NHS Reform

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arthursboy

Striker
So what ideas would this board have to reform the NHS to help fund it.
People living longer and drugs costing a fortune are no doubt a contributing factor but how can it be funded to keep up with ever increasing costs.
Seems every government try's to sort it but never actually comes up with a solution.
Payment at source must come at some point but how ?

Doctors fee, similar to going to the dentists £20 std fee
A&E visit £100 fee
Drop in ctr £50 fee
Foreign nationals pay cost of entire treatment

Ok I'm sure many will think that's bollocks, and it will have many flaws, but surely the NHS can't continue to be free to all, for ever, great idea but someone has to pay more for it then we do currently through taxes.
 


Some savings perhaps from the following changes:
We retire (state pension wise) at 65 and plus so why free prescriptions at 60 when you are likely well able to afford them.

No branded meds when a generic is suitable and cheaper

Maybe a nominal charge for every item by everybody ??

Sort the tax and nic system out , and ensure our health system is properly funded

Nominal charge for GP/walk-in/A&E as suggested with safeguards

Think about waste, the amount of medicine thrown away untouched, (pills, drinks and dressings, and testing strips etc)is criminal.

People who get free meds like insulin and levothyroxine, fine; but why should they get all their meds free, it should just be the ones for those diseases.
 
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So what ideas would this board have to reform the NHS to help fund it.
People living longer and drugs costing a fortune are no doubt a contributing factor but how can it be funded to keep up with ever increasing costs.
Seems every government try's to sort it but never actually comes up with a solution.
Payment at source must come at some point but how ?

Doctors fee, similar to going to the dentists £20 std fee
A&E visit £100 fee
Drop in ctr £50 fee
Foreign nationals pay cost of entire treatment

Ok I'm sure many will think that's bollocks, and it will have many flaws, but surely the NHS can't continue to be free to all, for ever, great idea but someone has to pay more for it then we do currently through taxes.
Start by charging if you miss an appointment. Disgusting the amount of people who just don't turn up
 
They put the figure each month on the wall at my surgery. It was 654 missed appointments at mine the other month.£20 a miss would soon have a member of staff salary sorted eg another nurse etc.
This. Takes nothing to contact them and cancel.
 
They put the figure each month on the wall at my surgery. It was 654 missed appointments at mine the other month.£20 a miss would soon have a member of staff salary sorted eg another nurse etc.

Agreed if it was a private company they would not let you away with it as time has already been allocated to you.
Would be a simple fix and generate thousands until people realise and stop doing it.
 
So what ideas would this board have to reform the NHS to help fund it.
People living longer and drugs costing a fortune are no doubt a contributing factor but how can it be funded to keep up with ever increasing costs.
Seems every government try's to sort it but never actually comes up with a solution.
Payment at source must come at some point but how ?

Doctors fee, similar to going to the dentists £20 std fee
A&E visit £100 fee
Drop in ctr £50 fee
Foreign nationals pay cost of entire treatment

Ok I'm sure many will think that's bollocks, and it will have many flaws, but surely the NHS can't continue to be free to all, for ever, great idea but someone has to pay more for it then we do currently through taxes.

Legalise cannabis and use the tax revenue for the NHS.

Thinking outside the envelope is what is required here, not the same old shit ideas.
 
It's not the NHS that has to change, it's the patients. Missing appointments like its a waste of time going and 'popping' into A&E with fuck all to skip a GPs queue.

It couldn't be done because of human rights laws but anyone going A&E with a headache or sore throat should be sent home. I worked A&E reception at the eye infirmary many years ago and the amount of people who came in for treatment with conjunctivitis was a joke. They'd be other people with a detached retina and they'd moan when they were seen to first.

Then there's fat people. Stop abusing your body, eat healthier and do a little bit exercise once in a while you lazy bastards.
 
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They put the figure each month on the wall at my surgery. It was 654 missed appointments at mine the other month.£20 a miss would soon have a member of staff salary sorted eg another nurse etc.

I'm suspicious about ideas like this. The cost of collection would be huge, and it would end up with the NHS chasing lots of people for small sums of money that they didn't have. It would also penalise people who live in rural areas with poor public transport who might end up missing an appointment for reasons out of their control

The big cost saving in the NHS is the internal market. Scrapping that would save more money than all of the other schemes suggested here put together. The NHS spends about 5-6% of it's total budget on the bureaucracy associated with commissioning and outsourcing.

