NHS admin…..shockingly bad

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Jonathan Kay
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It's like that Monty Python sketch... 

Receptionist: I see. Well, do you want to have the full argument, or were you thinking of taking a course?

Man: Well, what would be the cost?

Receptionist: Well, It's one pound for a five minute argument, but only eight pounds for a course of ten.

I can give the five minute argument, but I don't expect it to change anyone's views...

Jonathan

PS: Usual offer to help Members navigate the system. Or how to find out what has gone wrong.

StevehS3
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I can't comment on that. I suppose there are geographical differences in the population for such health, wealth, illnesses etc. Having said that, one of the NHS hospitals near here would pass as a National Trust house with the standard of the building and gardens!

wild bill
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I agree Tony NI it's been brilliant BUT its just not enough to cover increased costs of medical technology advances or the massive increase in ageing/obese population. Also as a lefty i'd have thought you were in favour of those with bigger incomes helping. I don't think it needs to be massively high as a monthly charge and those charged could easily afford it but the dogged mantra of it must be free to all yada yada  is just sadly lovely and fluffy but nuts and anachronistic. Obviously it would need to go in hand with making it more efficient. This is the big one to overcome. Like any massive organisation it becomes bloated with empire building jobsworths who are brilliant at hiding amongst the truly amazing workers (medical and admin) who do the work. Pareto at its finest.

I think we'll also need to start educating people to stop stuffing themselves with cake. We did it with smoking so why not sugar? That'll help too. All the medicals in my tribe seem to agree. That's 2 GP's, a Consultant Physician, a Consultant anaesthetist, A nursing sister, a Physiotherapist and a senior registrar.

Or we could carry on headbutting the wall and opening a selection of newspapers with "NHS in crisis" as a headline because that would be novel. Banghead Rolleyes

I realise it's massively complicated but sometimes you gotta start somewhere. Half the problem is everyone in govt is frightened of being targeted with the 'your destroying the NHS sacred cow" as it's political suicide. I'll bet you nothing changes over the next 2 years and there'll be at least one "NHS in crisis" in the Daily Fail or similar.

Jonathan Kay
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"Today my wife attends clinic for minor surgery, in and out in 30 minutes. The receptionist is on the phone saying that she has no files for the 15 patients attending the clinic. Luckily the only notes she has are for my wife. This same day my mum receives four copies of letters sent to her GP from same hospital all dated 30th March but going back to dictated dates of 4 weeks ago. One letter states that my mum must seek urgent dental treatment for an infection."

Please let me know if you'd like to discuss how to tell them about this in the way that is most likely to have any effect. 

(I've seen a very large number of complaints and Serious Untowards Incidents and the like in the NHS in England.)

Jonathan

Jonathan Kay
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I'm finding it hard to think of an intervention that would be more counterproductive than charging fees to patients for seeing GPs.

Even if everyone was supposed to pay we'd end up with a vast increase in bureaucracy and debt collection.

But of course in practice (!) there would have to be a lot of exemptions. And that means a lot more bureaucracy, documentation and argument about the thresholds.

We have a real-life example of this in prescription charges in England... 90% of prescriptions are exempt! Scotland and Wales have simply abandoned the charges.

But the greatest damage would be done by deterring patients who need help from seeking it. That's why you see the advertising campaigns about early signs of cancer. The UK's late diagnosis rate is a major problem and the last thing that we need is a structural change that will make this worse.

Jonathan

Jonathan Kay
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Why do we see differences between hospitals?

I'm sure that everyone could construct a list of reasons, and most of them would be right.

But another way of thinking about it is whether the system has any mechanisms that could reduce unwarranted variation in performance. The NHS in England isn't designed for local delivery of a national product line. More as independent providers run as separate organisations. And when those structural changes were introduced the units were intended to compete with each other... we don't hear so much about that now.

Jonathan

Jonathan Kay
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Does more income produce better output?

There are many examples where it has. But the easiest to demonstrate is the effects on waiting times for elective surgery in England from 2007 onwards. Remember "From 18 months to 18 weeks"?

Jonathan

Jonathan Kay
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National policy on obesity and the like?

Yes, there should be. And we know what the appropriate interventions are and what their effects have been elsewhere.

But very little of this is the responsibility of the NHS. Much more lies in policy on food and drink and transport and planning and formal education. All of those should have explicit and consistent public health objectives.

But who can name where the lead responsibility lies for this in government in England? Or the body responsible for public health since the amazing decision to close the old one during the outbreak?

Jonathan

aerobod
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I agree with Jonathan, equal access and treatment to everyone is the best approach. Income in itself is not necessarily a good benchmark to determine who and how much people should be charged anyway, Although the tax systems are a bit different in the UK compared with Canada, typically in both countries those who are not on a salary (and PAYE taxed) and are contractors or self employed can have quite distorted income amounts.

As an example, I found in 2020 that I only needed to pay myself a small salary out of my company, ending up in a slightly embarrassing situation that I was considered 'low income', received a GST (VAT) refund tax credit and paid no income tax at all. Yet I put about 10 times my net income from a tax perspective into various corporate investments to help fund my retirement, so would have had taxable income in the highest tax bracket if I hadn't been able to legitimately tax shelter so much, if I had received all compensation in salary. From a health / NHS means testing perspective if it was brought in, I probably would pay zero contribution, yet outwardly I probably should pay a lot.

James

Hampshire West AR
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NHS Admin shockingly bad, probably yes. NHS if you having life threatening condition, superb. In the last two years I have had treatment for testicular cancer and open heart surgery for a replacement of my ascending aorta. All done under the NHS and all fixed Beer The doctors, surgeons, nurses, auxiliary staff have all been amazing.  I belong to a Facebook group for people who have or had an aortic aneurysm like me and most of them are Stateside.  Their insurance payouts for their treatment often run into multiple hundreds of thousands of dollars, sum with big excess payments.  

The one bit that has not always been great is the communications, it's very outdated and needs improving, ie. Zoom, emails Whatapp.  Not anyones fault working in the NHS, just needs a big overhaul by the seniors/politicians.  My neighbour has experienced very poor communication over his cancer treatment, and this has caused stress and failures that could have been avoided.  Going back to the Facebook group, being mostly Americans they have really good communications with their consultant prior to and post treatment and are given detailed results of scans etc, probably because they are treated as a paying customer. I have not experienced any of that.  These people are the haves in the US system though, wonder what happens as a have not with no medical cover? Think I'll stick with our NHS!

Nick