NHS Reform

[Geronimo]

So what ideas would this board have to reform the NHS to help fund it.
.

Euthanise the chronically obese upon their 3rd admission to hospital for weight-related illnesses.

 

[Pop]

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.

That is the issue for me, chucking more and more cash at it every year is not going to solve the problems.

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.

The people who use the NHS the most wouldn't pay any of these fees as they would be exempt, something like 80% of presecriptions aren't paid for so the it would just be a further tax on people who rarely use the services.

I've brought up foreign nationals using the NHS before, the usual arguement is it only costs 100 million so it doesn't matter in the grand scheme!

 

[nelford_safc]

Good post. I'd add drinkers and smokers to the last comment about fat people, too.

Agreed.

 

[Pop]

Agreed.

Been done a thousand times on here but smokers contribute significantly more in tobacco duty than smoking related diseases cost the NHS. Smokers will also generally die younger meaning further savings to the exchequer.

 

[Hammer]

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.

That'll happen when you form a brand new organisation and refuse any help with how to set up an effective correspondence correspondence unit.

 

[arthursboy]

How do others countries manage it ?
When I'm in a foreign country I take out insurance, should this be mandatory before tourists or visitors are allowed entry ?
I've always wondered why no fuss is made about dentists charging yet doctors charging is taboo
IRarely visit the doctors and A&E fortunately but would gladly pay when the occasion arose,I'm sure Irelend charges also.
Why is this country so stuck in there ways

 

[Hammer]

I've brought up foreign nationals using the NHS before, the usual arguement is it only costs 100 million so it doesn't matter in the grand scheme!

It's a similar issue to the charging for missed appointments one: at present trusts and CCGs don't have any sort of infrastructure in place to recover that money. When you factor in the additional cost and probable low recovery rate, the impact is going to be minor.

In some areas (particularly the North East), the biggest group of non-eligible users is Brits who have retired abroad and come back for free treatment. Does the NHS also need to start seeking proof that all patients are continuously resident in the UK before treating them?

 

[Lankester Merrin]

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.

I don't know of anyone who has an agenda for it to fail.

I think that the Government doesn't have a clear view on the NHS. If think that some of the current government would prefer an american style for profit service but are scared of the electoral consequences, I think that others including Cameron are genuinely in favour of the NHS but don't really know what to do, and others just want to keep things quiet. The agenda Hunt is working to is happy days good news stories only, which was never going to work long term.

There is also a serious problem at the top of the NHS with cliques. The circle of people at the top with the SofS is so small that it is hard for reality to permeate, and there is a lot of "magic thinking" going on.

Personally I think that large scale privatisation of the NHS is a non starter. From Margaret Thatcher onwards governments have encouraged the private sector to take on more and more NHS work. After 30 odd years only about 4% of the NHS budget is spent on private sector provision. That is because NHS work is difficult, cash constrained and the patient volumes are unpredictable - these discourage the private sector for bidding for it. The only way that the private sector could be persuaded to take on things like A&E would be if they were paid an enormous risk premium which would make it unaffordable.

It is the staffing issues that terrify me. I have never known the medical workforce so fucked off. Unless something is done about this the NHS will lose the support of it's Doctors. When that happens it is doomed no matter what the political will is to save it.

In some areas (particularly the North East), the biggest group of non-eligible users is Brits who have retired abroad and come back for free treatment. Does the NHS also need to start seeking proof that all patients are continuously resident in the UK before treating them?

A decade or so ago I commissioned a survey of "foreign" patients using local services. 90% of the foreigners were Brits who had lived abroad. The other 90% were visiting sailors treated as temporary residents to screen for communicable diseases.

The government blames foreigners because it is easier than being honest about the bad policy decisions that they have made. When I worked at DH this was called "the filthy foreigners theory" - you could blame anything which goes wrong in the NHS on foreigners and the media will believe you.

 

[Hammer]

I don't know of anyone who has an agenda for it to fail.

I think that the Government doesn't have a clear view on the NHS. If think that some of the current government would prefer an american style for profit service but are scared of the electoral consequences, I think that others including Cameron are genuinely in favour of the NHS but don't really know what to do, and others just want to keep things quiet. The agenda Hunt is working to is happy days good news stories only, which was never going to work long term.

Cameron really dropped a bollock when he just left Lansley to get on with it and didn't check what he was actually planning.

 

[Nefarious Ned]

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.

The devolution work for the north east has been forced to include health within its remit. Looks like over the next few years local authorities will take over the commissioning of health services alongside social care and CCGs will go the journey.

They've started some of it via the "better care fund" but the future is health budgets into LAs.

Also noted yesterday in the HSJ, that Somon Stevens is looking at system-wide budgets. In this example a health economy is responsible for breaking even and not the indovidal organisations within it. This will really shake things up, in the North East there are some real basket cases financially, so interesting times ahead.

As for NECS, it is well regarded, but speak to most staff members and they can't wait to get out of there, the place is toxic.

 

[John Steed]

How do others countries manage it ?
When I'm in a foreign country I take out insurance, should this be mandatory before tourists or visitors are allowed entry ?
I've always wondered why no fuss is made about dentists charging yet doctors charging is taboo
IRarely visit the doctors and A&E fortunately but would gladly pay when the occasion arose,I'm sure Irelend charges also.
Why is this country so stuck in there ways

Why not just get these fucjers and their kind to pay up instead of hitting the sick and elderly?

http://www.independent.co.uk/news/b...les-but-amazon-pays-119m-in-tax-10346781.html

 

[Lankester Merrin]

Cameron really dropped a bollock when he just left Lansley to get on with it and didn't check what he was actually planning.

