It has taken a little over 10 years and Tory cuts to push the NHS from the top to second from the bottom of risk nation health care.

Thanks Baggs. I think it would take a very long time and there would be considerable resistance from within the NHS with each senior manager having his own little empire to defend.
During my working life I purchased a number of redundant hospital sites for developers and I saw the increasing complexity and bureaucracy at close quarters. The seller was usually the Secretary of State for Health but I saw the treacle his solicitor had to wade through in order to get instructions from the relevant Trust or whatever. A law unto themselves, each of them.

Well said, gsm. Let's hope it's high on the list of the next government.

growstuff

Baggs

Thank you.

This system does not sound very cost-effective from a tax-payers point of view.

But that's the system which was imposed by the Conservative government with the Health and Social Care Act 2012. Providers and users don't have any choice.

Thanks. Yes. So where was the BMA? Why weren't they making a stink?

Well they focused on the NHS to bring it up to scratch after years of Tory neglect (same old story) and look how successful that was! Perhaps dentistry was something they intended to look at (although I don’t know). I could look I suppose🙂

In short, it has taken a lot more than ten years.

The NHS has had various reorganisations over far more than the life of the current government. Each time it has become more fragmented and more complicated. With fragmentation and increased complexity come increased bureaucracy and costs with no apparent benefit to the consumer and a tremendous lessening of purchasing power. It’s a multi-headed behemoth out of control and in need of root and branch reorganisation to take it back to something approaching a manageable entity.

Baggs

Thank you.

This system does not sound very cost-effective from a tax-payers point of view.

But that's the system which was imposed by the Conservative government with the Health and Social Care Act 2012. Providers and users don't have any choice.

Whitewavemark2

Maybe.

But I would just like to point out that The Kings Fund has looked at the reason for the NHS catastrophic fall in the ratings and the conclusion is

Government cuts.

Now those trying to defend the government are welcome to do so, but I think it is a losing battle tbh.

Don't count me in as trying to defend government (notice I don't say The Government. I mean all government in the last several decades).

I think the NHS has been badly managed for a long time and, as someone pointed out up thread, what is expected of the NHS has expanded exponentially.

Germanshepherdsmum

growstuff

Germanshepherdsmum

growstuff

Germanshepherdsmum

I agree eazybee. The sort of managers we have in the NHS are good at wasting money. Since my days in local government I have referred to what I witnessed as a public sector mentality’ based on the way people I worked with, at all levels, functioned. Entering the private sector was like a baptism of fire.

In what way?

Being accountable to real people with high expectations rather than other departments with low expectations. Getting through the work no matter how long that took (for no extra payment). Not letting it build up to unmanageable levels (which I never did but colleagues thought entirely acceptable). Far greater demands in every way than I ever experienced in the public sector.

How could the NHS prevent work from building up to unmanageable levels, if people keep getting ill?

Who do you think NHS staff are accountable to, if not real people?

You asked what I meant by a baptism of fire. I answered.

However my personal experience of what I called public sector mentality can be applied elsewhere. Maybe one good ex-private sector manager could do the work of two mediocre managers, at no extra cost. One level of management within the NHS is accountable to the next and so on. Being directly accountable to the client who is paying your fees is rather different.

It’s errant nonsense to suggest that managers in the private sector are in any way more competent than (equivalent level but much lower paid) managers in the public sector. They work within different constraints. They have different values. They don’t work harder. They get more perks and none of the brickbats.
Only somebody who hasn’t worked in the public sector ever or for over 25 years and who has no real knowledge but plenty of opinions makes such ignorant comments. Do you have any concept of how deeply insulting you have been?

NHS dentistry started to be attacked/phased out way back before this last decade. Was that before 1997? And if so why didn't New Labour sort it out?

Maybe.

But I would just like to point out that The Kings Fund has looked at the reason for the NHS catastrophic fall in the ratings and the conclusion is

Government cuts.

Now those trying to defend the government are welcome to do so, but I think it is a losing battle tbh.

Whitewavemark2

So are you arguing that the management was good up to a decade or so ago?

If so what has changed?

