The NHS and PPE

[King Nuts]

All manner of stories seem to be circulating. Some areas have tons of PPE, others don't. On the face of it, there's no clear explanation or answer.

But we do know this: that the NHS burns through close to £3 billion per week of public money. And that the NHS employs something like 600,000 doctors and other medical and clinical staff, and double the number, i.e. 1.2 million, of others. Of that 1.2 million, they can't ALL be cleaners, porters and receptionists. So is it too much to expect that NHS Procurement can actually procure some gowns, gloves and masks etc, with all their financial and personnel resources?

More generally, it seems to me that we could throw literally all the money we've got at the NHS and some nimrod somewhere, probably a Daily Mirror reader, would say it's not enough.

We needed the NHS in 1948 to get a nation back on its feet and to deal with a physically exhausted population, where malnutrition, rickets, TB, polio and all the rest of it were rife. A collectivised method was the only way, and it worked brilliantly.  But we're 70+ years on, and the free-at-the-point-of-use model has meant GP surgeries are clogged up with people with the sniffles, and A 'n' E with drunks and people with fractured eyelashes.

The NHS is an asset alright. And it needs looking after. But it's having the piss taken out of it at both ends.

[timsussex]

The NHS staff are superb but the organisation is crap.

Too many top brass being paid too much while the nurses get too little. Simply throwing money at it is not the answer

All large organisations are slow to adapt and so is government so the NHS is very slow at adapting to new situations while  it should have been clear for months that more would be needed but it takes far too long to change the NHS ordering system

When it tries to move quickly we get
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[winkywanky]

When it tries to move quickly we get
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I do hope we'll be asking for our money back. Did they get them off eBay?

[winkywanky]

All manner of stories seem to be circulating. Some areas have tons of PPE, others don't. On the face of it, there's no clear explanation or answer.

But we do know this: that the NHS burns through close to £3 billion per week of public money. And that the NHS employs something like 600,000 doctors and other medical and clinical staff, and double the number, i.e. 1.2 million, of others. Of that 1.2 million, they can't ALL be cleaners, porters and receptionists. So is it too much to expect that NHS Procurement can actually procure some gowns, gloves and masks etc, with all their financial and personnel resources?

More generally, it seems to me that we could throw literally all the money we've got at the NHS and some nimrod somewhere, probably a Daily Mirror reader, would say it's not enough.

We needed the NHS in 1948 to get a nation back on its feet and to deal with a physically exhausted population, where malnutrition, rickets, TB, polio and all the rest of it were rife. A collectivised method was the only way, and it worked brilliantly.  But we're 70+ years on, and the free-at-the-point-of-use model has meant GP surgeries are clogged up with people with the sniffles, and A 'n' E with drunks and people with fractured eyelashes.

The NHS is an asset alright. And it needs looking after. But it's having the piss taken out of it at both ends.

They can't be magicked out of nowhere, I should imagine there's a worldwide run on these items?

We probably should have been ordering lots of this stuff weeks and weeks ago (our response seems to have been late in every respect). Now we're trying to play catch-up.

Frontline health workers are getting through FOUR sets a day is my understanding?

[timsussex]

They can't be magicked out of nowhere, I should imagine there's a worldwide run on these items?

We probably should have been ordering lots of this stuff weeks and weeks ago (our response seems to have been late in every respect). Now we're trying to play catch-up.

Frontline health workers are getting through FOUR sets a day is my understanding?

Four sets is reasonable  thats only 3 breaks in an 8-10 hour shift Breaks inc Coffee, Loo, Lunch etc

Assuming that the patients have COVID (and you'd be stupid not to)  PPE has to be changed if you leave the ICU otherwise you will just spread  it

[WARSZAWA16]

They can't be magicked out of nowhere, I should imagine there's a worldwide run on these items?

Somebody said on the radio (LBC) that the Chinese bought up a lot of it before the shit hit the fan and they had to go public.

[winkywanky]

Four sets is reasonable  thats only 3 breaks in an 8-10 hour shift Breaks inc Coffee, Loo, Lunch etc

Assuming that the patients have COVID (and you'd be stupid not to)  PPE has to be changed if you leave the ICU otherwise you will just spread  it

Of course, I'm just pointing out the fact that once you start getting supplies late (as I think we did), it's virtually impossible to keep up with demand when everywhere else in the world wants the same thing.

[winkywanky]

Somebody said on the radio (LBC) that the Chinese bought up a lot of it before the shit hit the fan and they had to go public.

I should imagine they actually manufacture by far the biggest amount in the world anyway, both in terms of them being the workshop of the world, and with the fact that the Far East just 'does' masks anyway. Any 'stock footage' of Chinese society always has lots of people wearing masks anyway, be that because of high pollution levels or simply because they all wear a mask when they have a cold.

[scutty brown]

I should imagine they actually manufacture by far the biggest amount in the world anyway, both in terms of them being the workshop of the world, and with the fact that the Far East just 'does' masks anyway. Any 'stock footage' of Chinese society always has lots of people wearing masks anyway, be that because of high pollution levels or simply because they all wear a mask when they have a cold.

