NHS Code Black

[merlin]

As ever Markus you make a fair point. I am a man of contradictions

Maybe we could have a clause where medical professionals are able to decide whether an illness is the direct or indirect result of personal gluttony or acknowledged self harming?

Subsidy of any health care provision to be decided based upon said clinician's opinion.

Tie such a clause in with compulsory genetic testing prior to acceptance and Mr Hunt could be onto a winner.

 

[Tim Jones]

You have mentioned this before. What is that solution?

In the absence of an answer from Jack (who knows? Perhaps he has something up his sleeve?), I suspect the answer is simply to tax and spend more.

From the Treasury's point of view (and this is running-the-country bit of HMT, not the political bit) that simply removes any incentive for the NHS to run itself more efficiently.

More broadly we're still left with this problem of how we prevent the NHS consuming a larger and larger and larger proportion of GDP. Health care inflation, driven by a combination of factors but not least by the point that medicine just gets better and more expensive, is likely to go on outstripping economic growth. In fact it may accelerate relative to growth.

 

[Brian]

Define 'more efficiently' and how much is spent proving/measuring it?

Edit: Can you describe the current tory thinking on what constitutes incentives to be more efficient?

 

[oldie]

By the way, the annual cost of running Trident is around £2.4bn. The NHS annual budget (for England alone) is over £100bn. So, whatever the other arguments about Trident, it certainly would not 'cover the cost of the...NHS for decades' I'm afraid.

Hi Tim,
I did say cancel, that would of course include the new submarines that they intend building to deliver the weapon and all of the support and manufacturing oganisation in Scotland.

Seeker_UK
It was not a slighly to the left rant, I just can not get my head round the fact that we can spend more to kill people than to heal them. I do hope that you never need the services of the NHS only to find that there is not a bed available for you due in the main for lack of funding of one sort or another be it care of the elderly or shortage of qualified staff.
oldie

 

[Tim Jones]

Define 'more efficiently' and how much is spent proving/measuring it?

Edit: Can you describe the current tory thinking on what constitutes incentives to be more efficient?

Of course. Efficiency is measured by improving health outcomes relative to cost. You can do it by number of patients treated relative to cost (although that's a bit iffy). This is just what Treasury push for and have always pushed for in any public service. Their job - and again this is the civil servants, not the politicians - is to maximise value to the taxpayer.

I don't know what you mean by 'how much is spent measuring it'. It's not difficult and can be worked out from figures pretty well in the public domain. The NHS is already very efficient in some ways. But that doesn't mean it shouldn't keep trying to improve on that.

There's nothing 'tory' about efficiency in the NHS. You seem to be under the misapprehension that this is somehow a political act. It's not. It's just good Government to try to make things more efficient - especially when GDP growth is only about 1%, while demand growth is 4%. As I explained above...

Now, I think a different question was being asked.

 

[merlin]

Of course. Efficiency is measured by improving health outcomes relative to cost. You can do it by number of patients treated relative to cost (although that's a bit iffy). This is just what Treasury push for and have always pushed for in any public service. Their job - and again this is the civil servants, not the politicians - is to maximise value to the taxpayer.

For my own clarity of mind Tim, if a consultant writes a discharge letter stating that they have not been able to demonstrate a condition and therefore that it's time for the patient and his GP to move onto strategies for coping with symptoms, would that be efficiency - as in patient discharged (tick) and course of action recommended (tick)?

We could call this tick box health care - criteria satisfied in short period of time to fill the objective markers. This would represent efficiency for his (or her) department. A fast moving conveyor belt if you like. Does their efficiency "measurement" end at this point? Does the discharge represent an outcome of sorts as far as your boards are concerned?

What then happens then if, say six months down the line, said patient ends up in a coma in ITU because he DID have the condition indicated but the consultant did not have funding or facilities to carry out the correct testing, nor the time to investigate beyond ticking those boxes? If the consultant's primary concern was efficiency and treating patient numbers?

I would imagine not only is the cost considerably higher for the taxpayer but the impact of the patient's life is unnecessarily severe.

