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BS: UK An NHS Story

The PA 15 Jun 06 - 04:22 AM
The Fooles Troupe 15 Jun 06 - 05:52 AM
GUEST,Fogie 15 Jun 06 - 05:57 AM
Strollin' Johnny 15 Jun 06 - 07:32 AM
Bunnahabhain 15 Jun 06 - 08:51 AM
mandotim 15 Jun 06 - 08:56 AM
The PA 15 Jun 06 - 09:15 AM
mandotim 15 Jun 06 - 09:26 AM
The PA 15 Jun 06 - 09:33 AM
The Fooles Troupe 15 Jun 06 - 08:56 PM
Strollin' Johnny 16 Jun 06 - 07:30 AM
mandotim 16 Jun 06 - 10:59 AM
Cllr 16 Jun 06 - 11:48 AM
mandotim 03 Jul 06 - 10:06 AM
Dave (the ancient mariner) 03 Jul 06 - 11:04 AM
Richard Bridge 03 Jul 06 - 11:27 AM
The PA 03 Jul 06 - 11:39 AM
Dave (the ancient mariner) 03 Jul 06 - 01:48 PM
Tootler 03 Jul 06 - 04:42 PM
McGrath of Harlow 03 Jul 06 - 09:36 PM
mandotim 04 Jul 06 - 03:20 AM

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Subject: BS: UK An NHS Story
From: The PA
Date: 15 Jun 06 - 04:22 AM

On Tuesday 13 June my 86 year old mother fell and dislocated her atificial hip. She was taken by ambulance to hospital where she waited on a trolly from 10.15am until 7.15pm, to be transferred to an orthopaedic hospital 3 miles away. She was not able to have anything to drink, eat, or any pain relief because they did not know what the other hospital were going to do with her, surgery wise etc. The wait was caused because there were no ambulances available in the city, to transport her. She had to wait for an ambulance to come from the next available NHS area, some 40 miles away. Due to staff shortages there were very few civilian staff at the first hospital, she was treated by military medical staff on secondment. At the second hospital, the nurse who admitted here was Chinease, the ward sister was from Saudi and the on call doctor was from Syria. Mom had great difficulty understanding them, or making herself understood. She arrived so late at the second hospital the theatre team waiting for her had gone home. Her hip was finally relocated 31 hours after the fall.

I'm not talking about some cottage hospital out in the sticks. This was the second largest hospital in a major UK city.

I have absolutely no criticism of the staff or the care they were able to give, but surely this situation in 2006 is not acceptable? Your comments please Mr Blair?


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Subject: RE: BS: UK An NHS Story
From: The Fooles Troupe
Date: 15 Jun 06 - 05:52 AM

Gee whizz, in Queensland, we fixed little hassles like that - we just shut down the emergency wards at those hospitals, till we can find private contractors (at higher wages than they would get in the Public Hospital system!) to plug the gaps!

"military medical staff on secondment"

Brilliant! We better tell Peter Beattie that!

:-)

Ah! Little Johnny runs the guys with the guns, they're Federal, and Johnny and Peter play for opposing Political teams...


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Subject: RE: BS: UK An NHS Story
From: GUEST,Fogie
Date: 15 Jun 06 - 05:57 AM

I sympathise with your mothers history. As a part of the front-line NHS I have had a worrying feeling for a decade or so that we are overseeing the run-down of what we understand as the NHS, while being urged to do more and more for patients, with an increased but still inadequate budget. I also think that now even the management costs are now pared to the bone,( but not neccesarily the business advisors the government takes on.)
I can't really report on what is happenning in hospitals,but hospitals and primary care services and ambulances and other services are all fighting for their own costs.
It makes me angry at leaks the government puts out about GPs income, and before anyone kicks the GP contract funding and out-of hours costs it is important to realise what a demoralised bunch they were, and how little money was offered to continue working their previous hours, which led to the acceptance of the new contract and rejection of the OOH funding- (now many times the cost it was)
Much of the direction of the new GP contract is admirable, but has resulted in many extra costs to the system, which are not specifically being funded.
It is interesting that the GP contract, far from being set in stone seems to have become elastic again as treatments for new diseases have been hoisted on them, without negociation and once again reimbursement is dependant upon ticking boxes doing tests prescribing more drugs etc. etc. -all from the same pot!
It really must be a difficult job pleasing all the people all the time within a country that is not making more and more money, and with so many other commitments, such as keeping world class armed services!
Just to give two examples of budget problems, 1 the number of elderly being kept alive for longer has vastly increased,as has what is able to be treated, and so the drug budget has rocketed. 2 The cost of herceptin for breast carcinoma for a single woman year is £22K which is a good percentage of keeping a nurse in her post! Unfortunately the NHS is a bottomless pit of needs which is unlikely ever to be fully met, so its just a matter of politicians jumping in and sorting the most emotive issues as the rest go to the wall.
I'm not sure how to fix the system, it depends as a society what we elect to spend our taxes on, and how our usual party political system copes with everyone wanting different things from that money.
I find it perplexing, and too complex a subject for a "bear with little brain" to try grasp or explain all the facets of the system.