I heard that Landsley arranged an event at Downing St so Cameron could meet GPs who supported his proposals. There weren't enough normal GPs who supported Landsley so GPs were recruited by a marketing company who were hired by some of the commercial companies like Care UK who stood to benefit from the changes. Cameron thought he was meeting a representative cross section of GPs, and there was widepsread support for the proposals. He didn't realise that the event at Downing St was actually stage managed by a marketing company.

Reminds me of the episode of In The Thick of It when the realise that the woman from the focus group is an actress hired to make up the numbers.....

 

[Butcher's Coat]

Pay an extra couple of pence in the pound stamp.

 

[Lankester Merrin]

The devolution work for the north east has been forced to include health within its remit. Looks like over the next few years local authorities will take over the commissioning of health services alongside social care and CCGs will go the journey.

They've started some of it via the "better care fund" but the future is health budgets into LAs.

Also noted yesterday in the HSJ, that Somon Stevens is looking at system-wide budgets. In this example a health economy is responsible for breaking even and not the indovidal organisations within it. This will really shake things up, in the North East there are some real basket cases financially, so interesting times ahead.

As for NECS, it is well regarded, but speak to most staff members and they can't wait to get out of there, the place is toxic.

Sounds like you have some inside knowledge.

I would love to continue this debate, but I have to actually do some work!

 

[Gaz]

The devolution work for the north east has been forced to include health within its remit. Looks like over the next few years local authorities will take over the commissioning of health services alongside social care and CCGs will go the journey.

They've started some of it via the "better care fund" but the future is health budgets into LAs.

Also noted yesterday in the HSJ, that Somon Stevens is looking at system-wide budgets. In this example a health economy is responsible for breaking even and not the indovidal organisations within it. This will really shake things up, in the North East there are some real basket cases financially, so interesting times ahead.

As for NECS, it is well regarded, but speak to most staff members and they can't wait to get out of there, the place is toxic.

Necs may be well regarded in some places, but certainly isn't with practices. A lot of practices have major concerns over them. If the ccg disappears which looks likely imo, then it may get interesting up here

 

[Nefarious Ned]

There's millions wasted in the NHS because of the fear of litigation. Maternity services are unaffordable be jade the premiums are through the roof.

Consultants could switch to drugs "off patent", the use of biosimlars in the north east could save in excess of £10m, using Avastin instead of Lucentis to treat eye desires as could save the NHS £200m but they won't do it for fear of litigation (this is exactly the same drug but licensed for different uses).

Big pharma indistries take billions out of the NHS, they give drugs away free to hospitals for clinical trials etc and once approved hike the price up. Regulation of the NHS' interaction with big pharma should be a top priority, but too many of the elite would lose out if this happened.

Also we need to address locum costs, I know of examples in Sunderland where some locums are on £1000 a day for work that should pay £70k per year.

Necs may be well regarded in some places, but certainly isn't with practices. A lot of practices have major concerns over them. If the ccg disappears which looks likely imo, then it may get interesting up here

CCGs seem to be getting bigger at the moment with co-commissioning etc, just in time to be merged with local authorities to create "holistic" commissioning.

 

[Hammer]

A decade or so ago I commissioned a survey of "foreign" patients using local services. 90% of the foreigners were Brits who had lived abroad. The other 90% were visiting sailors treated as temporary residents to screen for communicable diseases.

The government blames foreigners because it is easier than being honest about the bad policy decisions that they have made. When I worked at DH this was called "the filthy foreigners theory" - you could blame anything which goes wrong in the NHS on foreigners and the media will believe you.

The margin for error must have been pretty high if you ended up with a total of 180%

When I was there the media seemed to be driving the foreigner stories. Not helped by Jezza deciding to pluck figures for the cost out of thin air.

 

[Pop]

It's a similar issue to the charging for missed appointments one: at present trusts and CCGs don't have any sort of infrastructure in place to recover that money. When you factor in the additional cost and probable low recovery rate, the impact is going to be minor.

In some areas (particularly the North East), the biggest group of non-eligible users is Brits who have retired abroad and come back for free treatment. Does the NHS also need to start seeking proof that all patients are continuously resident in the UK before treating them?

If the recovery rate is low because we have to employ more staff but the cost of hiring the staff is offset by the revenue brought in that otherwise would have been missed is a good thing surely?

 

[Randy Ostrich]

Been done a thousand times on here but smokers contribute significantly more in tobacco duty than smoking related diseases cost the NHS. Smokers will also generally die younger meaning further savings to the exchequer.

Depends what you class as a smoking related disease. I bet it doesn't include delayed recovery from surgery due to poorer circulation.

 

[Hammer]

The devolution work for the north east has been forced to include health within its remit. Looks like over the next few years local authorities will take over the commissioning of health services alongside social care and CCGs will go the journey.

They've started some of it via the "better care fund" but the future is health budgets into LAs.

Also noted yesterday in the HSJ, that Somon Stevens is looking at system-wide budgets. In this example a health economy is responsible for breaking even and not the indovidal organisations within it. This will really shake things up, in the North East there are some real basket cases financially, so interesting times ahead.

As for NECS, it is well regarded, but speak to most staff members and they can't wait to get out of there, the place is toxic.

System-wide budgets have always seemed sensible to me. Properly integrated health and social care commissioning/provision would also have a positive impact (unless it's used for another stealth budget cut).