On more than one occasion I've heard the words "these tests are very expensive", "we simply don't have the equipment", "we have to buy through charitable sources as the NHS does not provide them - they are expensive". It's a shame that these considerations are at the forefront of consultants' thinking and the resultant outcomes are often hugely more costly to the taxpayer than they need be. Is this typical of "efficiency" Tim?

 

[Brian]

Of course. Efficiency is measured by improving health outcomes relative to cost. You can do it by number of patients treated relative to cost (although that's a bit iffy). This is just what Treasury push for and have always pushed for in any public service. Their job - and again this is the civil servants, not the politicians - is to maximise value to the taxpayer.

I don't know what you mean by 'how much is spent measuring it'. It's not difficult and can be worked out from figures pretty well in the public domain. The NHS is already very efficient in some ways. But that doesn't mean it shouldn't keep trying to improve on that.

There's nothing 'tory' about efficiency in the NHS. You seem to be under the misapprehension that this is somehow a political act. It's not. It's just good Government to try to make things more efficient - especially when GDP growth is only about 1%, while demand growth is 4%. As I explained above...

Now, I think a different question was being asked.

No, it is not simple at all. That people making decisions probably think it is simple is a large part of the problem. Interesting also that you don't grasp what I'm on about.

For my own clarity of mind Tim, if a consultant writes a discharge letter stating that they have not been able to demonstrate a condition and therefore that it's time for the patient and his GP to move onto strategies for coping with symptoms, would that be efficiency - as in patient discharged (tick) and course of action recommended (tick)?

We could call this tick box health care - criteria satisfied in short period of time to fill the objective markers. This would represent efficiency for his (or her) department. A fast moving conveyor belt if you like.

What then happens then if said patient ends up in a coma in ITU because he DID have the condition indicated but the consultant did not have funding or facilities to carry out the correct testing, nor the time to investigate beyond ticking those boxes? If the consultant's primary concern was efficiency and treating patient numbers?

I would imagine not only is the cost considerably higher for the taxpayer but the impact of the patient's life is unnecessarily severe.

That is tory efficiency.

Changing the terms of employment such that hours worked that are classed as unsocial hours (for example, late evenings, nights, weekends) attracting additional salary to be 'normal' is also considered by tories an improvement in efficiency. Of course, that people subjected to this abuse will leave their job is an unimportant side issue.

 

[Kendun]

Of course. Efficiency is measured by improving health outcomes relative to cost. You can do it by number of patients treated relative to cost (although that's a bit iffy). This is just what Treasury push for and have always pushed for in any public service. Their job - and again this is the civil servants, not the politicians - is to maximise value to the taxpayer.
.

Sometimes, non-clinicians do not grasp what is required for a patient and come up with figures to predict capacity and demand, and this is not always a true reflection of a service.

 

[Tim Jones]

Brian - the question that I think is just as interesting as your own was that asked by eturnumviti of Jack - what the left's solution to these issues was. I note no answer has been forthcoming and you are not providing one either but sidestepping the issue by just asking questions of the questioners.

Requiring efficiency in public services is not a 'Tory' policy. It has been practised by the Treasury and other Government departments for decades. You might as well say that were you the Chancellor, you wouldn't really mind if any given public service was not getting as much for the taxpayers' pounds as it could.

Efficiency is relatively simple. Sure, there are questions about what indicators one is using, but ultimately it's a relationship between input cost and output across the system. You are sliding from this into something different - rationing. And that's why we have NICE, which makes evidence-based recommendations about effective treatment which clinicians and commissioners are (in theory) supposed to follow.

The point at which efficiency meets demand management works like this - if a patient with (say) diabetes receives poor long term care such that they have to be admitted for a foot amputation, or even loses their sight, that is clearly more expensive for everyone and poorer care for that patient. I don't see what is philosophically wrong with moving resources from acute care into long term, integrated care if you can evidence that not only does it enable the NHS to do more within its finite resources, but also improve the quality of care. I do see what is politically difficult about it, which is why it is so difficult to do, even though we've been telling ourselves we'd do it for at least 30 years.

 

[Brian]

Tim,

I'm not 'left' so I can't help you with what that particular group may believe.