The Chinese ARE the biggest manufacturers, but you have real quality control issues buying any safety critical gear from there. Buy from a new supplier and you stand a good chance of receiving crap.
Any PPE has to meet required standards

[hullad]

We where told that we had supply problems

Today they admit we are short and now NHS  staff are expected to reuse PPE equipment as hospitals run out. Lie after lie the business loan scheme is a mess only 5% have actually managed to get through the paperwork and banks red tape. This is all going Pete tong before our eyes, no one guiding it through just a sready stream of liars supported by phsocophants who can see no wrong.

[winkywanky]

The Chinese ARE the biggest manufacturers, but you have real quality control issues buying any safety critical gear from there. Buy from a new supplier and you stand a good chance of receiving crap.
Any PPE has to meet required standards

I'm sure that's true.

I was just trying to show that China had a big head start in being able to use available PPE, when the outbreak started.

[Beamer]

Four sets is reasonable  thats only 3 breaks in an 8-10 hour shift Breaks inc Coffee, Loo, Lunch etc

Assuming that the patients have COVID (and you'd be stupid not to)  PPE has to be changed if you leave the ICU otherwise you will just spread  it

We have an arrogant and inept man without a backbone managing one of the largest and most complex businesses in the world - our NHS- so we should expect confusion and incompetence.

[timsussex]

We have an arrogant and inept man without a backbone managing one of the largest and most complex businesses in the world - our NHS- so we should expect confusion and incompetence.

I agree but I dont actually blame Boris or Hancock
1) they arent managing the NHS - there are a lot of people getting paid £millions to do that or not
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2) there are 27 quangos for the NHS
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3) its not a problem that is down to this or any previous government They may not have helped and they certainly should have reformed it
4) ask a nurse or any other frontline staff and they will tell where the problem lies - its at the top

[Kev40ish]

I agree but I dont actually blame Boris or Hancock
1) they arent managing the NHS - there are a lot of people getting paid £millions to do that or not
External Link/Members Only
2) there are 27 quangos for the NHS
External Link/Members Only
3) its not a problem that is down to this or any previous government They may not have helped and they certainly should have reformed it
4) ask a nurse or any other frontline staff and they will tell where the problem lies - its at the top

I tend to agree with what you have said.

The NHS is over managed and it’s easy for them to blame the government and not look at their own shortcomings.

There is incredible waste. A lot of people are very well paid and they seem to have an inability to organise their own departments.

In the private industry they would be fired, but unfortunately they seem to be protected by the system.

The only people I feel sorry for are the F2 doctors and below the rest are generally overpaid and entitled.

They are the ones I clap for on a Thursday...

[Beamer]

I agree but I dont actually blame Boris or Hancock
1) they arent managing the NHS - there are a lot of people getting paid £millions to do that or not
External Link/Members Only
2) there are 27 quangos for the NHS
External Link/Members Only
3) its not a problem that is down to this or any previous government They may not have helped and they certainly should have reformed it
4) ask a nurse or any other frontline staff and they will tell where the problem lies - its at the top

Agreed your comments about the NHS. It is "unmanageable" in its present format.  I
just think that Hancock doesn't help the situation. He has a history of credibility issues in his other government roles. I wouldn't trust him as far as I could throw a "ton of spuds".
Shame, as others i.e. Boris (before his problem) and Rabb have come across as believable in the daily briefing.

[Blackpool Rock]

Agreed your comments about the NHS. It is "unmanageable" in its present format. I
just think that Hancock doesn't help the situation. He has a history of credibility issues in his other government roles. I wouldn't trust him as far as I could throw a "ton of spuds".
Shame, as others i.e. Boris (before his problem) and Rabb have come across as believable in the daily briefing.

Just be grateful they haven't replaced him with Chris Grayling yet after his wonderful job fucking up the Railway timetables etc 

Initially I thought the Government was doing OK as it's always going to be a fast moving and fluid situation so to speak.
Things are now coming out however and it's clear that lack of PPE and testing are not good enough with everybody playing catch up and seemingly unable to make any significant progress.

The fact is that we failed to adequately plan for this so weren't prepared, as Bill Gates said on TV this morning this should have been planned for in the same way as we plan for a war in case it happens.
I'm thinking this virus could easily kill more people in the UK than a war would 

[Beamer]

External Link/Members Only 

Initially I thought the Government was doing OK as it's always going to be a fast moving and fluid situation so to speak.
Things are now coming out however and it's clear that lack of PPE and testing are not good enough with everybody playing catch up and seemingly unable to make any significant progress.

The fact is that we failed to adequately plan for this so weren't prepared, as Bill Gates said on TV this morning this should have been planned for in the same way as we plan for a war in case it happens.
I'm thinking this virus could easily kill more people in the UK than a war would

Absolutely right about Grayling.

