NHS Code Black
- Thread starter merlin
- Start date
Brian
Eating fat, staying slim
That sounds like paranoia. There is no ad-hom anywhere, certainly nothing from anyone much different to what you're posting when you refer to 'the left'.
First, I didn't say all you've done in 20 years is change working practices in the NHS, assuming that's what you mean in para 1.
I told you earlier what I would do, having admitted I'm not qualified, so you didn't read the 'weasel' words properly and understand the very basic message. I also never mentioned 2008 and don't make a habit of it, that's part of the tory narrative of 'it was Labour wot done it'. I don't see why they are weasel words but they have been quoted above by Mull, so not far to go to find them.
I don't like what has been happening to the NHS, people are accepting it has become less efficient so whatever has been happening to improve efficiency tory style hasn't been working. You may disagree.
Finally, I didn't realise saying someone is a tory supporter is ad-hom. I reckon you have me down as a 'leftie' with all the implications of that from some members here. I'm not whinging about it though because I know where I stand and it's at neither extreme.
droodzilla
pfm Member
Always this. It's the elephant in the room that bedevils almost all political discussion. I wish people would give it some thought when, for example, evaluating the Conservative Party's economic record both within the coalition and beyond. How much stronger would our economic recovery (feeble, at best) have been had Osborne not been ideologically committed to austerity and reducing investment in public services and infrastructure.
merlin
Avatar changed - Town names deemed offensive.
I'm genuinely surprised by Tim's response to being questioned. Particularly coming from someone who is not a politician.
To press reset, how about Tim agreeing that no one has called him a politician. Then how about starting again by answering the (I thought simple) questions politely posed some pages back?
There's a culture in the NHS whereby many consultants have something of a "god complex". It's undoubtedly a hindrance to the efficiency of the operation on occasion. It would be a real problem if some civil servants and management personnel sufferered from a similar condition and were unable to step back and take a critical view of their work IMHO.
Now I'll possibly be accused of "weasel words" and "passive aggressive" behavior but IMHO I'm only saying what perhaps needs to be said. There is a culture that is a problem within the NHS.
To press reset, how about Tim agreeing that no one has called him a politician. Then how about starting again by answering the (I thought simple) questions politely posed some pages back?
There's a culture in the NHS whereby many consultants have something of a "god complex". It's undoubtedly a hindrance to the efficiency of the operation on occasion. It would be a real problem if some civil servants and management personnel sufferered from a similar condition and were unable to step back and take a critical view of their work IMHO.
Now I'll possibly be accused of "weasel words" and "passive aggressive" behavior but IMHO I'm only saying what perhaps needs to be said. There is a culture that is a problem within the NHS.
Joe Hutch
Mate of the bloke
Same here!
Merlin
You have got yourself into the habit of non stop whinging to the point I don't think you even realise you are doing it and also you do dig at your "enemies" quite nastily and I for one nearly always avoid a discussion with you. I always flounce after an exchange with you or else it will develop into WW3.
Your comments to Tim were just plain acid
As regards to Brian, I agree he is not extreme but he does overdo the constant mild criticism without ever coming up with any alternative ideas and eventually it is pointless talking to him. Even that this late stage, he has not come up with a single idea after Tims request for one.
Suggestions of applying common sense in a large organisation such as the NHS are pointless, what is common sense to one department is unacceptable to another.
The simple fact is that the population is aging and hence bed blocking is inevitable. The simple truth is that 90% of us will eventually become a bed blocker and this will get worse as standards rise and people are kept alive in an hospital bed for far to long.
Possibly there is an argument that non resuscitation orders are given to the over 75s where it is obvious they will have a low quality of life and are going to spend their last few months just lying in a bed in discomfort. Nature has given us a natural life span and perhaps we should honour it more and stop prolonging the agony.
Also people should exploit their rights under the EU a bit more and become "health tourist" in other countries. However be warned that the UK favours well with other countries who have the same ageing problems as we do.
