What do you get for an extra £500 m in the NHS?

 

             One of my most poignant memories of being a Minister was trying to secure some benefits when I offered more money to the Welsh NHS in their budget settlement. I wanted them to appoint more Consultants, doctors and nurses to clear hospital backlogs and shorten waiting lists.  As soon as I revealed I had found a substantial sum from other budgets to offer  to the NHS, a vanishing trick started with plenty of other ways appearing to use or lose  the money on offer without hiring more medical staff.

             Listening yesterday to the offer of £500 million extra over two years to the NHS in England made me ask what will we  buy with this?  The politics was well thought through. The offer of extra money demonstrates Ministers’ concerns. It tackles head on the likely response to the question why are A and E departments under too much pressure. If the NHS counters by saying their budgets have not gone up enough to cater for demand, the extra money answers that criticism. Minsters can say they cared, they did what Ministers can do by voting the money. Now it is up to the NHS managers to deliver with better A and E services.

          Then I heard the usual efforts to claim that £500 million would soon vanish. Some said it would be diverted to paying for social services, so more elderly people could be taken care of in the Community and not sent to A and E. Some said it was simply not enough. Others implied they would not be rushing to spend it on more Consultants and nurses to ensure the work could be done in  a timely and professional way.

           The government has said more money must be allied to reform. That was Mr Blair’s mantra, though he failed to deliver much of the reform. They say this, as they understand the problem. If every problem is perceived to be  caused by a lack of money rather than by bad management, failure to run an efficient and high quality service, or failure to spend wisely on technology to assist good staff, then it will always be possible to use that excuse. If the government gives £250 m and there are still problems in A and E the answer can still be that £250 m was not enough.

         The money we learn is to be given to a limited number of A and E departments that are under particular stress. That makes sense if it is the result of varied levels of demand compared to the size of the unit. It is less sure footed if it means more money is given to the departments and hospitals which have performed worse. There is a danger that awarding more money selectively can reward poor conduct and penalise good practice.

           It is easier pointing out the problems than solving them. The government does need to insist on sensible reforms to make sure this time the extra money buys something  we want and need. It should ensure that extra money is allied to better performance in those A and E departments that are struggling.

 

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86 Comments

  1. Jerry
    Posted August 9, 2013 at 5:51 am | Permalink

    John, for over 30 years the Tories have been promising reforms of the NHS but all we have to show is the failed NHS Trusts and internal markets, complete with multitudes of pyramids containing multiple layers of managers to see for it, so quite why you feel able to be so smug and attack Labour once again (via mention of the Blair government escapes me, you must take all your readers as (word left out) Tory members lapping up pre-election spiel… Quite frankly both parties have been an utter disgrace with regards the NHS over the last four decades. 🙁

    But to the matter in hand, this “sticking plaster and Aspirin” for the patient who has had lost a leg in a accident. Of course the real reforms won’t happen as managers will never vote for Christmas, so I suppose the best we can hope for is that this £500m will be ring-fenced, that it can only be directly used to fund more front-line A&E staff.

  2. Leslie Singleton
    Posted August 9, 2013 at 6:05 am | Permalink

    My local GP Group is absolutely wonderful and it seems very strange indeed that their superb skills and experience and direct relationship with their patients and their patients’ records should shut up shop out of hours. Illnesses don’t know how to read a clock, and nobody but nobody would choose to use an out of hours service unless they absolutely had to for obvious reasons. Remember that there are more hours “out” than “in” and weekends don’t bear thinking about. On top of that, if GP’s resumed, repeat resumed, 24 hours responsibility that would unarguably mean a considerable load off the A & E’s. Assuming so, resources could be transferred from hospitals to GP’s. An analogy is a battleship surrounded by its destroyers with the destroyers being the first line of defence. Why isn’t all this simply obvious? No we don’t need a Committee of MP’s to tell us about it. Another thing (and I did recently work for a while in the NHS indeed have not too long ago been taken in to hospital in an ambulance for a month’s stay) is that the powers that be seem fixated with new building above all else which does not come cheap. No doubt this was Labour throwing money around.