[j_181]

But we do know this: that the NHS burns through close to £3 billion per week of public money. And that the NHS employs something like 600,000 doctors and other medical and clinical staff, and double the number, i.e. 1.2 million, of others. Of that 1.2 million, they can't ALL be cleaners, porters and receptionists. So is it too much to expect that NHS Procurement can actually procure some gowns, gloves and masks etc, with all their financial and personnel resources?

They're lab techs, pathologists, estates and maintenance staff, bioinformaticians, etc, etc. My experience working as a consultant (as in I consult - not a medical doctor) for the NHS was that, if anything, the procurement/finance teams (at least the ones I interacted with) were understaffed in comparison to similar teams in both universities and the private sector. I would also question whether that 1.2million is full-time equivalent, or simply the number of people on the payroll. I am  on NHS payroll - last year I was paid for 10 hours work, this year (so far) I have been paid for 6. Including people like me (which I suspect is what you are doing) in that 1.2million figure would be very misleading. I do agree that upper management in the NHS are overpaid, and difficult to remove when incompetent.

More generally, it seems to me that we could throw literally all the money we've got at the NHS and some nimrod somewhere, probably a Daily Mirror reader, would say it's not enough.

We could spend a little more, personally don't think we are far off, but you get what you pay for. We spend about 7% of GDP on healthcare, the really high-quality healthcare systems across Europe (Germany, Austria, Switzerland) spend more like 10%.

GP surgeries are clogged up with people with the sniffles

The number of FTE-equivalent GPs in England has decreased from 66 per 100,000 population in 2010, to 58 per 100,000 today. That, along with our ageing population structure is why GP surgeries are "clogged". I'm not sure the middle of a global pandemic of a respiratory virus is the right time to be shaming people for seeking medical attention for respiratory virus symptoms.

and A 'n' E with drunks

Yes. We have a huge problem with binge-drinking in the UK. Any suggestions that we should deal with it are met by cries of "nanny state!". You can't have it both ways - either deal with the problem, or pay the consequences of choosing not to.


Regarding shortages, in 2016 the government ran Operation Cygnus, a tabletop simulation of an influenza-like pandemic. Although the full results are still classified, we do know that key findings were that our healthcare system would collapse due to lack of resources, with lack of ventilators, the small size of our PPE and essential medicine stockpiles, and inadequate logisitics for "disposal" of the dead indentified as major weaknesses. The government of the time chose not to act on these findings. Since no-one has publicly explained this decision, we can only speculate on the motivations for ignoring the findings of Operation Cygnus.

[Doc Holliday]

Some excellent points in the post above.

I have avoided making any comment because UKP probably doesn't have enough bandwidth for my response. 

35 years of being part of it have only taught me that it is an increasingly highly complex, not to mention frustrating, organisation. I was glad to have retired. Morale across most sectors is low.

One point I would make though was that in 1948 death was still acceptable and not questioned. Now it is unacceptable and highly complex treatment to achieve that is massively expensive. It is therefore a money pit. However just feeding the pit is not the answer.

The starting point is to take it out of politics, but that has never happened. It may now happen following what we now face but I'm not holding my breath?

[King Nuts]

They're lab techs, pathologists, estates and maintenance staff, bioinformaticians, etc, etc. My experience working as a consultant (as in I consult - not a medical doctor) for the NHS was that, if anything, the procurement/finance teams (at least the ones I interacted with) were understaffed in comparison to similar teams in both universities and the private sector. I would also question whether that 1.2million is full-time equivalent, or simply the number of people on the payroll. I am  on NHS payroll - last year I was paid for 10 hours work, this year (so far) I have been paid for 6. Including people like me (which I suspect is what you are doing) in that 1.2million figure would be very misleading. I do agree that upper management in the NHS are overpaid, and difficult to remove when incompetent.

We could spend a little more, personally don't think we are far off, but you get what you pay for. We spend about 7% of GDP on healthcare, the really high-quality healthcare systems across Europe (Germany, Austria, Switzerland) spend more like 10%.

The number of FTE-equivalent GPs in England has decreased from 66 per 100,000 population in 2010, to 58 per 100,000 today. That, along with our ageing population structure is why GP surgeries are "clogged". I'm not sure the middle of a global pandemic of a respiratory virus is the right time to be shaming people for seeking medical attention for respiratory virus symptoms.

Yes. We have a huge problem with binge-drinking in the UK. Any suggestions that we should deal with it are met by cries of "nanny state!". You can't have it both ways - either deal with the problem, or pay the consequences of choosing not to.


Regarding shortages, in 2016 the government ran Operation Cygnus, a tabletop simulation of an influenza-like pandemic. Although the full results are still classified, we do know that key findings were that our healthcare system would collapse due to lack of resources, with lack of ventilators, the small size of our PPE and essential medicine stockpiles, and inadequate logisitics for "disposal" of the dead indentified as major weaknesses. The government of the time chose not to act on these findings. Since no-one has publicly explained this decision, we can only speculate on the motivations for ignoring the findings of Operation Cygnus.

Thanks for your post. Always good to hear from someone on the inside who knows what he's on about, and some good insight there.

