywhere. Which makes it nothing about the NHS.

Edited February 6, 2013 by eFestivals

[eFestivals]

It is clearly inefficient to have a full set of staff on a ward drinking tea with only one in-patient.

and it's clearly far more inefficient to not have enough staff at busy periods than it is to have too many at quiet times.

I suggest that you try casualty at 10pm on a Saturday night and try telling me again that they're all sat around drinking tea.

[abdoujaparov]

as I said, it's possible to strive for realistic improvements. As I also said, it's not realistic to strive for the impossible.

The improvements that can be made for the same money are marginal. The facts of different systems elsewhere in the world show beyond all doubt that this is the case.

really? Where?

It's certainly not been the case in the NHS, that's beyond all doubt whatsoever.

It's also not been the case with every single privatisation which has happened, nor with any conmtracted out service at local levels or national levels.

There have been some money savings for the taxpayer in some instances, granted, but they have not been for everything else remaining equal. Cheaper cleaning has always equalled worse cleaning and staff paid less - which has then impacted back into other stuff, including often a bigger loss in tax revenue than what has been saved.

Your examples is stuff like staff having the tea break they're perfectly allowed when you'd rather they'd be unnecessarily fussing over your missus.

And if it's not only that, it needs remembering that healthcare is not a production line where the work is always reasonably spread across the working day. There needs to be slack at times so that there's the resources available when it's needed - and at those times those staff won't get a tea-break or lunchbreak at all.

At the same time, I'm also aware that there's an awful lot of wasted time. For example, I've experienced five different people who have come and checked that my name, address & DoB is what I told them ten minutes earlier.

However, I suspect that it's not merely the waste of time that it appears to be. Cos if you take the time to notice, plenty of patients want to believe they're being left to die if there's not someone fussing around them at least once every hour, and so what I experienced is probably a reaction to the stupidity and selfishness of so many patients who want to think that their own ailment is the most urgent one in the hospital.

There's also stuff like the working practices of doctors, which is not really anything to do with or about the NHS - the doctors drive their own conditions of work. The communication and arrogance of doctors is often astounding (such as one telling me I was a liar for saying what he was looking at was a mole - who had to sheepishly apologise for his error afterwards; like I didn't know I'd had a mole since birth on my face ). Or his junior who stated with a straight face that nothing could possibly go wrong with his work prior to doing it, again to give a sheepish apology afterwards.

To me, those errors scream gross stupidity and arrogance, but I'm only on one side of the situation. I suspect that despite how they came across to me there's a more-than-payback in other areas of their work.

But whatever it was, they'll be nothing much different by doctors everywhere. Which makes it nothing about the NHS.

[abdoujaparov]

and it's clearly far more inefficient to not have enough staff at busy periods than it is to have too many at quiet times.

I suggest that you try casualty at 10pm on a Saturday night and try telling me again that they're all sat around drinking tea.

[eFestivals]

I think what Neil is saying is...

Pay more for more shit and be happy about it as long as its a public failure rather than a private one, because it would be even more shit if it was private.

Nope, I'm merely saying that failure is due to people and only people. Any system is subject to those people. In an 'industry' that requires so very many people, it is not possible to only have perfect people.

Do scandals such as Stafford happen within the USA's only-private system? Yes they do, and all for the same reasons.

It is right to strive for improvements, but it stupid to strive for impossible improvements - because that impossible will impact elsewhere (as Stafford shows).

[pink_triangle]

My experience of using the NHS over the past several months suggests that you could deliver better care with fewer staff. It is clearly inefficient - caused by poor communication - to undertake the same clinical procedure more than once. It is clearly inefficient to have to repeat clinical procedures because of the antiquated way of transporting blood samples etc round the hospital. It is clearly inefficient to have a full set of staff on a ward drinking tea with only one in-patient. It just strikes me that, despite everything, the NHS remains inflexible, inefficient and frankly rubbish at communication....