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Subject: RE: BS: UK An NHS Story
From: Strollin' Johnny
Date: 15 Jun 06 - 07:32 AM

I've had two spells in an NHS hospital recently, totalling just short of four weeks. The care I received from the nursing staff was absolutely first class - my condition the first time was life-threatening and I couldn't have wished for better treatment. Those ladies (and gentlemen!) were fantastic.

However, I couldn't help but notice that the nursing staff were heavily outnumbered by administrative staff, most of whom seemed to spend their entire working day walking the corridors with a sheet of paper in their hands. Every time I ventured out of the ward on to the corridors there they were, the same people with (presumably) the same sheet of paper, wandering around apparently aimlessly.

Maybe the NHS should offload a goodly percentage of those in seemingly parasitic jobs, and put the money they save where it's needed - into the medical and nursing side?
S:0)


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Subject: RE: BS: UK An NHS Story
From: Bunnahabhain
Date: 15 Jun 06 - 08:51 AM

But Strollin' Johhnie, you've got to actually know what you're doing to be a part of the medical staff. All those paper pushers provide perfect employment for all those new graduates in psycology from the we're-really-a-University of the rough side of Glasgow.

Anybody remember 1997?- "24 hours to save the NHS"?

If the NHS goes on a strict diet, and has it's booze and fags taken away, then there might just be time to stop it dropping dead. But Labour have shown they can't or won't do that.


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Subject: RE: BS: UK An NHS Story
From: mandotim
Date: 15 Jun 06 - 08:56 AM

I worked in the NHS for nearly 20 years; trotting out the old adage about 'too many administrators' doesn't hold water, but most people who do it don't want to be bothered with the facts. Here's a few;

Most successful large commercial organisations spend between 11 and 14 percent of their total paybill on management and administration. The NHS spends less than 7 percent, from which it is possible to conclude that the service is undermanaged, not overmanaged. When did you last complain about too many managers at Tesco? (Incidentally, the like-for-like figure for the oft-admired commercially driven health system in the USA is close to 19 percent.)

The NHS is a huge and highly complex organisation, employing over a million staff. In the 1980's a large number of managers were drafted in from private industry to 'sort out' the NHS. Hardly any of them survived, as they were unable to make the transition from the relative simplicity of the pursuit of profits to the complexity of an organisation where every individual patient is a product line in themselves. NHS managers are by and large highly skilled, and in my experience work far harder than their industry counterparts (I worked in industry for 10 years too)

Again in the 1980s; the government of the day ran a campaign to strip out administrative staff; the biggest consequence was that Ward Clerks work is now done by relatively highly paid nurses, who are taken away from their prime function of caring for patients.

In any organisation the size of the NHS, things will go wrong; no system is perfect. It is easy to make a huge fuss about each and every error, giving the impression that the service is in some kind of permanent crisis. The truth is that most commercial chief executives would sell their grandmother for the kind of efficiency and effectiveness that the NHS provides. Good news is no longer news thanks to the massed ranks of cynical, under-employed English graduates posing as serious journalists in the UK.

The UK is near the bottom of the list of developed nations in terms of the proportion of GDP we spend on health care. The vast bulk of the money is spent on front-line care (e.g. 60% of the pay bill is spent on nurses alone.) Looked at like this, the NHS starts to look like a bargain.

Rant mode off, back to being a peaceful academic.
Tim


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Subject: RE: BS: UK An NHS Story
From: The PA
Date: 15 Jun 06 - 09:15 AM

Thank you all for your contributions.

Unfortunately Tim, when your 86 year old mother is in agony for 31 hours, you feel very justified in making a 'hugh fuss'. At that time you are not interested in statistics. We are only human and see the situation from a very personal point of view. We are not interested in efficient management, all we want is a doctor and a nurse who can help. When you go into Tesco's you get produce and a person on the check-out, not empty shelves a manager telling you how wonderful his store is.