I don't doubt any of what you say, but my experience is from the other end of the syringe, so to speak. Have had some brilliant medical care from doctors, consultants, nurses and so on over the years, but when it comes to the admin/management side of things, it's been borderline woeful on occasion. I guess part of this is the result of having to size-up everything, where untold thousands of people have to be treated at once, mostly for a sort-of standard set of ailments, and individual, personalised care just isn't always feasible.

I could go on ad nauseum about my personal experiences, which have been mixed, but I think my experiences are no different to those of a great many people. I speak as someone who runs a small enterprise that's labour- and capital-intensive, where use of people's time and skills has to be managed precisely, along with budgets. So when I see the rubbish way the appointments system is handled, for example, it makes me realise that when you're in a business that benefits from an endless supply of money, and where you're not really answerable to anyone, then there's little or no motivation to do things any differently.

But back to the PPE thing, for the sheer cost of the NHS and volume of personnel it employs, shouldn't this thing really have been seen off? And if some trusts are well stocked and others aren't, doesn't that show there's a lot of people who just don't have their eye on the ball?

As regards your point about GPs, I've thought for ages that one way out of it would be to charge people for appointments. Doesn't have to be much, maybe 25 quid. People who are on benefits, kids, pensioners etc wouldn't have to pay, but there's no reason people of in work shouldn't. I pay for a haircut, to go the dentist, and to get an MOT for my car. Nothing weird about that.

Two real benefits accrue:

1. Number of no-shows goes down
2. GPs surgeries have more money for more/better facilities, staff and so on

Everyone wins, right?

[GreyDave]

Thanks for your post. Always good to hear from someone on the inside who knows what he's on about, and some good insight there.

I don't doubt any of what you say, but my experience is from the other end of the syringe, so to speak. Have had some brilliant medical care from doctors, consultants, nurses and so on over the years, but when it comes to the admin/management side of things, it's been borderline woeful on occasion. I guess part of this is the result of having to size-up everything, where untold thousands of people have to be treated at once, mostly for a sort-of standard set of ailments, and individual, personalised care just isn't always feasible.

I could go on ad nauseum about my personal experiences, which have been mixed, but I think my experiences are no different to those of a great many people. I speak as someone who runs a small enterprise that's labour- and capital-intensive, where use of people's time and skills has to be managed precisely, along with budgets. So when I see the rubbish way the appointments system is handled, for example, it makes me realise that when you're in a business that benefits from an endless supply of money, and where you're not really answerable to anyone, then there's little or no motivation to do things any differently.

But back to the PPE thing, for the sheer cost of the NHS and volume of personnel it employs, shouldn't this thing really have been seen off? And if some trusts are well stocked and others aren't, doesn't that show there's a lot of people who just don't have their eye on the ball?

As regards your point about GPs, I've thought for ages that one way out of it would be to charge people for appointments. Doesn't have to be much, maybe 25 quid. People who are on benefits, kids, pensioners etc wouldn't have to pay, but there's no reason people of in work shouldn't. I pay for a haircut, to go the dentist, and to get an MOT for my car. Nothing weird about that.

Two real benefits accrue:

1. Number of no-shows goes down
2. GPs surgeries have more money for more/better facilities, staff and so on

Everyone wins, right?

We lost almost all of the machine sewing industry about 15-20 years ago ...the subject of Careworkers and Health workers in their work clothes not at work is a badly planned and managed state of things there are in many other countries " Locker rooms " shower and change of clothing here its take your stuf home and wash it weather youre Burger Bar Butcher or Care worker etal we have slipped after the deaths of freinds of daughter I remembered a comment from a customer who was miss diagnosed twice and in panic went private ....the NHS is the envy of the world ...yeah the 3rd world as its agreat place to get a job..Lets clapp for the crap managers that saved cash and earnt well Dont forget 13 billion was frauded much of it by these heros ...
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[Doc Holliday]

Thanks for your post. Always good to hear from someone on the inside who knows what he's on about, and some good insight there.

I don't doubt any of what you say, but my experience is from the other end of the syringe, so to speak. Have had some brilliant medical care from doctors, consultants, nurses and so on over the years, but when it comes to the admin/management side of things, it's been borderline woeful on occasion. I guess part of this is the result of having to size-up everything, where untold thousands of people have to be treated at once, mostly for a sort-of standard set of ailments, and individual, personalised care just isn't always feasible.

I could go on ad nauseum about my personal experiences, which have been mixed, but I think my experiences are no different to those of a great many people. I speak as someone who runs a small enterprise that's labour- and capital-intensive, where use of people's time and skills has to be managed precisely, along with budgets. So when I see the rubbish way the appointments system is handled, for example, it makes me realise that when you're in a business that benefits from an endless supply of money, and where you're not really answerable to anyone, then there's little or no motivation to do things any differently.

But back to the PPE thing, for the sheer cost of the NHS and volume of personnel it employs, shouldn't this thing really have been seen off? And if some trusts are well stocked and others aren't, doesn't that show there's a lot of people who just don't have their eye on the ball?

