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Famous London Teaching Hospital
http://www.dailymail....nurses-beds-norm.html
This is a hospital from which I qualified some years ago and did my junior appointments with pride.
Surely, but SURELY, reading this, the British public must now realise that the NHS is not the "Envy of the world" and changes and reorganisation MUST take place.
This is a hospital from which I qualified some years ago and did my junior appointments with pride.
Surely, but SURELY, reading this, the British public must now realise that the NHS is not the "Envy of the world" and changes and reorganisation MUST take place.
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I'm sure there will be another side to the Mail's story - consultants getting better offers elesewhere for example and sounding off on the way out. But I agree with Sqad that the model that the NHS was designed for needs to be seriously re-evaluated.
This in itself is a process that will take time and should ideally be cross-party. And there's your two stumbling blocks.
In 1945 there was massive national desire to rebuild a devastated country and make it a fair place - equality in education, work, health. Most people did not live many years beyond retirement.
Now, health and social change means that people live decades longer than the system was designed for. But sadly we have descended into a country run by sound-bites, quick fixes and expedience.
So the danger is that some vote-grabber shouts 'hands off' while another shouts 'make it like America' - both are wrong, and we the taxpayers get to support their vanity with our hard-earned.
This in itself is a process that will take time and should ideally be cross-party. And there's your two stumbling blocks.
In 1945 there was massive national desire to rebuild a devastated country and make it a fair place - equality in education, work, health. Most people did not live many years beyond retirement.
Now, health and social change means that people live decades longer than the system was designed for. But sadly we have descended into a country run by sound-bites, quick fixes and expedience.
So the danger is that some vote-grabber shouts 'hands off' while another shouts 'make it like America' - both are wrong, and we the taxpayers get to support their vanity with our hard-earned.
Reorganisation is the last thing the NHS needs Sqad.
There have been at least 15 identifiable major structural changes in three decades, or one every two years or so.
Firstly, structural reorganisations don’t work. Although NHS performance may be problematic, there is often little evidence to show that the causes of poor performance are structural or that the proposed structural changes will improve performance.
Secondly, the transitional costs of large scale NHS reorganisations are huge, although they are often discounted or ignored, and the intended or projected savings from abolishing or downsizing organisations are rarely realised.
Thirdly, and most importantly, reorganisation adversely affects service performance.
It is a huge distraction from the real mission of the NHS—to deliver and improve the quality of health care—and it can absorb a massive amount of managerial and clinical time and effort. It saps morale and creates uncertainty for many people about their careers and futures.
These are brief points taken from this article by Prof Kieran Walshe
http://www.bmj.com/co...341/bmj.c3843.extract
So if the government were to spend the money they presumably have set aside (billions likely) for the planned reorganisation on front line clinical services instead, this very sad state of affairs might be averted.
There have been at least 15 identifiable major structural changes in three decades, or one every two years or so.
Firstly, structural reorganisations don’t work. Although NHS performance may be problematic, there is often little evidence to show that the causes of poor performance are structural or that the proposed structural changes will improve performance.
Secondly, the transitional costs of large scale NHS reorganisations are huge, although they are often discounted or ignored, and the intended or projected savings from abolishing or downsizing organisations are rarely realised.
Thirdly, and most importantly, reorganisation adversely affects service performance.
It is a huge distraction from the real mission of the NHS—to deliver and improve the quality of health care—and it can absorb a massive amount of managerial and clinical time and effort. It saps morale and creates uncertainty for many people about their careers and futures.
These are brief points taken from this article by Prof Kieran Walshe
http://www.bmj.com/co...341/bmj.c3843.extract
So if the government were to spend the money they presumably have set aside (billions likely) for the planned reorganisation on front line clinical services instead, this very sad state of affairs might be averted.
slaney....I have read your comments and have indeed agreed with many of your points.
However, I am speaking from the "lot" of the healthcare workers where, particularly with the doctors, the moral has been declining over a period of 30-40years. I think that we would all agree that the NHS in it's present form is unaffordable and unsustainable and some form of "reorganisation" or change of emphasis is needed.