The final answer is that we cannot keep throwing money at the NHS and that we need to make it far more cost effective by employing better procurement polices (that are currently shambolic), more joined up thinking between the trusts and more outsourcing to a pre agreed specification where it is shown to save money.
Also instead of the constant snide comments against Tim, best to use his knowledge and take it from there. We need his expertise in this thread and hounding him out with snide and petty insults does none of us any favours.
Regards
Mick
You have got yourself into the habit of non stop whinging to the point I don't think you even realise you are doing it and also you do dig at your "enemies" quite nastily and I for one nearly always avoid a discussion with you. I always flounce after an exchange with you or else it will develop into WW3.
Your comments to Tim were just plain acid
As regards to Brian, I agree he is not extreme but he does overdo the constant mild criticism without ever coming up with any alternative ideas and eventually it is pointless talking to him. Even that this late stage, he has not come up with a single idea after Tims request for one.
Suggestions of applying common sense in a large organisation such as the NHS are pointless, what is common sense to one department is unacceptable to another.
The simple fact is that the population is aging and hence bed blocking is inevitable. The simple truth is that 90% of us will eventually become a bed blocker and this will get worse as standards rise and people are kept alive in an hospital bed for far to long.
Possibly there is an argument that non resuscitation orders are given to the over 75s where it is obvious they will have a low quality of life and are going to spend their last few months just lying in a bed in discomfort. Nature has given us a natural life span and perhaps we should honour it more and stop prolonging the agony.
Also people should exploit their rights under the EU a bit more and become "health tourist" in other countries. However be warned that the UK favours well with other countries who have the same ageing problems as we do.
The final answer is that we cannot keep throwing money at the NHS and that we need to make it far more cost effective by employing better procurement polices (that are currently shambolic), more joined up thinking between the trusts and more outsourcing to a pre agreed specification where it is shown to save money.
Also instead of the constant snide comments against Tim, best to use his knowledge and take it from there. We need his expertise in this thread and hounding him out with snide and petty insults does none of us any favours.
Regards
Mick
Having entered this thread late, I have some sympathy with Tim's comments because very clearly (to me at least) the state of the NHS at present is not down to just any one political party but to a general lack of funding combined with mistakes by successive governments in procurement and by the NHS itself in management and procurement practices. This has in real terms failed to keep required investment up with demand.
I have seen this myself as I have been treated over the years for some chronic injuries, and waiting times for consultants in my part of the world seems to be growing year on year.
Earlier this year, when a chap who was sharing the workshop space that I was using managed to cut two of his fingers off on a bench saw, a call for paramedic assistance and an ambulance was treated as an emergency due to the amount of blood-loss and danger of shock. The ambulance never arrived as it had been diverted and I was called and told to rush him to hospital myself, a harrowing journey which left the poor chap howling in agony the whole way with pools of blood all over the car despite best efforts to stop the bleeding and unbelievable bureaucracy at the hospital from reception which I had to simply ignore and march this poor chap into a treatment room pleading for someone to treat him. Transpired that it was a life threatening injury and he went on to require hours of emergency surgery.
My father was in need of an ambulance just a few weeks ago, and the ambulance never arrived, having been diverted, so once again, I had to do the mercy dash and help him through triage until happy that he was being properly cared for.
Wake up and smell the coffee people instead of personal sniping and blaming everything on politicians. The NHS itself at management level has to take some responsibility in some areas (both geographical and medical) but lets not confuse the terms "efficiency savings" and "service cuts" because what we are going through at the moment are real cuts to services, to availability of beds, to staff and even to the size and kitting up of available ambulance services.
My own view fwiw is that the NHS drifted too far towards the more expensive end of healthcare procurement over the past few decades with the cumulative effects of debt accumulation and poor management in areas including procurement (PFI especially), contracted out servicing, too many (expensive) contract staff on the payrolls, a real growth in middle management and a shrinking of more traditional management roles of front line staff (which perversely in many ways were more efficient), a growing UK population and a cutting back in real terms of budgets to enable investment in maintenance, serviceability, staffing etc. In particular there has been a vast underestimation of real whole life costings for keeping up with technology required to run and deliver a 21st century healthcare system.