Just to put that in perspective - the administration costs of outsourcing stuff to the private sector costs more than the actual value of the all of the NHS contracts with the private sector.

I would also have a ban on pointless re-organisations. The last government spent £3bn on re-organisations, all of which left the management structure weaker. It is common knowldege inside the service that an other re-organisation is needed, but there is a lack of political will. Agreeing on a workable management structure and sticking with it would save the NHS billions

Finally I would scrap the stupid rule about people being paid more than the Prime Minister. Instead I would have a rule that every NHS organisation should have a Dr on the board, and that no NHS manager can earn more than the most highly paid clinician in their organisation.
 
Gp practices can't charge for dna's and believe me we've tried very hard to introduce something in durham.

Locum & contractor costs - massive costs because we can't train and more importantly keep clinicians in this country to fill the amount of posts needed. Typical government's that cut funding / budgets meaning less staff on permanent contracts but more locum cover needed on a lot more money

There have been severe cuts across the whole nhs. While there are obvious areas where money can be saved and things ran more effective, you can't make those sort of cuts and expect the service provided to be as good. Investment is needed, or a radical change to how the whole nhs system is run and funded. How that can happen god only knows

I agree with @Lankester Merrin above, reorganisations / pct abolished / ccg's taking over hasn't worked and was all bollocks from the start. Certainly primary care is being run a lot worse now than it ever was under pct's. No doubt another reorg will happen in the future at another massive cost.
 
Gp practices can't charge for dna's and believe me we've tried very hard to introduce something in durham.

Locum & contractor costs - massive costs because we can't train and more importantly keep clinicians in this country to fill the amount of posts needed. Typical government's that cut funding / budgets meaning less staff on permanent contracts but more locum cover needed on a lot more money.

Coalition government cut nurse training places by 5,000 in 2010. The staffing crisis we are now in was inevitable from that moment on.

This is the really scary figure. If we can't sort that out than the NHS will collapse. It is that bad.

http://www.theguardian.com/society/...or-doctors-left-nhs-after-foundation-training

There have been severe cuts across the whole nhs. While there are obvious areas where money can be saved and things ran more effective, you can't make those sort of cuts and expect the service provided to be as good. Investment is needed, or a radical change to how the whole nhs system is run and funded. How that can happen god only knows

I agree with @Lankester Merrin above, reorganisations / pct abolished / ccg's taking over hasn't worked and was all bollocks from the start. Certainly primary care is being run a lot worse now than it ever was under pct's. No doubt another reorg will happen in the future at another massive cost.

Sounds like you know a bit about primary care and commissioning.

I think that there is already a blueprint for some of the changes. NHS England will create regional offices that will look rather like SHAs. Monitor and the CQC have been merged under "Jim'll Fix It". All of the other ALBs will learn their fate soon, but there will be a big change. Commissioning support will be outsourced in places were it isn't working, although the North East one will continue as it is well regarded, and has a good management team.

I don't think that there is any clear vision for CCGs. They aren't working, but the costs of fixing them are unaffordable. I think that they might just be allowed to fail, and used as a scapegoat.
 
It's not the NHS that has to change, it's the patients. Missing appointments like its a waste of time going and 'popping' into A&E with fuck all to skip a GPs queue.

It couldn't be done because of human rights laws but anyone going A&E with a headache or sore throat should be sent home. I worked A&E reception at the eye infirmary many years ago and the amount of people who came in for treatment with conjunctivitis was a joke. They'd be other people with a detached retina and they'd moan when they were seen to first.

Then there's fat people. Stop abusing your body, eat healthier and do a little bit exercise once in a while you lazy bastards.
Good post. I'd add drinkers and smokers to the last comment about fat people, too.
 
I'm not sure why we have to pay for NHS dental appointments and not GP appointments, is it because dentists are evil?

Tin hat on but the NHS probably is funded well enough but the cash probably isn't spent well.

Some ideas anyway:

- Renegotiate drug deals with suppliers and use generics whenever possible.
- Stop using PPI to pay for new buildings and facilities as in the long run it will cost billions more and other people will be making a profit.
- More use of private medical companies if it's cost effective.
- Scrap/limit medical tourism.