Two ways to look at this :
a) the patient's point of view"
b) the point of view of the healthworker.
The patients would be reluctant for any change in the NHS, as that is the only healthcare system that they have known, which puts the Politicians in a bit of a "straight jacket" as they know that any move away from FREE healthcare would see them back into opposition.
The healthcare worker has had it "good" up until recent events and even the doctors have been pampered to financially, by successive Governments the last of which gave a pay rise to the GP's for less work.
The only Prof Walshe that i knew was a Neurologist, but I put my money on the fact that his experience of working in a district general hospital was limited.
It is a difficult situation, I have never been interested in Medical Politics and i do not know the answer, except to say that this is a chronic (medical def) situation and to give billions to the GP's is madness.
However, I am speaking from the "lot" of the healthcare workers where, particularly with the doctors, the moral has been declining over a period of 30-40years. I think that we would all agree that the NHS in it's present form is unaffordable and unsustainable and some form of "reorganisation" or change of emphasis is needed.
Two ways to look at this :
a) the patient's point of view"
b) the point of view of the healthworker.
The patients would be reluctant for any change in the NHS, as that is the only healthcare system that they have known, which puts the Politicians in a bit of a "straight jacket" as they know that any move away from FREE healthcare would see them back into opposition.
The healthcare worker has had it "good" up until recent events and even the doctors have been pampered to financially, by successive Governments the last of which gave a pay rise to the GP's for less work.
The only Prof Walshe that i knew was a Neurologist, but I put my money on the fact that his experience of working in a district general hospital was limited.
It is a difficult situation, I have never been interested in Medical Politics and i do not know the answer, except to say that this is a chronic (medical def) situation and to give billions to the GP's is madness.
My experience of hospitals here in Edinburgh ...not good...as a carer to an Alzheimers sufferer I had to fight tooth and nail for half way decent care and attention for him...when visiting spent my entire time helping other patients to eat/drink/empty catheter bags..and even changed a bed while the nursing staff sat and chatted...not a cardex just chit chat...bring back the old fashioned matron and discipline to the wards..nursing is about patient care not money..
The Royal London was my poor brother-in-laws hospital (the renal unit). He`d had polycystic kidneys and had had a transplant. As far as my sister was concerned, there were several cock ups that took place there. Long story but it culminated in the Royal London telling him he didn`t have cancer (even though he was yellow and down to about 7 stone by then). I went to visit and was shocked. The hospital looked like something out of Victorian London. There was a metal sort of cage around the stairwell. The paint was all peeling off. The chair by his bed had a plastic lining and the plastic had split, exposing the foam inside. That must have been a potential site to harbour germs. The nurse had dreadlocks which weren`t even tied back and were hanging over the patients. I actually said as we left "Thank God I don`t live in the catchment area for this place". They were wrong about it not being cancer. My brother in law was dead two months later. The only saving grace was that he died in a hospice and not that Godforsaken place.
237SJ....I am sorry for that story, as i have a great regard for the "old" London that I knew well.
It seems that nobody, patients, medical politicians have the answer to the problem. Medical Politicians, like Politicians are sitting pretty, they have merit awards adding to their salaries and pensions, they have less patient contact as their lives revolve around "meetings" thus leaking the workload to juniors and other non politically inclined colleagues........and so it goes on.
It seems that nobody, patients, medical politicians have the answer to the problem. Medical Politicians, like Politicians are sitting pretty, they have merit awards adding to their salaries and pensions, they have less patient contact as their lives revolve around "meetings" thus leaking the workload to juniors and other non politically inclined colleagues........and so it goes on.
The NHS has been run like a budiness marketplace for the last 15 years. Each separate business is called a Trust and gets to spend its own budget and compete for patients.
Under this system, there will be some businesses that are brilliant, and some that are poor like the one in the article. Market forces are supposed to kill off inefficient poorly run Trusts just as poorly run businesses fail.