I never said requiring efficiency is exclusive to tories, I don't believe anyone likes to see waste. What I'm saying is tories have a peculiar understanding of what efficiency is.

As for an answer, I am not qualified to come up with an answer, which is why I haven't made any suggestions. Are you qualified? Are government ministers? Are members of treasury? Sorry it's more questions but I do think this is the problem. From what I've seen, read and heard of schools, the medical profession, fire service and others, people making demands for 'improved efficiency' don't have the faintest idea what they are talking about. They just make demands and set targets etc etc. There is a cost to measuring performance against these often ridiculous targets in a way that demonstrates some improvement or other but if you speak to people 'on the ground' there hasn't been an improvement anyway. It's become a job demonstrating a target has been met and then it's on to the next one. The whole approach is flawed and frustrating.

I guess the only suggestion I would have to 'improve efficiency' would be to move away in general from being so dominated by targets and measurements. Let people get on with their job. 99.9% of people want to do their best and they will do that without targets that a whole industry is being paid to devise and another industry is being paid to measure. A bit like switching traffic lights off for a month at a certain busy section in London improved traffic flow a few years ago. Not many would have thought that would be better.

 

[merlin]

Efficiency is relatively simple.

Clearly it isn't Tim.

It's dependent on the markers used and where you choose to take them.

Sadly those decisions are often politically driven.

 

[hifinutt]

" And that's why we have NICE, which makes evidence-based recommendations about effective treatment which clinicians and commissioners are (in theory) supposed to follow."

to illustrate tims point . before nice recommended topical pain treatment like ibubrufen cream or movelat cream it was exceedingly hard to get it for people in pain.
now it is easy because it has been recommended . its very effective in some bony pain and saves taking oral painkillers

its this efficiency which is so important

however there are still huge ways to improve on efficiency like getting on top of repeat drug prescribing . sometimes you see huge bags of inhalers or pain killers in folks houses because the chemist keeps rolling them out
some of these can cost over 50 pounds each

http://www.ggcprescribing.org.uk/me...rces/inhaler_indentification_guide_-_1310.pdf

sometimes you see the same with nutritional drinks which are stockpiled

with incontinence pads there has been huge savings because instead of rolling them out on repeat prescription which resulted in great piles of them in bedrooms [they cost over £25 a packet] folks now have to ring up to reorder so you don`t get overload

as I mentioned before if hospital social workers were not running around bogged down in finding out whether a pressure sore was preventable or not you just might have more resources for finding granny smith a place to live when she is discharged freeing up beds in a&e or hospital beds

 

[Suffolk Tony]

Brian - the question that I think is just as interesting as your own was that asked by eturnumviti of Jack - what the left's solution to these issues was. I note no answer has been forthcoming and you are not providing one either but sidestepping the issue by just asking questions of the questioners.

Requiring efficiency in public services is not a 'Tory' policy. It has been practised by the Treasury and other Government departments for decades. You might as well say that were you the Chancellor, you wouldn't really mind if any given public service was not getting as much for the taxpayers' pounds as it could.

Efficiency is relatively simple. Sure, there are questions about what indicators one is using, but ultimately it's a relationship between input cost and output across the system. You are sliding from this into something different - rationing. And that's why we have NICE, which makes evidence-based recommendations about effective treatment which clinicians and commissioners are (in theory) supposed to follow.

The point at which efficiency meets demand management works like this - if a patient with (say) diabetes receives poor long term care such that they have to be admitted for a foot amputation, or even loses their sight, that is clearly more expensive for everyone and poorer care for that patient. I don't see what is philosophically wrong with moving resources from acute care into long term, integrated care if you can evidence that not only does it enable the NHS to do more within its finite resources, but also improve the quality of care. I do see what is politically difficult about it, which is why it is so difficult to do, even though we've been telling ourselves we'd do it for at least 30 years.

Good post Tim. Good to see someone on this debate who's actually got knowledge of the situation, and doesn't get deflected by political dogma. The real challenge is how to get folk to change to cope with the modernisation of the NHS, And how to get integration across acute and long-term care.

 

[merlin]

If Tim has been involved in efficiency studies and recommendations over recent decades vis a vis the NHS then I'm not sure his area of "expertise" is necessarily of a great deal of use when discussing the current crisis.