    • Iain Gill
      Posted August 9, 2013 at 8:46 am | Permalink

      Good for you.

      (You can now see informaiton to tell you who are the bad GPs -ed) I regard it as madness to hand these bottom quartile GP’s more power. The power should be going to patients and patients should have buying power over GP’s as much as anything else. If patients had buying power you can bet your bottom dollar these rubbish GP’s would soon change or be forced to shut. And you can be sure GP’s would be available when the patients needed them JUST LIKE IN EVERY OTHER SINGLE DEVELOPED COUNTRY ON THE PLANET!

      Why oh why people continue to support this failing NHS is beyound me. Just replace it with the system used in Belgium, Italy, New Zealand or similar.

      • stred
        Posted August 9, 2013 at 3:18 pm | Permalink

        Iain. If you are describing the NHS internet feedback system on GPs. it is about as much use as Holiday Advisor or Checkup a Tradesman (not real names). The locum put himself on and I received an email from them. It attracted very negative criticism from another patient which was unfair in my experience and so I tried to put in a good word for my excellent GP. They edited my contribution wrongly and atrributed it to the wrong GP.

      • Jerry
        Posted August 9, 2013 at 4:52 pm | Permalink

        @Iain Gill: Or just mend what we have, after all if the politicains would just ge6ty the hell out and allow the professionals run it, and I don’t mean professional administrators who don;t know one end of a syringe from the other until it pricks them. There is nothing fundamentally flawed in the NHS, indeed the systems you cite are based on the NHS, other than the management not being fit for purpose.

        • Iain Gill
          Posted August 13, 2013 at 6:57 am | Permalink

          Sadly there are some rubbish GP’s and there needs to be a mechanism to sort them out. Current regulation does not sort them out, and the patients currently have no ability to go elsewhere in many places. There has to be some mechanism to resolve this.

          Most decent GP’s will acknowledge that there are some poor GP’s in their town, this is no secret.

      • lifelogic
        Posted August 9, 2013 at 5:21 pm | Permalink

        “Why oh why people continue to support this failing NHS is beyond me”

        Well in the UK it is another “BBC/Guardian think” religion. Once you have taxed all the money off people they are rather dependent on what pathetic services the state deigns to dole out, however poor these may be.

        The others religions are: the fake green AGW nonsense, the ever bigger state sector, the bike, train & electric car religion, the ever more anti-democratic EU, ever more daft regulation and the enforced equality religions. Though the BBC do seem rather keen in huge pay offs and pensions for their slightly dim, lefty, art graduates, often with chips on their shoulders.

        • Iain Gill
          Posted August 13, 2013 at 6:57 am | Permalink

          you missed the anti car nutter state religion?

    • Bob
      Posted August 9, 2013 at 9:58 am | Permalink

      Well said Leslie, you’ve hit the nail on the head.

    • uanime5
      Posted August 9, 2013 at 4:16 pm | Permalink

      GPs are unlikely to resume 24 hours responsibility unless they are paid for working 24 hours per day.

      • Bob
        Posted August 11, 2013 at 11:20 am | Permalink

        @uanime5
        “GPs are unlikely to resume 24 hours responsibility unless they are paid for working 24 hours per day.”

        Have you never heard of a duty roster?

    • Hope
      Posted August 10, 2013 at 7:42 pm | Permalink

      A and E is used by people who will not register or feel they cannot register with a GP. Not too many questions about identity or residence and in the sound knowledge any answer will not be chased up if false. World Health Service given a minor boost for those who should not receive treatment in this country.

  3. alan jutson
    Posted August 9, 2013 at 6:12 am | Permalink

    I assume someone has worked out the reasons for some A&E departmenrs to be struggling before this money was voted through.

