NHS - I want to love them but it is hard.

[UncleEbenezer]

Telephone sanitisers are probably quite useful in these viral times...

When did you last use a public telephone?

I last used one in July 2009. It was a whole lot more pleasant than in Adams's time.

[88V8]

All large organisations whether public or private, are resistant to change.
When I was working, the only changes I wanted were those I devised myself or could implement myself.

As has been said, the problem with our political system is that changes are not given time to settle down.
And too many of them are top-down, and those on the top are the admins and not the medical staff.

V8

[gryffron]

There has long been calls to have fewer administrators in the NHS and more nurses, when what we actually need is better administration. I'm sure we all have examples of good staff using bad systems so errors that balloon into wasting far more effort overall.

The best employer I ever worked for in this regard was British Aerospace at Warton. It was a matter of policy that each person only spent 12-18 months in each job, and then moved to a different role, often in a completely different department. I know the UK military do this too.
This had several beneficial effects:
1) Wide experience of how the whole company works.
2) People picked up best practice from different departments.
3) Job cover. If someone left/was sick/died, the previous occupant of their post had experience and could cover it for a while
4) Backdoor networks. People had friends in other departments, they were more likely to co-operate and less likely to isolate. Things could get done even if there weren't "official" channels.

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.

Do doctors and nurses become administrators or purchasers? Do administrators become medical professionals? No? There's your problem then.

Gryff

[JohnB]

Er, even the Army have specialisations, and require people to get suitable qualifications before doing different jobs, especially at the technical expert NCO level. Clearly administrators can't become doctors, but too many doctors have strong opinions on how to administer, as "how hard can it be"

[swill453]

The best employer I ever worked for in this regard was British Aerospace at Warton. It was a matter of policy that each person only spent 12-18 months in each job, and then moved to a different role, often in a completely different department. I know the UK military do this too.
This had several beneficial effects:
1) Wide experience of how the whole company works.
2) People picked up best practice from different departments.
3) Job cover. If someone left/was sick/died, the previous occupant of their post had experience and could cover it for a while
4) Backdoor networks. People had friends in other departments, they were more likely to co-operate and less likely to isolate. Things could get done even if there weren't "official" channels.

So their best engineers would be doing stints in HR or purchasing? Hmmm...

Scott.

[UncleEbenezer]

So their best engineers would be doing stints in HR or purchasing? Hmmm...

Scott.

That'll be why far-and-away the worst software I've ever encountered was developed by BAe (at taxpayer expense, under cover of secrecy both commercial and military). Clearly the chief programmer was the tealady on a different job.

[kiloran]

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.
Gryff

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

--kiloran

[tjh290633]

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.
Gryff

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

--kiloran

I knew quite a lot of people who worked or had worked at GEC. I got the feeling that the company did not deserve the people that they employed. Those who moved elsewhere did a lot better. They had a good Technical Centre/Research Centre at Wembley.

Quite a few regretted having a lot of GEC shares when the Marconi fiasco happened.

TJH

[swill453]

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

Yes, a mate of mine left a US tech company and went to work at Leonardo, the latest incarnation of Ferranti/GEC-Marconi/BAE Systems/Selex etc. He constantly comes up against ingrained practices like that and finds it very frustrating. There's also an informal battle to see who can delay retirement as long as possible, I think the current leader has over 50 years service with many at 40+ years...

Scott.

[bluedonkey]

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.
Gryff

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

--kiloran

I worked at the head office of a major bank for a while. It was just like that.

[XFool]

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.
Gryff

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

"what became of GEC "? Wasn't that down to the 'financial genius' of the City of London, if I remember correctly.

[gryffron]

The best employer I ever worked for in this regard was British Aerospace at Warton.

So their best engineers would be doing stints in HR or purchasing? Hmmm...

Not necessarily quite so inter-disciplinary. Although it could happen.

But, of the two companies I mentioned, I note that one has become a massive global player, whilst the other has disintegrated and the parts been absorbed by foreign competitors. Who could have predicted that? Oh yes, me! I couldn't get out of GEC fast enough.

[kiloran]

In contrast, GEC Plessey everyone stayed in the same job for life. Unless promoted, usually in the same department. Result, no change ever. "We've always done it this way". No chance to learn how to do it better. No appreciation of the problems your systems might cause for others.
Gryff

Ah, a real dinosaur of a company. I was an electronics engineer at GEC and one day I was chastised by an wizened old mechanical engineer for having an informal chat with the marketing manager about a project. Apparently I should have spoken to my engineering manager who would then have spoken to the marketing manager.
I wonder what became of GEC

"what became of GEC "? Wasn't that down to the 'financial genius' of the City of London, if I remember correctly.

I left! It went downhill from there

--kiloran

[sunnyjoe]

Do doctors and nurses become administrators or purchasers?

Yes, frequently
https://improvement.nhs.uk/documents/18 ... 251017.pdf

[absolutezero]

I think the NHS has become a sacred cow - politicians are scared to enact the radical changes needed because "the NHS" and "free healthcare at the point of delivery" have become interchangeable. In other words there's the assumption/ false dichotomy that ending the NHS as we know it means US-style 'pay or die' healthcare, and hence no debate about whether the NHS is the best way to deliver care.
The majority, possibly all, Western European countries provide health care to all who need it regardless of their ability to pay. The German system is a mixture of public and private insurance schemes (from memory) and it works very well.

The thing is everyone in the UK seems to mix up the health insurance with the health provision.