I can't be the only one who wonders how much of the current fiasco is down to people like Tim getting areas of healthcare provision so horribly wrong over the past thirty years or more.

Straight answers to straight questions would be a start IMHO - I see far too much politico arse covering for my taste both in threads like this and in the discussion in general.

 

[Cav]

Surely Public Services should be both efficient, which is mainly a cash issue, and effective, which is mainly about doing what it is there to do.

The NHS seems unique in that the Government claims to be spending more, which is hardly efficient, but is achieving less, which is not effective.

 

[Brian]

If Tim has been involved in efficiency studies and recommendations over recent decades vis a vis the NHS then I'm not sure his area of "expertise" is necessarily of a great deal of use when discussing the current crisis.

I can't be the only one who wonders how much of the current fiasco is down to people like Tim getting areas of healthcare provision so horribly wrong over the past thirty years or more.

Straight answers to straight questions would be a start IMHO - I see far too much politico arse covering for my taste both in threads like this and in the discussion in general.

Good post, Mike. Good to see someone on this debate who has first hand knowledge of the situation, and doesn't get deflected by political dogma. The real challenge is how to wrestle the running of the NHS and other public services away from accountants, bean counters and politicians.

 

[Brian]

Surely Public Services should be both efficient, which is mainly a cash issue, and effective, which is mainly about doing what it is there to do.

The NHS seems unique in that the Government claims to be spending more, which is hardly efficient, but is achieving less, which is not effective.

Spending more in isolation does not necessarily mean reduced efficiency. In combination with achieving less would be less efficient.

If more is being spent it seems obvious a greater perecentage than ever before is being lost to profit, but govt won't want to admit that so let's just babble on about inefficient working practices.

Obviously we need some govt and treasury experts to sort this out.

 

[Suffolk Tony]

If Tim has been involved in efficiency studies and recommendations over recent decades vis a vis the NHS then I'm not sure his area of "expertise" is necessarily of a great deal of use when discussing the current crisis.

I can't be the only one who wonders how much of the current fiasco is down to people like Tim getting areas of healthcare provision so horribly wrong over the past thirty years or more.

Straight answers to straight questions would be a start IMHO - I see far too much politico arse covering for my taste both in threads like this and in the discussion in general.

There's no value in trying to point the finger at any one group. Unfortunately, I found the NHS to be riddled with "Blame culture". Everyone has played a part in making the NHS less efficient than it should be, and I include myself in this on occasion.

 

[merlin]

Hi Tony,

I wasn't trying to point the finger at any one group and sorry if it came across as such.

I was just suggesting that perhaps all of those previously involved in attempts at efficiency improvements and restructuring might not be the best people to ask about where improvements can be found given the chaos the system is now in.

From my own point of view, I've seen such horrendous waste with absolutely no result. This appears to be primarily a case of clinicians being afraid of not following NICE guidelines to the letter. There seems to be a fear culture that overrides the application of common sense. How do you get common sense back into a nationalised industry? What would happen if you stripped out some of the levels of management and gave those funds to the medical professionals?

 

[doctorf]

Hi Tony,

I wasn't trying to point the finger at any one group and sorry if it came across as such.

I was just suggesting that perhaps all of those previously involved in attempts at efficiency improvements and restructuring might not be the best people to ask about where improvements can be found given the chaos the system is now in.

From my own point of view, I've seen such horrendous waste with absolutely no result. This appears to be primarily a case of clinicians being afraid of not following NICE guidelines to the letter. There seems to be a fear culture that overrides the application of common sense. How do you get common sense back into a nationalised industry? What would happen if you stripped out some of the levels of management and gave those funds to the medical professionals?

If the doctors ran the show I suspect we would go bankrupt very quickly or else a lot of stuff would have to be outwith the NHS to allow the expensive stuff to take place.
I do some work at a charity and we are considering a grant at the moment to keep a teenager alive. The health service provider involved is not prepared to spend £300,000 a year to keep him alive. If doctors ran the show I suspect he would be funded although that sort of money could provide x hip replacements or y cataracts etc etc.