As regards your point about GPs, I've thought for ages that one way out of it would be to charge people for appointments. Doesn't have to be much, maybe 25 quid. People who are on benefits, kids, pensioners etc wouldn't have to pay, but there's no reason people of in work shouldn't. I pay for a haircut, to go the dentist, and to get an MOT for my car. Nothing weird about that.

Two real benefits accrue:

1. Number of no-shows goes down
2. GPs surgeries have more money for more/better facilities, staff and so on

Everyone wins, right?

Many good points also but much of what you have said has been discussed for decades, but we are still where we are. I know that's not very constructive but that is the frustration of it.

[King Nuts]

The starting point is to take it out of politics, but that has never happened.

Agreed. Politicians know the problem, as do we all. But they lack the balls to stand up and say that truly radical reform is needed.

As I see it, there are two problems to overcome first:

1. The NHS has replaced religion. It's a cult and people worship at its altar. 'Our NHS' etc. No, it's not 'our' NHS any more than it's 'our' HMRC or 'our' Network Rail. You challenge this thing, and you'll face the ire of the devoted.

2. Because it's 'free', people seem to think it's a charity. Columnists rail against 'privatisation' without seeming to grasp the notion that every damn product and service the NHS pays for, is supplied by people and companies who are in the business of making a profit. And the staff don't work for nothing either. Why should they?

[Beamer]

Just seen that well over 1,000,000 contributions to Captain Tom NHS charity on just giving website. As of now it's £22.3 million. Clearly people value the NHS workforce.

[Kev40ish]

Just seen that well over 1,000,000 contributions to Captain Tom NHS charity on just giving website. As of now it's £22.3 million. Clearly people value the NHS workforce.

I doubt there is anyone who wouldn’t say they are doing a fantastic job. I stand there applauding on a Thursday for the underpaid and overworked nurses and F2 doctors and below. I’m not really there applauding the Managers and Overpaid entitled consultants..

[southcoastpunter]

Agree with most of what king Nuts says.

My immediate family have more reason than most to be grateful to the NHS - the medical care received was great. But i thinks the NHS's main problems areas are:
- its overall size and structure makes it difficult to manage effecectively. Trying to then make it "answerable locally" has in effect led to "postcode lotteries" in the type and standard of care received
- its processes (like appointments ) are very inefficient
- there is too much duplication of work/effort (eg i had a minor op as a day case about 3 years ago and was asked the same set of questions on a form by 5 different people in less than 2 hours)
- too many people who work in the NHS see "more money needed" as the ONLY answer to its problems (maybe that is a political thing?)
- the NHS has resources that it does not (and is highly unlikely to) use but doesn't do anything about it. I know someone who works in Property Management and estimates that in the London area alone, the NHS has land and/or unesed building valued at about 10 BILLION pounds.
- the increasing demand for its sercices it faces (we need a proper debate on should it meet all of this demand or should it charge for some services (eg to drunk people)
- and of course one of the biggest problems it faces, is from polital management (or interference if you prefer to call it that) but this is hardling surprising given just how much the taxpayer puts into it!

The answer? - don't know to be honest! But whatever its issues, I think we are all glad its there!!

[winkywanky]

I think it's clear that the vast majority of the public think that the people in the NHS, especially the 'frontline', do an amazing job. Especially at times like these.

It's precious to the vast majority too, because they've either received great care or have a relative/good friend who has. It's there to save your life, it's owned by the people and paid for by the people. Yes, it is almost a religion. That's why politicians are so wary of going anywhere near it to consider any type of reform.

Looking at how much we spend per head for healthcare in this country, and the service we receive, despite all the wrangling about over-management, overpaid management and inefficiencies and bad practices, overall we get a reasonable service for the amount paid. I would say certainly better than the US for example, where they spend more than we do yet very many have only very rudimentary healthcare.

It is a shame that we can't seem to have a dispassionate and wide-ranging debate about healthcare in this country. I think we could probably learn a lot from some European countries, and possibly even from some in the Far East. Certainly France and Germany (Scandinavian countries too?) have very, very good healthcare, and I know at least Germany has provision based on private insurance companies, but nationally-guided and controlled, with a NI-type payment system not unlike our own?

So long as we set out the basic tenets of what we want, equal healthcare for all regardless of personal wealth, and by and large free at the point of delivery, why can't we do that?

[southcoastpunter]

WW - agree with your last sentence (and others as well) but it seems to me that too many people in this country are blinded by political dogma - its has to be run and provided by the NHS itself.... you are trying to privitise the NHS, the Tories want to sell it off (who in their right mind would want to buy it?) etc etc

Personally I want good quality and free health care, i don't care if its provided by staff who work direct for the NHS or another (private) company. I think governments of both colours have shown over the years that beither can effeciently run anything

[j_181]

2. Because it's 'free', people seem to think it's a charity. Columnists rail against 'privatisation' without seeming to grasp the notion that every damn product and service the NHS pays for, is supplied by people and companies who are in the business of making a profit. And the staff don't work for nothing either. Why should they?

