NHS rant alert

[Bunkermagnet]

Lets be honest, every part of the NHS could and should be looked at regarding it's financial accountability. I know plenty of nurses who would rather be an agency nurse than be "on the books". They get paid more for less days worked. Whatever the rights or wrongs of the permanent staff pay levels, there are still plenty milking it for their own gains.

 

[Kellfire]

I see it every day in my job (determining inpatient/day case patient cost) how much tighter the NHS is getting with its funding and (more precisely, in my case) how Trusts are determined to secure as much funding as they can for the patients that they see from the NHS. There are levels of scrutiny behind patient flow and treatment (planning, at the time and after the event) that wasn't evident even five years ago.

The NHS is in new levels of accountability.

 

[Foxholer]

I see it every day in my job (determining inpatient/day case patient cost) how much tighter the NHS is getting with its funding and (more precisely, in my case) how Trusts are determined to secure as much funding as they can for the patients that they see from the NHS. There are levels of scrutiny behind patient flow and treatment (planning, at the time and after the event) that wasn't evident even five years ago.

The NHS is in new levels of accountability.

Is that actually 'accountability' - as in being accountable/responsible - or simply 'requesting cost justification/affordability/funding allocation' - as in 'charge-ability!'? Both laudable, but very different, exercises!

 

[Kellfire]

Is that actually 'accountability' - as in being accountable/responsible - or simply 'requesting cost justification/affordability/funding allocation' - as in 'charge-ability!'? Both laudable, but very different, exercises!

Actual accountability - clinicians are much more involved in the allocation of funding to their work, making themselves more available to discuss the recording of their work for example. My Trust is also implementing new processes constantly to stream line areas of the hospital (A&E being under extremely high scrutiny for their admittance times), all staff being asked to give a simple idea for cost saving at their annual performance review, posts that are vacated undergo much tighter scrutiny (my department have had to justify two posts recently to the board that were up for filling).

Compared to what I saw when I first joined the NHS, times are changing rapidly.

 

[Hobbit]

There are some fantastic, commercially aware managers within the NHS, and they are a blessing to deal with. They drive a proper hard bargain and 'win' much for the organisation but, equally, understand that the 'win' has to be for both sides.

And then there are the dinosaurs from a time long, long ago who should be put out to grass.

 

[Tashyboy]

There are some fantastic, commercially aware managers within the NHS, and they are a blessing to deal with. They drive a proper hard bargain and 'win' much for the organisation but, equally, understand that the 'win' has to be for both sides.

And then there are the dinosaurs from a time long, long ago who should be put out to grass.

Hobbit the bit I don't understand is, X number of years ago when Sherwood Forest hospitals decided to become a trust. Someone signed for the "financial package" of the deal. If it was the chief exec at that time. Surely signing a multi billion deal was not his forte. So how was this/these allowed to happen. Money being made by trusts is going out of the hospital into banks.

 

[Ethan]

The internal market introduced by the Tories around 1990 set the NHS on the road to ruin. Ostensibly it was intended to introduce innovation using market techniques, but a national (or even local) health service does not operate like a proper market. Instead, what happened was that a lot more transaction costs were introduced and activity switched to that which could be measured at the expense of other less measurable things which mattered. Then people start to game the system. Set a 4 hour A&E waiting time (from check in to disposal) and what happens is that ambulances are not allowed to park when things are busy, so drive around the car park. Seriously.

The results of this massive disaggregation has been hugely costly. Every NHS Trust has a separate committee to evaluate new medicines., But medicines work the same in one part of the country as another. This is all massive duplication. Same for loads of other stuff, which bleeds money, and enforced PFI deals costs a fortune.

But the long game was privatisation, at least in part, so work continued to put in place systems to measure stuff for billing and productivity measures, and to make the workforce more flexible by changing work practices and reducing pension and salary bills. Legislative steps have been taken to allow parts of the NHS to be tendered to any wiling provider, with no preference allowable to NHS services, removing ultimate responsibility for the NHS from the Sec of State for Health and making much of the correspondence relating to the contractual deals inaccessible to FOI requests.

It is probably too far gone now to fix. I would favour removal of the internal market entirely and going back to an old style top down command and control system.

 

[Hobbit]

Hobbit the bit I don't understand is, X number of years ago when Sherwood Forest hospitals decided to become a trust. Someone signed for the "financial package" of the deal. If it was the chief exec at that time. Surely signing a multi billion deal was not his forte. So how was this/these allowed to happen. Money being made by trusts is going out of the hospital into banks.

Turning it into a Trust wasn't the worst thing. PFI + all the other outsourced (read money syphoning) dept etc is what is killing it.

You've hit one of the nails on the head, i.e. money going out of the NHS at disproportionate levels. Depts/organisations being set up to, basically, syphon money off. NHS Supply Chain; its a misnomer. Its majority owned by DHL. They skim a bit of every deal from the Trust and a bit from the supplier....

Aaaaaarrggghhh! And breathe in, 2,3,4 and relax.