I can't see any easy answer, and changing who runs the country is not a panacea either. This is a serious and deep wound to the NHS caused by years of neglect, under investment allied to serious global issues with the economy which we were not immune from last time I checked. Serious investment is needed to get things back on track and at present, we just do not have the money, so the guise of "improved efficiencies" is rolled out ad nausea to describe service cuts. Unless we accept that tax rises are the only real way of plugging the massive hole in NHS spending, then we can argue till the cows come home and nothing much is likely to change for the better without real investment and some serious and well thought out changes are made to standardise management and procurement methods nation-wide.
I have seen this myself as I have been treated over the years for some chronic injuries, and waiting times for consultants in my part of the world seems to be growing year on year.
Earlier this year, when a chap who was sharing the workshop space that I was using managed to cut two of his fingers off on a bench saw, a call for paramedic assistance and an ambulance was treated as an emergency due to the amount of blood-loss and danger of shock. The ambulance never arrived as it had been diverted and I was called and told to rush him to hospital myself, a harrowing journey which left the poor chap howling in agony the whole way with pools of blood all over the car despite best efforts to stop the bleeding and unbelievable bureaucracy at the hospital from reception which I had to simply ignore and march this poor chap into a treatment room pleading for someone to treat him. Transpired that it was a life threatening injury and he went on to require hours of emergency surgery.
My father was in need of an ambulance just a few weeks ago, and the ambulance never arrived, having been diverted, so once again, I had to do the mercy dash and help him through triage until happy that he was being properly cared for.
Wake up and smell the coffee people instead of personal sniping and blaming everything on politicians. The NHS itself at management level has to take some responsibility in some areas (both geographical and medical) but lets not confuse the terms "efficiency savings" and "service cuts" because what we are going through at the moment are real cuts to services, to availability of beds, to staff and even to the size and kitting up of available ambulance services.
My own view fwiw is that the NHS drifted too far towards the more expensive end of healthcare procurement over the past few decades with the cumulative effects of debt accumulation and poor management in areas including procurement (PFI especially), contracted out servicing, too many (expensive) contract staff on the payrolls, a real growth in middle management and a shrinking of more traditional management roles of front line staff (which perversely in many ways were more efficient), a growing UK population and a cutting back in real terms of budgets to enable investment in maintenance, serviceability, staffing etc. In particular there has been a vast underestimation of real whole life costings for keeping up with technology required to run and deliver a 21st century healthcare system.
I can't see any easy answer, and changing who runs the country is not a panacea either. This is a serious and deep wound to the NHS caused by years of neglect, under investment allied to serious global issues with the economy which we were not immune from last time I checked. Serious investment is needed to get things back on track and at present, we just do not have the money, so the guise of "improved efficiencies" is rolled out ad nausea to describe service cuts. Unless we accept that tax rises are the only real way of plugging the massive hole in NHS spending, then we can argue till the cows come home and nothing much is likely to change for the better without real investment and some serious and well thought out changes are made to standardise management and procurement methods nation-wide.
merlin
Avatar changed - Town names deemed offensive.
Mick,
I learned from the master.
If you could explain how the above is different to my comments to Tim I'd be fascinated to hear your take on it.
What has been said is this. The NHS is in chaos. Doctors are not responsible. Politicians are not directly responsible. That leaves management and civil servants. Tim falls into that category. To criticise these people is "pure poison" and "ad hom"?
They've had thirty f***ing years Mick. In my field you are lucky to get 30 days.
Mick said:
My inclination would not be to use the knowledge of those failing to address issues but I did try by asking simple polite questions about efficiency markers. Tim's welcome to answer those and start a conversation that might go somewhere useful. It's his choice not to do so.