Actually in German system the majority of people use the public insurers, not private. But the majority of health care providers are private practice, not public. Only the large teaching hospitals are state run.

So you go to a GP of your choice with, say, a dodgy knee. They tell you you need a CAT scan and give you a list of CAT scan clinics in the area, and you choose the one you want. Then you take your CAT scan back to the GP and they maybe give you a list of surgical clinics to choose.

Competition, as Lootman said.

In the German system competition exists at all levels and the patient always has a choice. Not just those who 'can afford to go private'. There's even a choice of public insurers.

Not saying that it's perfect, there's a lot wrong with the private insurance system actually. But it's way better than the Uks NI+NHS.

And that is what I would do

As I posted somewhere else:
The NHS is not fit for purpose but I do believe in taxpayer funded healthcare for all.
Every time I have some form of interaction with the NHS there is some kind of problem. usually administrative but occasionally medical.

How to fix it?
Simple. All UK citizens get a healthcare card. Unlimited budget. Financed by the state. No individual pays for their treatment. It comes from taxation.
They use this to access healthcare. Needs to be shown at the GP of their choice and this triggers GP payment.
GP then decides they need to be referred. Database linked to card updated.
Patient then accesses an online portal where they choose a provider for that referral.
Lots of providers compete on waiting times, service etc. State decides what the fees for each procedure is. Providers work to this or don't take part.
Current NHS trusts welcome to be part of this but they are just a provider like all the others.
Crap ones go bust. High performing ones grow.
That's how to fix the NHS without having an 'insurance based' system

[Arborbridge]

The NHS is not fit for purpose but I do believe in taxpayer funded healthcare for all.
Every time I have some form of interaction with the NHS there is some kind of problem. usually administrative but occasionally medical.

I know we just love knocking things here, but it would be nice to have someone posting experiences that are positive rather than negative. Negativity is so tiresome and not good for the soul. The difficulty is that positive experiences are just taken as "read" and not commented on: it is the negative ones which stick in mind. Rather akin to newspapers only publishing bad news because it sells papers, no one ever says " Big news: everthing went right today". Whatever, who cares, who would bother to post that?

Well, I have to say I've had three major operations and many interactions with the NHS, both minor and medium, and I am full of praise for the service I have received. I'd have to be ultra cynical and hard to please to remark that the service I've had shows me that the NHS isn't fit for purpose.
The exception over the years must be chalked up: appointments running late, up to an hour or more, but even that hasn't happened at least for five years now, so I believe things must have improved.

That's my experience, and I've no doubt others have different experiences. I also agree that the NHS could be better, but since I haven't lived in any other country, I wouldn't know by what degree.
But there is a huge difference between being "not fit for purpose" and "could be better".

Arb.

[AleisterCrowley]

Without going into details - a close relative was seriously ill about ten years ago. The medical care he received was excellent, but the administration was an absolute shambles.
He did a wasted round trip of 50 miles to attend an appointment the medical staff had no record of
After his initial diagnosis there were multiple delays due to admin 'issues', which may have caused his eventual death - of course there's no way to know.
His GP and his surgeon expressed frustration with the admin processes, and I got the impression of a highly motivated and professional 'frontline' being let down by the admin function.

[UncleEbenezer]

How to fix it?
Simple. All UK citizens get a healthcare card. Unlimited budget.

No chance. Unlimited budget grows without limit. When you have 100% tax, and 100% tax take is going to the unlimited health budget, it's still not enough.

[Lootman]

How to fix it?
Simple. All UK citizens get a healthcare card. Unlimited budget.

No chance. Unlimited budget grows without limit. When you have 100% tax, and 100% tax take is going to the unlimited health budget, it's still not enough.

My solution:

1) Scrap the NHS and privatise its assets.
2) Give every UK resident a voucher equivalent in value to the cost of the NHS divided by the number of residents.
3) The voucher can only be used to offset the cost of buying medical insurance, which is mandatory in much the same way as car insurance is.
4) Medical care is provided by the same doctors, staff, climics and hospitals as now, and an insurance claim is made to cover the cost, minus a nominal co-pay.
5) Insurance is regulated to avoid anyone being denied coverage or dinged for pre-existing conditions.

Bingo.

[scrumpyjack]

How to fix it?
Simple. All UK citizens get a healthcare card. Unlimited budget.

No chance. Unlimited budget grows without limit. When you have 100% tax, and 100% tax take is going to the unlimited health budget, it's still not enough.

My solution:

1) Scrap the NHS and privatise its assets.
2) Give every UK resident a voucher equivalent in value to the cost of the NHS divided by the number of residents.
3) The voucher can only be used to offset the cost of buying medical insurance, which is mandatory in much the same way as car insurance is.
4) Medical care is provided by the same doctors, staff, climics and hospitals as now, and an insurance claim is made to cover the cost, minus a nominal co-pay.
5) Insurance is regulated to avoid anyone being denied coverage or dinged for pre-existing conditions.

Bingo.

One of the problems with that is that you end wasting vast amounts on the whole panoply of insurance administration etc. It is one of the reasons why US health expenditure is much bigger than the UKs with a worse average outcome. As you will see from the accounts of any insurance company, the amount that goes on claims, as opposed to costs, commissions, other overheads etc, is a lot less that the gross premium income.

The NHS may be inefficient but the private/insurance route simply exchanges one lot of of inefficiencies for another lot, which are probably worse.