Are people arguing that what gs called "associated commissioning charges" all happened in the last decade?

So are you arguing that the management was good up to a decade or so ago?

If so what has changed?

Indeed.

Which I would put down to bad management. I think that was the issue someone mentioned.

Thank you.

This system does not sound very cost-effective from a tax-payers point of view.

Incidentally, it's this fragmentation which is responsible for GPs' not prescribing or carrying out procedures ordered by hospitals. From their point of view, the hospitals are offloading costs which they should be spending.

Baggs

*the internal market with all the associated commissioning charges.*

Could you explain what you mean by this, please, gs? I don't understand to what you refer.

From an accountancy point of view, GPs have to "buy in" all external services. The new Integrated Care Systems (formerly Clinical Commissioning Groups) "buy in" services from hospitals, etc for the patients in their area. The NHS is fragmented into numerous different cost centres. Each of them has its own admin team and the GPs and ICGs have to have admin and legal staff to sign all the contracts, some with existing NHS providers and others with private organisations.

Casdon

fancythat

Casdon

eazybee

I would say poor management has a great deal to do with it.

You’d be wrong. Lack of investment over a sustained period has everything to do with it.

You could be right.

But how much more can we afford to spend on the NHS.
The figures spent are absolutely staggering.

People complained about the cost of the Coronation. It was the cost of running the NHS for 5 hours.

This is worth a read fancythat.
www.nhsconfed.org/articles/is-nhs-awash-with-cash
It comes down to either reducing what the NHS does, or paying more so that it can do what it was doing a decade or more ago properly, and accounting for the increased population and life expectancy, plus clinical advances.

That is a good link.
And good comments from yourself.

Several things that are not apparent at first thoughts sometimes.

Life expectancy may have reached its peak? Cant quite remember right now. I will take a look later.

What people expect from the NHS, has been increasing for years.

the internal market with all the associated commissioning charges.

Could you explain what you mean by this, please, gs? I don't understand to what you refer.

growstuff

Germanshepherdsmum

growstuff

Germanshepherdsmum

I agree eazybee. The sort of managers we have in the NHS are good at wasting money. Since my days in local government I have referred to what I witnessed as a public sector mentality’ based on the way people I worked with, at all levels, functioned. Entering the private sector was like a baptism of fire.

In what way?

Being accountable to real people with high expectations rather than other departments with low expectations. Getting through the work no matter how long that took (for no extra payment). Not letting it build up to unmanageable levels (which I never did but colleagues thought entirely acceptable). Far greater demands in every way than I ever experienced in the public sector.

How could the NHS prevent work from building up to unmanageable levels, if people keep getting ill?

Who do you think NHS staff are accountable to, if not real people?

You asked what I meant by a baptism of fire. I answered.

However my personal experience of what I called public sector mentality can be applied elsewhere. Maybe one good ex-private sector manager could do the work of two mediocre managers, at no extra cost. One level of management within the NHS is accountable to the next and so on. Being directly accountable to the client who is paying your fees is rather different.

BTW, whitewave, I'm not disputing anything else, I was just surprised at The Kings Fund say that the NHS has a very efficient administration system.

Perhaps it's patchy because that is not our experience nor that of many people we know.

Callistemon21

DaisyAnneReturns

Whitewavemark2

eazybee

I would say poor management has a great deal to do with it.

The Kings Fund say that the NHS has a very efficient administration system.

With the strangling of investment, I wonder if we would have any NHS care at all if we didn't have efficient management.

Administration does not consist of just the managers.

Indeed! So what is inherently wrong with the management systems?

Callistemon21

It's fine when you can get past the administrative blunders, growstuff which the medical staff find equally frustrating.

I won't list all of them as they are anecdotal, but suffice it to say there has been yet another one where two patients were mixed up this week - it could have cost them both their lives.

That's not the system as a whole, but it sounds as though your provider(s) have problems.

It's fine when you can get past the administrative blunders, growstuff which the medical staff find equally frustrating.

I won't list all of them as they are anecdotal, but suffice it to say there has been yet another one where two patients were mixed up this week - it could have cost them both their lives.