    Was it because appointments at doctors surgeries are now difficult to get organised in time.

    Was it because those who are going to A&E are not registered with a GP.

    Was it because 111 has failed to perform.

    Was it because other local A&E services have been cut or Closed.

    Was it because of a lack of Consultants and nurses exist in A&E.

    Was it because the hospital overspent on other Departments.

    Unless you find the reason and tackle that at source, its money down the drain and a request for more will be made.

    • Nina Andreeva
      Posted August 9, 2013 at 7:19 am | Permalink

      Speaking as a hospital doctor’s spouse, I would suspect its the conditions that you work under in A&E that puts people off. Be a GP instead, you get paid more and the
      hours are more family friendly. You have to be an adrenalin junkie to enjoy that sort of stuff. Plus you also have to put up with the Great British public with their fondness for drink, drugs etc. Its quite easy to get a job in that field at the moment, as a friend of ours landed his first consultant position after just one interview (and not as a locum either) It usually takes around four to five goes to land your first job.

      I would urge everyone to watch that program on how to be a German that has been mentioned earlier this week. The answers are there staring you in the face on how to fix the NHS and everything else in the UK for that matter. The British are too individualistic (I want to be seen first), relatively lazy (texting at work) and management is a load of crap for letting them get away with it in the first place.

      • alan jutson
        Posted August 9, 2013 at 3:39 pm | Permalink

        Nina

        Thanks for the response.

        So it seems its a mangement problem !

        More doctors on duty would share the workload, so not as much pressure on individuals.

        Drugs and drink related problems are self inflicted, so charge these people for their care, and that should pay for the extra consultants and nurses needed to look after them.

        Eventually when enough people have been charged for drink and drug problems, they may learn a bit of self control and not self inflict their behaviour on others, and we get back to treating those who have had real accidents or are really ill.

        Perhaps we could call it an Accident and Emergency Department.

      • uanime5
        Posted August 9, 2013 at 4:18 pm | Permalink

        According to this programme we’re also underpaid and overworked.

        • alan jutson
          Posted August 12, 2013 at 8:38 am | Permalink

          Uni5

          Underpaid compared to who ?

    • John Eustace
      Posted August 9, 2013 at 11:03 am | Permalink

      Another possible cause is the difficulty in discharging patients so beds re blocked and patients cannot bbc moved out of A and E.
      And also we heard yesterday that there a lot more of us in the country than there were.
      A and E problems are often a symptom of underlying issues elsewhere in the system. Treating those symptoms will not cure the underlying condition.
      That’s why the extra money is just politics and not a cure and things are not as simplistic as John would have us believe.

      There is a technique in Lean thinking called the 5 Why’s. When faced with a problem you ask why it has happened. Then ask why that explanation happened. Keep going until you get to he underlying issue. That way the real problem m can be addressed. The Prime Minister never gets beyond the first superficial “Why”.

      • alan jutson
        Posted August 12, 2013 at 8:41 am | Permalink

        John

        I would agree that a shortage of beds is a problem once a patient has been diagnosed and admitted, but that should not impact on waiting times to be seen.

        I have never understood the closure of wards and reduction of beds programmes, when we have a growing population in total and in particular a growing elderly population.

        Hot bedding simply increases the risk of infection.

  4. Old Albion
    Posted August 9, 2013 at 6:49 am | Permalink

    Well done John! You managed to make the distinction that this money is going to the NHS ENGLAND. If only we had an English parlliament to overee what happens to it

    • Stephen Almond
      Posted August 9, 2013 at 7:27 am | Permalink

      If only we had an English parlliament to overee what happens to it

      Yes, another layer of politicians will usually cure matters…

    • Jerry
      Posted August 9, 2013 at 4:57 pm | Permalink

      @Old Albion: Well seeing that most of the British government is in London, that most of the civil service are in London, that the nations parliament is London, England, we already have all the English government we need thanks – now if you were calling for a return to the UNITED KINGDOM…

  5. David Thompson
    Posted August 9, 2013 at 6:53 am | Permalink

    I share your fears about this being seen as rewarding bad practice. It is long overdue that NHS management be held accountable for their actions, but no one in government appears willing to address this. All we ever get are serious case reviews that say we have learnt from this or that incident but no one held responsible. Then at best we put some trusts under special measures but not a single manager is ever sacked. This would simply not happen in the private sector.