That's the key question isn't it - how much should the NHS be paying for as external services, and how much should be done in-house. External services are typically more expensive on a per-patient or per-sample basis, but in-house services have start-up costs that require large one-off spends. I suspect one year of the books in red, even if it means savings later, means someone in management doesn't get their bonus, and for politicians will look like they are overspending in the short-term, which goes over badly with certain parts of the electorate.

[Doc Holliday]

Agreed. Politicians know the problem, as do we all. But they lack the balls to stand up and say that truly radical reform is needed.

As I see it, there are two problems to overcome first:

1. The NHS has replaced religion. It's a cult and people worship at its altar. 'Our NHS' etc. No, it's not 'our' NHS any more than it's 'our' HMRC or 'our' Network Rail. You challenge this thing, and you'll face the ire of the devoted.

2. Because it's 'free', people seem to think it's a charity. Columnists rail against 'privatisation' without seeming to grasp the notion that every damn product and service the NHS pays for, is supplied by people and companies who are in the business of making a profit. And the staff don't work for nothing either. Why should they?

Once again cannot disagree.

My immediate family have more reason than most to be grateful to the NHS - the medical care received was great. But i thinks the NHS's main problems areas are:
- its overall size and structure makes it difficult to manage effecectively. Trying to then make it "answerable locally" has in effect led to "postcode lotteries" in the type and standard of care received
- its processes (like appointments ) are very inefficient
- there is too much duplication of work/effort (eg i had a minor op as a day case about 3 years ago and was asked the same set of questions on a form by 5 different people in less than 2 hours)
- too many people who work in the NHS see "more money needed" as the ONLY answer to its problems (maybe that is a political thing?)
- the NHS has resources that it does not (and is highly unlikely to) use but doesn't do anything about it. I know someone who works in Property Management and estimates that in the London area alone, the NHS has land and/or unesed building valued at about 10 BILLION pounds.
- the increasing demand for its sercices it faces (we need a proper debate on should it meet all of this demand or should it charge for some services (eg to drunk people)
- and of course one of the biggest problems it faces, is from polital management (or interference if you prefer to call it that) but this is hardling surprising given just how much the taxpayer puts into it!

The answer? - don't know to be honest!

Yep all good points again but all historically been on the table for consideration ... but no real action plan.

I have highlighted one of your points in particular which you rightly point out as an example of inefficiency. I could mention many more. (don't get me started on weighing each patient who attend outpatients!!)
The irony is that such examples have arisen partly due to attempts to prevent medical negligence occurring, but the exact opposite has happened. For every complimentary story about treatment received from the NHS there will sadly be a horror one and it has little to do with underfunding.

[winkywanky]

I've had a couple of operations recently, and two family members as well, at a nearby Private hospital.

All done under the NHS, and of course as we all probably know, under the same NHS Consultants as usual but in their 'Private time', paid for by the NHS in this instance.

Last time I was in there I had a good chat with a Nurse...apparently 50% of the work of that hospital is NHS work, gradually built up over the years. They've made such a success of it that they've recently opened up two specialist units (in addition to the existing Oncology unit) and I'm sure these will also be doing lots of NHS work. The environment is clean, efficient, 'customer-focused', the food is great, the Nurses wonderful. Car parking isn't a problem, it's free, there's always (just about) a space and in actual fact they've recently built a new car park to keep up with future increased demand.

As well as the modest size, the whole feel of the place is like a 'village hospital'. It's a nice place to be if you're sick and you don't feel stressed dealing with them

I'm not naive enough to think that this kind of set-up would be a nationwide panacea, and I have no doubt that the private healthcare company involved are making money out of this, coupled with the fact that the local NHS Trust is bursting at the seams and uses them for 'overflow'. I'm really lucky because in my local Trust (I believe different Trusts make their own decisions on this) does Choose & Book referrals, and when I get sent the letter with a list of possible hospitals for my treatment, my 'local Village hospital' is virtually always on the list. You can guess which one I choose every time!

So I'm still in the same waiting list as everyone else, but when the time comes, I'm able to almost 'cherry-pick' my care, and it will be a nicer experience than my closest big NHS hospital which is only five miles away, where there's insufficient and expensive parking, and the last time an ageing relative was there, they nearly managed to kill them because of clinical ineptitude, and when I visited there was much distress because despite pressing the nurse-button in the room, 10 minutes later around five nurses were all stood around at their station looking on their moblie phones and chatting the breeze.

I do think there might be a better way to provide healthcare in the UK, while keeping the principles we all hold dear. But it's a big shame we don't seem able to have a grown-up national discussion about it  .

[Doc Holliday]

I've had a couple of operations recently, and two family members as well, at a nearby Private hospital.

All done under the NHS, and of course as we all probably know, under the same NHS Consultants as usual but in their 'Private time', paid for by the NHS in this instance.

Last time I was in there I had a good chat with a Nurse...apparently 50% of the work of that hospital is NHS work, gradually built up over the years. They've made such a success of it that they've recently opened up two specialist units (in addition to the existing Oncology unit) and I'm sure these will also be doing lots of NHS work. The environment is clean, efficient, 'customer-focused', the food is great, the Nurses wonderful. Car parking isn't a problem, it's free, there's always (just about) a space and in actual fact they've recently built a new car park to keep up with future increased demand.