 

[Ethan]

Turning it into a Trust wasn't the worst thing. PFI + all the other outsourced (read money syphoning) dept etc is what is killing it.

You've hit one of the nails on the head, i.e. money going out of the NHS at disproportionate levels. Depts/organisations being set up to, basically, syphon money off. NHS Supply Chain; its a misnomer. Its majority owned by DHL. They skim a bit of every deal from the Trust and a bit from the supplier....

Aaaaaarrggghhh! And breathe in, 2,3,4 and relax.

This is the issue. Spending on the NHS rose under several GOvts, but spending on actual healthcare fell while spending on other rubbish within the NHS rose sharply. Some of this was obscured by failure to reclassify clinical personnel switched to managerial roles.

 

[Foxholer]

Actual accountability - clinicians are much more involved in the allocation of funding to their work, making themselves more available to discuss the recording of their work for example. My Trust is also implementing new processes constantly to stream line areas of the hospital (A&E being under extremely high scrutiny for their admittance times), all staff being asked to give a simple idea for cost saving at their annual performance review, posts that are vacated undergo much tighter scrutiny (my department have had to justify two posts recently to the board that were up for filling).

Compared to what I saw when I first joined the NHS, times are changing rapidly.

Still seems more like Accounting than Accountability to me!

To perhaps labour my point, what processes (and possible sanctions) have you specified for when something goes wrong? Or have you merely analysed/assigned costs to the specific procedures involved - perhaps including some sort of average/contingency for cases where things can go wrong?

 

[Kellfire]

Still seems more like Accounting than Accountability to me!

To perhaps labour my point, what processes (and possible sanctions) have you specified for when something goes wrong? Or have you merely analysed/assigned costs to the specific procedures involved - perhaps including some sort of average/contingency for cases where things can go wrong?

My department assign pre-determined cost codes for both diagnoses and procedures, based on WHO and NHS/HSCIC guidance - we don't have discretion to alter things on the fly. We do record any complications (aka things going "wrong") and longevity of stay changes the finances considerably. The costs behind the codes are reviewed every year, along with the rules behind them so it's a constantly changing process as medical advancements are made and the NHS analyses the information we send them each year.

Sanctions etc are handled by a separate team. We are kept away from that side of things so that we are not influenced in how to record the information in a way to maximise money or to obscure clinical error.

 

[Ethan]

Actual accountability - clinicians are much more involved in the allocation of funding to their work, making themselves more available to discuss the recording of their work for example. My Trust is also implementing new processes constantly to stream line areas of the hospital (A&E being under extremely high scrutiny for their admittance times), all staff being asked to give a simple idea for cost saving at their annual performance review, posts that are vacated undergo much tighter scrutiny (my department have had to justify two posts recently to the board that were up for filling).

Compared to what I saw when I first joined the NHS, times are changing rapidly.

Indeed, for the worse.

Some of the stuff you mention, A&E 4 hour wait, for example, is a complete and utter waste of time and diverts and distorts practice and resources, not to mention is gamed by every Trust. So long as people are triaged properly, people who have no need to be there can wait all day for all I care. Might encourage them not to come back for something trivial.

I can think of one great cost saving idea - get rid of Trust structures and process entirely and return to regional and local health authorities.

 

[SocketRocket]

So in short it's all the Conservatives fault then?

 

[Ethan]

So in short it's all the Conservatives fault then?

Well, the Tories started the internal market, Blair continued the job, but the present lot have accelerated further and probably through the point of no return. It is mostly the Tories fault.

 

[HomerJSimpson]

Find it hard recruiting an ever increasing raft of middle management (band 6-8) that seem to be providing little real term results. No idea what some of these fancy titles are designed to deliver but galling when we are struggling to get HCA's, nurses and midwives in to fill an increasing number of positions, thus becoming ever more reliant on agency spend and therefore more cost

 

[SocketRocket]

Well, the Tories started the internal market, Blair continued the job, but the present lot have accelerated further and probably through the point of no return. It is mostly the Tories fault.

In your opinion of course!

 

[Foxholer]

My department assign pre-determined cost codes for both diagnoses and procedures, based on WHO and NHS/HSCIC guidance - we don't have discretion to alter things on the fly. We do record any complications (aka things going "wrong") and longevity of stay changes the finances considerably. The costs behind the codes are reviewed every year, along with the rules behind them so it's a constantly changing process as medical advancements are made and the NHS analyses the information we send them each year.

Sanctions etc are handled by a separate team. We are kept away from that side of things so that we are not influenced in how to record the information in a way to maximise money or to obscure clinical error.

I'm now absolutely certain that what you are talking about is Accounting, NOT Accountability!

 

[Kellfire]

I'm in the "accounting" side of things. I'm not personally involved in the accountability side.

 

[Tashyboy]

I'm in the "accounting" side of things. I'm not personally involved in the accountability side.

Give over kellfire, that old cheggar. 😁

 

[Ethan]

In your opinion of course!

Have you an opinion? Care to share?

Tell me what I said that you think is incorrect and why.