Latest update - the hip has 'popped' again. But we have no information as to what they are going to do next. We have to 'wait for the doctors to decide'. Not another 31 hours we hope!


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Subject: RE: BS: UK An NHS Story
From: mandotim
Date: 15 Jun 06 - 09:26 AM

The PA; I understand what you say; I have aging and ill parents too, of roughly the same age as yours. What I was trying to point out is that one case (or even several cases) do not stand up as evidence of a service that doesn't work; the fact is that it does, most of the time. It doesn't organise itself; someone has to buy equipment, pay the wages, collect evidence about what treatment works and what doesn't, organise the staffing, recruit people, pay the bills, manage waiting lists, plan for future care needs, deliver training etc etc...managers contribute too, and most clinical staff would support that statement.
In Tesco you get produce on the shelves because the supply chain is well managed and the staff are well led. The function is fundamentally the same in the NHS; it's just that people who don't want to acknowledge the facts find managers an easy target.
I read the case history of your mother carefully; all the key decisions would have been made by clinical staff, not the managers you seek to scapegoat.
I hope your mother makes a full and speedy recovery.
Tim


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Subject: RE: BS: UK An NHS Story
From: The PA
Date: 15 Jun 06 - 09:33 AM

Tim - sorry if it came over that way, I'm trying not to use anyone as a scapegoat. Its just a system which I fail to understand. Feel free to rant - it does us all good!

My boss has just said 'does that make her hip-pop'. Bad Joke.

I'll keep you posted. PA.


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Subject: RE: BS: UK An NHS Story
From: The Fooles Troupe
Date: 15 Jun 06 - 08:56 PM

Sadly, if the artificial hip keeps popping out, it seems that perhaps the stresses are not correct for the design of the prosthetic device, simply, it may have been installed incorrectly, or something has changed - shifted.

This does not seem good news - and it is one of the possibilities I considered some time ago when I made the decision to not go down that path to ease my discomfort.

Things do sometimes go wrong - the same reason I have avoided laser eye corrective surgery - I had a friend who did this and it went wrong - now he needs stronger correction than before the surgery, and picked up a Golden Staph infection while going thru the nightmare too.

Sorry, was only trying to be sympathetic...


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Subject: RE: BS: UK An NHS Story
From: Strollin' Johnny
Date: 16 Jun 06 - 07:30 AM

Tim, the point I was making was that is HUGELY inefficient to have large numbers of bodies strolling the (many and incredibly long) corridors holding a sheet of paper (and, incidentally, stopping to natter with others of that ilk whom they meet along the way, or standing outside the main entrance gassing and having a fag)! While they're on their perambulations, they're not at their desks beavering away.

I fully understand the need for administrators (I'm one myself in a private sector business) but it's efficient practices and disciplined observance of those practices, not headcount, that makes the difference between a Debit or a Credit figure at the bottom of the Profit and Loss Account.


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Subject: RE: BS: UK An NHS Story
From: mandotim
Date: 16 Jun 06 - 10:59 AM

Strollin J; I agree, highly inefficient; and as an ex O&M practitioner I could take you to any organisation, anywhere in the world and point out people doing exactly the same things. Three points; hospitals are usually big places, with miles of corridors, and people have to get from one part to another occasionally; hospitals are non-smoking environments for obvious reasons, and the only place smokers can go is usually outside; and finally, the point I was making is that in comparison to the much-lauded private sector, there are actually smaller numbers of managers in the NHS as a proportion of overall staffing; most of these are grossly overworked (as evidenced by the occurrence of stress related diseases and the recorded hours worked.)
I have experience of working in both sectors, for many years. NHS managers stand comparison (as a group) with any I've seen. Try to deal in facts, not easy anecdotes.
Tim


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Subject: RE: BS: UK An NHS Story
From: Cllr
Date: 16 Jun 06 - 11:48 AM

three moths ago I did a course on operational managment as part of my MPA (masters in public administration) the key theme was the use of lean management aplications as used in the private sector. The academics at Warwick and NHS practioners involved in the studies have been severly frustrated by the lack of take-up (where it has been used the results have been little short of astonishing) The main focus of lean managment in this context has been the increase in throughput and an increase in quality without increasing capacity (ie shorter queues better service and no additional resources required)
I was very pleased to see in Te Tmes on thursday that two major hospitals have decided to use lean management theory and I really look forward to the results. To The PA i dont know if this helps but stories like your mothers are all too common and I hope finaly that changes will be made. Cllr