If you do not like this system, there are 2 alternatives. Returning to a centralised Dept of Health run NHS where civil servants make all the decisions, or a privatised NHS run for profit of large conglomerates, usually foreign owned.
Under this system, there will be some businesses that are brilliant, and some that are poor like the one in the article. Market forces are supposed to kill off inefficient poorly run Trusts just as poorly run businesses fail.
If you do not like this system, there are 2 alternatives. Returning to a centralised Dept of Health run NHS where civil servants make all the decisions, or a privatised NHS run for profit of large conglomerates, usually foreign owned.
Well, the Royal London was certainly a contrast to the last time I`d been in hospital which was a (admittedly private) hospital in India. The staff were immaculate. Hair tied back, smart uniforms. If frontline staff look smart that instils confidence in "customers". It doesn`t cost a Trust anything to enforce uniform standards. I will probably get slated for it but I`ve long said the NHS should no longer exist. They seem to do well in other countries without one. My cousin in Germany had a bad back. He went to the doc`s. Two weeks later he was with the Consultant. Two weeks after that he was operated on. There are too many people in this country drawing off the NHS but not paying into it. No other business could survive in those circumstances.
It's this Professor Walshe - he used to work for the Kings Fund..
http://www.mbs.ac.uk/...ople/profiles/kwalshe
I agree that giving GPs a large increase in salary while allowing them to opt out of on call and night duties was a major error. The hospital consultants rise was justified. I was working 60 hrs a week on site plus 25 hrs a week on call; my contract was for 11 notional half days - 38 hrs a week; a new deal needed to be negotiated. The government did not really believe we were working these hours, so when their bluff was called, they were forced into the higher payments. I'd hardly call it "pampering" - but we may agree to differ on that.
I wish I knew what the answer to all this was, but am pretty sure that less money spent on costly PFI ventures, management consultants and reorganisations would help greatly.
I agree giving all that power to GPs alone is unwise - while appreciating their crucial and key position in the NHS, any commissioning service needs input from a considerably broader base than this.
After so much agreeing with Sqad, I may have to go and have a little lie-down!
http://www.mbs.ac.uk/...ople/profiles/kwalshe
I agree that giving GPs a large increase in salary while allowing them to opt out of on call and night duties was a major error. The hospital consultants rise was justified. I was working 60 hrs a week on site plus 25 hrs a week on call; my contract was for 11 notional half days - 38 hrs a week; a new deal needed to be negotiated. The government did not really believe we were working these hours, so when their bluff was called, they were forced into the higher payments. I'd hardly call it "pampering" - but we may agree to differ on that.
I wish I knew what the answer to all this was, but am pretty sure that less money spent on costly PFI ventures, management consultants and reorganisations would help greatly.
I agree giving all that power to GPs alone is unwise - while appreciating their crucial and key position in the NHS, any commissioning service needs input from a considerably broader base than this.
After so much agreeing with Sqad, I may have to go and have a little lie-down!
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It was an awful indictment of RL&Barts. There is further backstory to this, in that I believe 6 senior consultants have recently resigned from that trust, pointing to a management crisis.
The NHS is suffering from reform fatigue at the moment. There have been a lot of significant reforms over the past decade, with scarcely time to catch a breath before having to engage with yet another set. The one success story has been the proliferation of middle management, at the expense of clinical input - a trend for the worse. The PFI initiatives, whilst I can understand the desire for them, were poorly negotiated by the NHS / Individual Trusts, leaving themselves hostage to private service sector companies. Whoever negotiated on behalf of the NHS for the PFIs should be taken to task - or shot, to use a Clarkson colourful phrase :)
Despite all this, the KPI for clinical performance remain extremely high for the NHS in comparison to other countries - we have the same overall mortality rate as the the US, for instance, at half the price and unlike the US health insurance system, we dont have 45 million not covered.
Cancer care is often cited as being an example of poor NHS performance when compared internationally, but the latest figures used for comparison are well out of date - there have been dramatic improvements in performance, far outstripping outcomes elsewhere.