As well as the modest size, the whole feel of the place is like a 'village hospital'. It's a nice place to be if you're sick and you don't feel stressed dealing with them.

I'm not naive enough to think that this kind of set-up would be a nationwide panacea, and I have no doubt that the private healthcare company involved are making money out of this, coupled with the fact that the local NHS Trust is bursting at the seams and uses them for 'overflow'. I'm really lucky because in my local Trust (I believe different Trusts make their own decisions on this) does Choose & Book referrals, and when I get sent the letter with a list of possible hospitals for my treatment, my 'local Village hospital' is virtually always on the list. You can guess which one I choose every time!

So I'm still in the same waiting list as everyone else, but when the time comes, I'm able to almost 'cherry-pick' my care, and it will be a nicer experience than my closest big NHS hospital which is only five miles away, where there's insufficient and expensive parking, and the last time an ageing relative was there, they nearly managed to kill them because of clinical ineptitude, and when I visited there was much distress because despite pressing the nurse-button in the room, 10 minutes later around five nurses were all stood around at their station looking on their moblie phones and chatting the breeze.

I do think there might be a better way to provide healthcare in the UK, while keeping the principles we all hold dear. But it's a big shame we don't seem able to have a grown-up national discussion about it  .

I'm well and truly in 'needle stuck' mode now but once again all correct. 

In my locality the choose and book option often included a local private Hospital doing NHS work as you describe. However in recent years the number of specialities covered by the scheme has been drastically reduced. Great to hear you still have that option which kind of highlights the 'post code' point. Also if you do attend a significantly more efficient private hospital for NHS care you will always see a consultant unlike an NHS outpatient appointment.

[winkywanky]

Good point, you normally only see the 'oily rag' Registrar at an NHS hospital, and very rarely have the actual Consultant operating on you.

[winkywanky]

I'm pretty sure I actually had a severe lower limb break bolted back together by a senior Houseman a few years ago? This was actually in the big and unwieldy NHS hospital from my earlier post .

Thinking back I seem to remember the Consultant (who they had to bring in specially because it was a Sunday) saying that he would at least devise the operation-plan, and possibly actually oversee it in Theatre? I think he must have done, although I was in cloudy haze of morphia at the time so not entirely sure.

Anyway, when I go out for a walk now I don't go round in cirlces like some crippled Bismarck, so I did actually have a pretty good job done.

[j_181]

- its overall size and structure makes it difficult to manage effecectively. Trying to then make it "answerable locally" has in effect led to "postcode lotteries" in the type and standard of care received
- its processes (like appointments ) are very inefficient

Isn't there a trade off between local adaptibility and nationwide efficiency? Maybe the NHS doesn't balance it right, but both approaches have their pros and cons.
Where I am, I can book GP appointments with a smartphone app, I can see all available slots in a 14-day period, and it takes about 30 seconds. There is a low-staffed phoneline for people who can't or won't use the app. This works great in my area, which is mostly populated by young professionals and students, who prefer to use an app to making a phonecall. For an elderly rural population who don't have smartphones and can barely use a computer this would be a disaster. So you do have to be careful with trying to find one-size-fits-all "efficient" solutions for heterogeneous problems.

- too many people who work in the NHS see "more money needed" as the ONLY answer to its problems (maybe that is a political thing?)

In my experience, and speaking very generally, lower-paid frontline staff tend to be left-leaning, higher paid clinical staff and management tend to be right-leaning, but they all think the NHS needs more money. So I don't think it is a political thing, so much as an institutional one. In my view it DOES need more - to be in line with the healthcare systems that some on this thread speak highly of (Germany, Switzerland, etc), we would have to increase spending by a factor of about 1.5. But alongside the spending increase we need a sensible, non-partisan plan for how to spend it, based on best practise in other countries that provide healthcare better than we do. The current ideas from the right (reform and don't increase spending), and the left (increase spending and don't reform) are both wrong in my opinion.

- the NHS has resources that it does not (and is highly unlikely to) use but doesn't do anything about it. I know someone who works in Property Management and estimates that in the London area alone, the NHS has land and/or unesed building valued at about 10 BILLION pounds.

What would you suggest? If they sell them, they get hammered by the left for selling off public assets, if they sit on them, they get hammered by the right for "inefficiency". Catch-22. Having spare property to use for future projects saves paying market-rate for property in the future, which to me feels sensible, and ultimately means our taxes go further. It also means there are buildings available for temporary projects (viral qPCR labs to give a timely example). 10 billion is, in any case, less than 10% of the yearly NHS budget so wouldn't go far.

[Doc Holliday]

The current ideas from the right (reform and don't increase spending), and the left (increase spending and don't reform) are both wrong in my opinion.

Very well summarised. That's the conundrum and always has been. As I said until politics is removed from the equation little progress will be made. If they could ever agree and meet in the middle we may get somewhere, but as I also said the NHS is an unbelievably complex beast to unravel.