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Subject: RE: BS: UK An NHS Story
From: mandotim
Date: 03 Jul 06 - 10:06 AM

i rather like the quote from Rosabeth Moss Kanter, a much respected guru; 'You can only carry on becoming lean and mean for so long before you become gaunt and dead'. The NHS has made net cost improvements of between 2 and 2.5% per annum for the last 20 years; at compound, that looks like becoming lean and mean to me. (Note; the fact that the NHS still costs more is due to higher public demand/expectations, improvements in science that allow more types of treatment and the cartels operated by people like pharmaceutical companies, all of which mean NHS inflation is higher than 'normal' inflation.
Tim


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Subject: RE: BS: UK An NHS Story
From: Dave (the ancient mariner)
Date: 03 Jul 06 - 11:04 AM

The admin work is what nurses are spending more time on instead of being primary care givers in Canada. A large part of their work is completing information sheets and logging treatment, then typing them up on computers (duplication of effort, the work and time)

Unfortunately, if you go to an emergency department in a hospital, they will place you in triage where you can linger for hours unless you display life threatening symptoms. The ambulances have emergency priority patients to deal with too, and transport from one facility to another is secondary.

As disturbing as it might be, they cannot always give certain medications to an 86 year old woman without an anesthetists permission. She could have died very easily if it conflicted with other medications; and if she could have received surgery sooner it might have compromised the anesthetists ability to administer the necessary drugs. Not making excuses for poor hospital services, but it sounds like you got stuck on a busy day. I spent hours with kidney stone pain, waiting to be treated once, but the poor bastards ahead of me could have died without help first, I was just in some pain but no immediate danger.

Yours, Aye. Dave


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Subject: RE: BS: UK An NHS Story
From: Richard Bridge
Date: 03 Jul 06 - 11:27 AM

IMHO a major problem was the introduction of a quasi-capitalist "internal market" on dogmatic Thatcherite principles. It is furthered by the irrational Blairite belief that the "free" market achieves optimum distribution of resources. Resources are wasted on nose jobs and viagra rather than real needs.

What is needed is a properly planned economy in this sector. And permanent staff not agency staff - whose agencies get the cream (and cream the NHS) while the staff are exploited and thereby demotivated.

Oh, and another thing that would be nice is less "managementspeak" (aka gibberish)


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Subject: RE: BS: UK An NHS Story
From: The PA
Date: 03 Jul 06 - 11:39 AM

Lastest update.

The hip dislocated a total of three times over a week, necessitating three general anasthetics to put it back in. When it was obvious this was not working she spent the next week in traction, followed by a total hip replacement. The amount of medication combined with the anasthetics caused an adverse reaction and she finished up in ITU for four days. It is 4 weeks tomorrow since her initial fall. The fall was caused by the failure of the artificial hip joint. It was 10 years old and had simply worn out. However she is now on the road to a full recovery (fingers crossed) but I have aged about 50 years!

Thank you all for your interest and contributions.


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Subject: RE: BS: UK An NHS Story
From: Dave (the ancient mariner)
Date: 03 Jul 06 - 01:48 PM

We wish her a speedy recovery, at 86 that is so much trauma to suffer. I do hope you recover your youth ;-) It must be very hard on your nerves, take care.

Yours, Aye. Dave


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Subject: RE: BS: UK An NHS Story
From: Tootler
Date: 03 Jul 06 - 04:42 PM

Glad to hear your mum is on the mend. Let's hope that she continues to improve.

Geoff


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Subject: RE: BS: UK An NHS Story
From: McGrath of Harlow
Date: 03 Jul 06 - 09:36 PM

It makes sense to have non-medical managers and administrators around, and there well be a need for more than there are currently. The object being to save clinical staff from wasting their time doing bureaucratic stuff. Basically it's the same principle as having people around who specialise in pushing trolleys, rather than relying on nurses and doctors to do that.

The trouble is when non-clinical staff get diverted into operating in a way that doesn't help things go more smoothly, but has the effect in practice of loading bureaucratic stuff back on the people doing the clinical work.

It's the same thing that is happening in all kind of fields of work - in education, in social work, in police work... And it happens in the private sector as well. It's the outcome of a deeply flawed managerial culture, and of people in positions of power (politicians and senior executives) who don't understand it, but have bought into it, largely because they are scared to admit they don't understand it. Emperor's new clothes.


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Subject: RE: BS: UK An NHS Story
From: mandotim
Date: 04 Jul 06 - 03:20 AM

Hope your Mum continues to get better; that's what really matters.
Tim


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