There needs to be a grown up debate about what we want from the NHS - and preferably a cross-party political consensus on the best long term strategy, so we can reduce the ridiculous number of top down dramatic revisions of health provision.
Some treatments should not be offered, some of the ancillary and support services can and probably should be privatised - but the core principle - that of responsive treatment, free at the point of care, should not be compromised.
And if GPs are truly going to be the drivers of health care for the future, they should do it properly - that means pro-active management of the patients, including acting as an active liason and communication channel for families and their relatives undergoing hospital treatment. The most common issue of dissatisfaction mentioned is the almost criminal lack of proper communication to family and friends by medical professionals. The GP could act as a mediator between the 2 groups. Seems fair enough, if they are to receive £80 billion a year from the taxpayer! :)
The NHS is suffering from reform fatigue at the moment. There have been a lot of significant reforms over the past decade, with scarcely time to catch a breath before having to engage with yet another set. The one success story has been the proliferation of middle management, at the expense of clinical input - a trend for the worse. The PFI initiatives, whilst I can understand the desire for them, were poorly negotiated by the NHS / Individual Trusts, leaving themselves hostage to private service sector companies. Whoever negotiated on behalf of the NHS for the PFIs should be taken to task - or shot, to use a Clarkson colourful phrase :)
Despite all this, the KPI for clinical performance remain extremely high for the NHS in comparison to other countries - we have the same overall mortality rate as the the US, for instance, at half the price and unlike the US health insurance system, we dont have 45 million not covered.
Cancer care is often cited as being an example of poor NHS performance when compared internationally, but the latest figures used for comparison are well out of date - there have been dramatic improvements in performance, far outstripping outcomes elsewhere.
There needs to be a grown up debate about what we want from the NHS - and preferably a cross-party political consensus on the best long term strategy, so we can reduce the ridiculous number of top down dramatic revisions of health provision.
Some treatments should not be offered, some of the ancillary and support services can and probably should be privatised - but the core principle - that of responsive treatment, free at the point of care, should not be compromised.
And if GPs are truly going to be the drivers of health care for the future, they should do it properly - that means pro-active management of the patients, including acting as an active liason and communication channel for families and their relatives undergoing hospital treatment. The most common issue of dissatisfaction mentioned is the almost criminal lack of proper communication to family and friends by medical professionals. The GP could act as a mediator between the 2 groups. Seems fair enough, if they are to receive £80 billion a year from the taxpayer! :)
redman....LO it was Jack the Ripper.
Lazygun. Walshe in the above post from the BMJ could have summed the whole situation up by saying that past "reforms" have been costly and ineffective and the changes that would be beneficial, we can't afford.
So we are stuck with it.
\\\Cancer care is often cited as being an example of poor NHS performance when compared internationally, but the latest figures used for comparison are well out of date - there have been dramatic improvements in performance, far outstripping outcomes elsewhere. \\\
I am not sure what you mean by "cancer care" but if you mean survival rates, then i would agree that they have improved, but well, well down the league in European survival rates.
//Seems fair enough, if they are to receive £80 billion a year from the taxpayer! ://
For that, "walk-in centres" should be abolished, that bloody stupid NHS phone line scrapped and GPs provide 24 hour cover on a rota basis. That would seem fair enough.
Lazygun. Walshe in the above post from the BMJ could have summed the whole situation up by saying that past "reforms" have been costly and ineffective and the changes that would be beneficial, we can't afford.
So we are stuck with it.
\\\Cancer care is often cited as being an example of poor NHS performance when compared internationally, but the latest figures used for comparison are well out of date - there have been dramatic improvements in performance, far outstripping outcomes elsewhere. \\\
I am not sure what you mean by "cancer care" but if you mean survival rates, then i would agree that they have improved, but well, well down the league in European survival rates.
//Seems fair enough, if they are to receive £80 billion a year from the taxpayer! ://
For that, "walk-in centres" should be abolished, that bloody stupid NHS phone line scrapped and GPs provide 24 hour cover on a rota basis. That would seem fair enough.
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