It's not "snide" to criticise those assuming some responsibility for the chaos I see when dealing with the NHS. That's your old post office mentality creeping through Mick. It's a different world. People have a right to expect results.
Merlin
What you and I think of each other is totally irrelevant. You have been snide, I criticised you and you have defended yourself. Fine - end of discussion.
What is unacceptable are comments like this
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.
That is a total insult to the point of personal attack. You could have made your point by not even mentioning Tims name and he has now departed from the discussion and who can blame him.
One figure currently being bandied around in my local hospital is that funding has increased by 1% in real terms but costs have risen by 4% due to more elderly people having to be cared for because they are too ill to be released and then you have the bed blocking issue on top of that. How do you cope with that without making cuts somewhere else.
Tim and his colleagues have to improve the service against that background and no matter what they do, someone, somewhere isn't going to like it and will complain which kick starts another time consuming enquiry and so on.
To use terms like "having got it so horribly wrong" demonstrates a total lack of understanding.
You seem to be having a multitude of health problems, so naturally you want more money spending on the NHS. Unfortunately teachers want more money spent on education, soldiers want more money spent on defence, some citizens want more money spent on child care, libraries, lamp posts, sewage, the police etc etc.
The money to keep everyone happy just is not there.
If you honestly think the NHS is being poorly run, why not get a job in the NHS and help put it right within the budget constraints.
Regards
Mick
What you and I think of each other is totally irrelevant. You have been snide, I criticised you and you have defended yourself. Fine - end of discussion.
What is unacceptable are comments like this
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.
That is a total insult to the point of personal attack. You could have made your point by not even mentioning Tims name and he has now departed from the discussion and who can blame him.
One figure currently being bandied around in my local hospital is that funding has increased by 1% in real terms but costs have risen by 4% due to more elderly people having to be cared for because they are too ill to be released and then you have the bed blocking issue on top of that. How do you cope with that without making cuts somewhere else.
Tim and his colleagues have to improve the service against that background and no matter what they do, someone, somewhere isn't going to like it and will complain which kick starts another time consuming enquiry and so on.
To use terms like "having got it so horribly wrong" demonstrates a total lack of understanding.
You seem to be having a multitude of health problems, so naturally you want more money spending on the NHS. Unfortunately teachers want more money spent on education, soldiers want more money spent on defence, some citizens want more money spent on child care, libraries, lamp posts, sewage, the police etc etc.
The money to keep everyone happy just is not there.
If you honestly think the NHS is being poorly run, why not get a job in the NHS and help put it right within the budget constraints.
Regards
Mick
Patrick Dixon
Imagineer
Mick you make some good points, but IMV the problem is that successive governments' approaches to universal services like the NHS is to introduce some kind of faux competition into the process to make them more efficient.
All this does is make them work to the benefit of the private companies and consultants that are drawn in to play the game. Those that are good at the game succeed, but that doesn't necessarily result in an improved or more efficient service for the public.
There seems to be a universal acceptance within the political class that 'private' is more efficient that 'public', and that competition is the reason for this, but IME 'large' is a byword for inefficient and the NHS is the largest of all.
What it needs is a different, more joined up, approach where NHS workers and public alike can see that measurements relate better to the overall objectives of our society, and that we are not merely moving the problems around at great expense to individuals and society as a whole.
Sadly that's a task that's going to be beyond the likes of merlin or Tim and it requires the kind of political leadership that we will never get.
All this does is make them work to the benefit of the private companies and consultants that are drawn in to play the game. Those that are good at the game succeed, but that doesn't necessarily result in an improved or more efficient service for the public.
There seems to be a universal acceptance within the political class that 'private' is more efficient that 'public', and that competition is the reason for this, but IME 'large' is a byword for inefficient and the NHS is the largest of all.