If there is a serious problem with NHS funding then people will either have to pay more taxes or there'll have to be a radical reorganisation. IMHO I wouldn't begrudge paying more if it was spent wisely and made a difference.
 
Investment is needed, or a radical change to how the whole nhs system is run and funded. How that can happen god only knows
Is it more urban myth that truth currently, that the current plight of the NHS is engineered for it to fail so that the current privitisation by the back door becomes privitisation by the front door?
 
Coalition government cut nurse training places by 5,000 in 2010. The staffing crisis we are now in was inevitable from that moment on.

This is the really scary figure. If we can't sort that out than the NHS will collapse. It is that bad.

http://www.theguardian.com/society/...or-doctors-left-nhs-after-foundation-training



Sounds like you know a bit about primary care and commissioning.

I think that there is already a blueprint for some of the changes. NHS England will create regional offices that will look rather like SHAs. Monitor and the CQC have been merged under "Jim'll Fix It". All of the other ALBs will learn their fate soon, but there will be a big change. Commissioning support will be outsourced in places were it isn't working, although the North East one will continue as it is well regarded, and has a good management team.

I don't think that there is any clear vision for CCGs. They aren't working, but the costs of fixing them are unaffordable. I think that they might just be allowed to fail, and used as a scapegoat.

Its just a mess tbh. Ccg's are a waste of time, most of the good pct staff got other jobs while the poor staff went to the ccg. I know for a fact our local ccg is very close to going into special measures. Its quite scary what is going on.

I've been through a cqc inspection, and to be honest it is far too easy to pass and look good. Practices are being told they are good when in reality what the patient received isn't up to standard. Great idea to monitor practices, poor implementation as usual.

The staffing crisis is a major problem in primary & secondary care. Doctors & nurses are retiring earlier due to the state of the nhs, not enough new clinicians across the board who want to work in the nhs (who can blame them when they can move abroad and have a much better lifestyle, more money and a lot less stress).

We can't get permanent doctors. Nobody wants to take on a partnership, salaried gp's want more and more money for less work and a large % would rather do locum work as they earn a lot more.

Things aren't looking good
 
@Lankester Merrin has just won the internet with that post!

Thanks, but I think you are overstating things slightly

the biggest problem for the NHS is that it has since day 1 been a political football...

I think that it is caught between the Labour Party, who have a sentimental attachment to the service which makes it blind to it's problems, and a Conservative Party who instinctively mistrust anything which smells of socialism, and who see it only as a source of potential profit for private companies their mates run.

At the moment the government is committed to having fewer NHS managers - which is a laudable ambition -- but it also wants to micro manage everything. The result is a overly centralised dysfunctional bureaucracy which adds nothing to patient care, and actively stops improvements taking place. No one really understands what is going on, there are confused responsibilities, and endless jokeying for power. The best people have left, and the ones who are left are scared that they will be out the door at the next re-organisation

I contacted Simon Stevens to raise my concerns about primary care commissioning. The medical director in charge of the local CCGs emailed me and told me that Simon Stevens had asked him to respond. And then I got an email from one of the National Directors telling me that Simon Stevens had asked her to reply. And then I got an email from a call centre manager who said that she was the person who Simon Stevens had asked to reply.

This has paralysed parts of the service. I know a very senior Dr who tried to help sort out Jr Doctors rotas over the winter to stop a potential winter crisis. They were told by a senior manager that they could not do this, as the Secretary of State was in dispute with the juniors and any attempt to sort out rotas would "potential embarass JH". As a consequence that problem still is solved, the rotas still have wholes in the snow has started falling.

Another Dr I know knew before the general election that there was a huge problem with GP training numbers, despite Hunt and Cameron telling the House of Commons that there were "record numbers". He was told not to tell anyone or else.
 
Is it more urban myth that truth currently, that the current plight of the NHS is engineered for it to fail so that the current privitisation by the back door becomes privitisation by the front door?

Tough question, i'll let @Lankester Merrin give his opinion.

Personally imo it is failing, and failing badly. Are governments pushing it to fail - i'd say there has to be some suggestion that is the case. They can't honestly believe the nhs can survive as it is now, either that or they are too thick to realise the effect they are having.
 
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