[winkywanky]

Perhaps just one single, enormous body, being in charge of and doing everything, is always going to too unwieldy?

[GreyDave]

Just seen that well over 1,000,000 contributions to Captain Tom NHS charity on just giving website. As of now it's £22.3 million. Clearly people value the NHS workforce.

And from King Nutts
1. The NHS has replaced religion. It's a cult and people worship at its altar. 'Our NHS' etc. No, it's not 'our' NHS any more than it's 'our' HMRC or 'our' Network Rail. You challenge this thing, and you'll face the ire of the devoted.

The Cow that keeps giving milk?
External Link/Members Only

  The NHS has replaced religion. It's a cult and people worship at its altar.

[King Nuts]

Just seen that well over 1,000,000 contributions to Captain Tom NHS charity on just giving website. As of now it's £22.3 million. Clearly people value the NHS workforce.

They value something they perceive they get for free. The adulation of the workforce comes second.

[Beamer]

They value something they perceive they get for free. The adulation of the workforce comes second.

No

[King Nuts]

No

Sometimes you post in a wonderfully abbreviated manner.

It's almost gnomic.

[lostandfound]

Is there a large / populous country whose citizens are happy with the way their goverment and health systems have responded to this crisis?

[winkywanky]

I can think of just two who might, Germany and South Korea.

[lostandfound]

I can think of just two who might, Germany and South Korea.

Fair comment, although would it be fair to suggest that our national character is quite different from both of those countries?

Anecdotal - I have German in laws and friends and they are almost never happy with their authorities - while at the same time preferring their country above all others. (OK does sound a bit like us).

S Korea - good example. Would we be happy with a phone app that tracked our whereabouts? I know one is planned, probably voluntary ...
 

[winkywanky]

Fair comment, although would it be fair to suggest that our national character is quite different from both of those countries?

Anecdotal - I have German in laws and friends and they are almost never happy with their authorities - while at the same time preferring their country above all others. (OK does sound a bit like us).

S Korea - good example. Would we be happy with a phone app that tracked our whereabouts? I know one is planned, probably voluntary ...

Yes, I'd agree with national character coming into the equation, I've previously discussed exactly that here before.

Your anecdote: that sounds about right, they know what they have is bloody good, but they always want more. I would say their 'willingness to comply' is greater than ours (no WW2 jokes please!) and of course with this particular scenario, that can only be good.

I personally would be happy with a phone App which tracked and monitored my movements, but then again, I live a relatively solitary and boring life (apart from the punting  ). So long as it all gets turned off afterwards, I'm fine with pretty much anything which would help.

[Colston36]

I can think of just two who might, Germany and South Korea.

And New Zealand.

40 odd years ago I spent a lot of time at the Middlesex, then a great hospital, because my second wife was suicidal. Not entirely my fault; she was before I met her. I got to know the Registrar. He told me the NHS was going to go down the drain because they had brought "management" in. You only have to read some of the guff managers talk to realise what a bunch of overpaid tossers most are. Add a bunch of inexperienced politicians who've never had proper jobs and a serial liar to lead them ... what do you get? A lot of dead people.

[lostandfound]

Fair comment - once more. Although I missed the obvious / main point in my response. Outside observers may think those two countries have done best - no contest - though that is not to say that their citizens don't bitch about their authorities.

[lostandfound]

And New Zealand.

40 odd years ago I spent a lot of time at the Middlesex, then a great hospital, because my second wife was suicidal. Not entirely my fault; she was before I met her. I got to know the Registrar. He told me the NHSwas going to go down the drain because they had brought "management" in. You only have to read some of the guff managers talk to realise what a bunch of tossers most are. Add a bunch of inexperienced politicians who've never had proper jobs and a serial liar to lead them ... what do you get? A lot of dead people.

I discounted NZ on account of their < 5 million population.

[winkywanky]

And New Zealand.

40 odd years ago I spent a lot of time at the Middlesex, then a great hospital, because my second wife was suicidal. Not entirely my fault; she was before I met her. I got to know the Registrar. He told me the NHS was going to go down the drain because they had brought "management" in. You only have to read some of the guff managers talk to realise what a bunch of overpaid tossers most are. Add a bunch of inexperienced politicians who've never had proper jobs and a serial liar to lead them ... what do you get? A lot of dead people.

Strictly speaking I don't think NZ can be regarded as either large or populous (in response to lostandfound's post). But certainly a country of note.

Yes, I well remember when the NHS (or perhaps more accurately, the govt) decided to get a load of suits and accountants in to jolly well sort out the NHS. It's been kicked around like a football ever since.

[lostandfound]

Yes, I well remember when the NHS (or perhaps more accurately, the govt) decided to get a load of suits and accountants in to jolly well sort out the NHS. It's been kicked around like a football ever since.

Perhaps that was just when you started taking notice? Because I suspect it has always been like that.

Which I don't necessarily see as a criticism of our system, providing public healthcare being about the most complicated undertaking there is.