What it needs is a different, more joined up, approach where NHS workers and public alike can see that measurements relate better to the overall objectives of our society, and that we are not merely moving the problems around at great expense to individuals and society as a whole.
Sadly that's a task that's going to be beyond the likes of merlin or Tim and it requires the kind of political leadership that we will never get.
merlin
Avatar changed - Town names deemed offensive.
We will have to disagree Mick. I think it's perfectly acceptable to point the finger at management and civil servants and Tim has made it quite clear in past threads that this is his field. Why he should therefore be free from the finger of suspicion I have no idea.
I can only assume you are misreading the post. Tim is a civil servant/ manager involved with the running of the NHS. People like Tim therefore run and have run the NHS for the past 30 years. It is therefore neither personal nor incorrect to suggest that maybe those people are at least partially responsible for the mess we see before us today.
When you have a health service in crisis literally killing people every day, the sensitive souls of the civil servants responsible for it's operation are low down the list of priorities IMHO. That's where we differ.
Patrick makes good points. The management (excluding Tim if you would prefer) have seemingly evolved a culture of moving problems around and hiding them rather than resolving them - one of the reasons I politely asked for some clarity regarding the efficiency metrics that Tim referred to earlier. He posted that efficiency was a simple concept. I asked him to expand on that because clearly it's not if targets are set at the wrong points.
Patrick
There is nothing wrong with outsourcing services because it genuinely saves money. If we let every contract expire and bring the work back in, you can bet your bottom dollar, prices will rise.
Also the authority also tenders for the bid and they have the right of appeal if the work goes outside. Work only goes out when money is saved.
Merlin
There is nothing wrong in criticising performance but you made it personal against Tim and the evidence is there.
I had a similar thing when we discussed energy prices, one of our resident thugs repeatedly called me a liar and claimed that I led a Walter Mitty existence when I related my own professional experience to the debate. I just left the discussion because no matter what I said, he accused me of being a liar and even suggested that I had not done the job that I claimed to have done.
When your professional integrity is insulted, then there is no point in continuing with the debate. By using expressions like - " 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." then the man has no alternative but to quit. No matter what he says in reply, you will just tell him he has got it all horribly wrong.
You could have challenged him a lot harder and fired tougher questions but you did not need to insult his professionalism.
Mick
There is nothing wrong with outsourcing services because it genuinely saves money. If we let every contract expire and bring the work back in, you can bet your bottom dollar, prices will rise.
Also the authority also tenders for the bid and they have the right of appeal if the work goes outside. Work only goes out when money is saved.
Merlin
There is nothing wrong in criticising performance but you made it personal against Tim and the evidence is there.
I had a similar thing when we discussed energy prices, one of our resident thugs repeatedly called me a liar and claimed that I led a Walter Mitty existence when I related my own professional experience to the debate. I just left the discussion because no matter what I said, he accused me of being a liar and even suggested that I had not done the job that I claimed to have done.
When your professional integrity is insulted, then there is no point in continuing with the debate. By using expressions like - " 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." then the man has no alternative but to quit. No matter what he says in reply, you will just tell him he has got it all horribly wrong.
You could have challenged him a lot harder and fired tougher questions but you did not need to insult his professionalism.
Mick
Patrick Dixon
Imagineer
My point is that it's not the management or the civil servants who are responsible for this, it's the misguided political approach that thinks that if you introduce 'competition' you will make it efficient. Yes you will make it efficient in terms of the competitive situation you have introduced but not necessarily in the jointed-up way that society requires.
And I agree with Mick; I don't think it's right to abuse Tim. It's not his fault and I'm sure he is doing his best within the constraints set by his political masters. And lets face it, if he was a free thinker who stood up to his bosses he wouldn't survive in the civil service.
merlin
Avatar changed - Town names deemed offensive.
Oh for heaven's sake 
I simply said "people like Tim" - go back and read the "offending post" for clarity.
I'm a cyclist. If someone referred to cyclists as "people like Merlin" would anyone have an issue with that? I certainly wouldn't. I would defend my position if I felt there was a case to do so but the poster would be right. He or she would be referring to a group of people through a character familiar to those involved in the conversation.
I will "insult" Tim personally for running at the first sign of his profession being criticized for failing to perform. That's symptomatic of much that is wrong with the system. Fresh minds are needed and a fresh approach.
I simply said "people like Tim" - go back and read the "offending post" for clarity.
I'm a cyclist. If someone referred to cyclists as "people like Merlin" would anyone have an issue with that? I certainly wouldn't. I would defend my position if I felt there was a case to do so but the poster would be right. He or she would be referring to a group of people through a character familiar to those involved in the conversation.
I will "insult" Tim personally for running at the first sign of his profession being criticized for failing to perform. That's symptomatic of much that is wrong with the system. Fresh minds are needed and a fresh approach.
Patrick
Merlin does have the right to challenge practices and to be fair, senior civil servants are creative thinkers because no matter what they come up with, their decisions will be criticised. The main criteria is to ensure that your Minister is not embarrassed and in practice this means that the work is carried out in the best way.
Tims main problem is budgets. The budgets usually went up in line with inflation but the demands on the health service increase every year. Also everyone is fighting for money and so on. He really is fighting a battle with his hands tied behind his back.
Outsourcing is still controlled internally, so it does not preclude joined up thinking. Like I said, if you banned outsourcing, costs would rise for the same level of service.
Regards
Mick
merlin
Avatar changed - Town names deemed offensive.
Mick
Trust me here. From an end user point of view, the problem is not simply budgets - it's every bit as much the waste of that budget through poor management.
I will not go into the unbelievable catalog of waste that I have encountered over the past three years but if we ever meet face to face, I'm sure you would be flabbergasted at the money wasted and the lack of results. Some of this is caused by budget restrictions, some of it by inefficiencies and poor management of resources.
I am one of those people who calls for greater health spending and a model similar to France with a top up insurance payable by citizens to bring health spending in line with other developed countries. The spectre of increased cost and taxation is one that successive governments refuse to confront - not for the good of the Country but purely for the security of their careers. This I find unacceptable.
Trust me here. From an end user point of view, the problem is not simply budgets - it's every bit as much the waste of that budget through poor management.
I will not go into the unbelievable catalog of waste that I have encountered over the past three years but if we ever meet face to face, I'm sure you would be flabbergasted at the money wasted and the lack of results. Some of this is caused by budget restrictions, some of it by inefficiencies and poor management of resources.
I am one of those people who calls for greater health spending and a model similar to France with a top up insurance payable by citizens to bring health spending in line with other developed countries. The spectre of increased cost and taxation is one that successive governments refuse to confront - not for the good of the Country but purely for the security of their careers. This I find unacceptable.
russel
./_dazed_and_confused
If the incentive structure is short term cost cutting it will, a good example is cleaning, yes they got lower costs but the cleaners did more areas and did them less thoroughly the consequence being the most efficient thing they did was spread infection.
Patrick Dixon
Imagineer
That may be Tim's main problem but it aint the NHS's. Yes we need to spend more money but we also need to spend it better. We just used up 2 hospital appointments and wasted 3 months waiting for something that could have easily been done by the GP - if only he wasn't working on 10min appointments and targeted with gate-keeping the system.
Russel
If the cleaners did not do the job adequately, then the authority will not pay the bills. Every complaint is logged and recorded and fines imposed. The authorities are incentivised to make complaints and that ensures that the work is carried out correctly.
Also there were as many complaints about cleanliness in the old days before outsourcing as what there are now.
Patrick
I cannot comment on individual cases, but most cancelled appointments are due to last minute bed blocking by an elderly person and usually it is the GP who refers the patient to the hospital.
Regards
Mick
Oh come on. Your personal circumstances and experience notwithstanding, I do agree with Mick that you should wind down the rhetoric agrression a notch or ten.