  6. Brian Tomkinson
    Posted August 9, 2013 at 7:02 am | Permalink

    JR: “The politics was well thought through.”
    Therein lies the problem. Too many spending decisions are based on political considerations rather than a proper analysis of what is required. This government, as on so many issues, is just like its predecessor throwing taxpayers’ money at any problem that hits the headlines. This is political posturing which keeps the myth that more government spending is the answer to all problems.

    • Atlas
      Posted August 9, 2013 at 9:29 am | Permalink

      Yep, Brian – it’s another case of “Gesture Politics”. Fascinating how this money can be spirited out of nowhere ( only when it suits scheming politicians, of course) whilst other things are delibrately wrecked by them to the words of ‘we have no money’, etc, etc, …

    • lifelogic
      Posted August 9, 2013 at 9:32 am | Permalink

      “Too many spending decisions are based on political considerations rather than a proper analysis of what is required.”

      Indeed and they even get the political considerations wrong anyway, people do not want HS2, “fake green” electricity at 40P+ , the enforced equality religion, most or indeed any of the EU, nor did they want the vastly expensive Olympics or the Millennium dome.

      • Bazman
        Posted August 9, 2013 at 7:58 pm | Permalink

        How about ‘clean’ energy liflogic? Energy without ‘pollution’ Are you against this? Tell me how much electricity now costs as an average in the USA? £0.07 or more. HOW MUCH!? Can you understand this Question?

        • lifelogic
          Posted August 11, 2013 at 6:53 pm | Permalink

          About 7P per KWH as I said, just look it up?

    • Robert K
      Posted August 9, 2013 at 10:07 am | Permalink

      You can do all the analysis you want – you won’t get a solution until the patient, i.e. the customer, is put before the political/medical establishment

      • lifelogic
        Posted August 9, 2013 at 12:53 pm | Permalink

        And you will not get that with free at the point of use.

        The NHS already have your money, so shut up and wait in that big queue and we might give you some treatment, if and when we feel like it. If you do not die first.

        • Bazman
          Posted August 9, 2013 at 7:59 pm | Permalink

          Your point being the privatisation of the NHS?

          • lifelogic
            Posted August 11, 2013 at 6:55 pm | Permalink

            My point being that the NHS, as currently structured, is a dreadful waste of peoples lives and tax payers money. It is so often totally dysfunctional.

      • Brian Tomkinson
        Posted August 9, 2013 at 5:01 pm | Permalink

        Robert,
        You have given us your analysis. Why can’t politicians be expected to do the same?

        • Robert K
          Posted August 12, 2013 at 1:17 pm | Permalink

          Some politicians do make the analysis. Which is why I blog on this site.

  7. lifelogic
    Posted August 9, 2013 at 7:03 am | Permalink

    The whole dysfunctional NHS system need to change hugely, start by charging a fee for all visits to doctors and hospitals. One could easily dye in A&E while waiting the 3+ hours.

    Say £20 for all, save the very few who really cannot pay, stop all the vanity treatments, make sure people having private vanity treatments have insurance to cover complications, let the patient choose and make the money follow the patients. If people can afford a hair cut or a holiday they can afford £20 for the doctor.

    We simply cannot have a free at the point of use NHS (nor a large social benefit systems) together with the coalition’s largely uncontrolled immigration and such a large population growth. Especially when the government wants to waste so much cash on silly green energy HS2 and hugely bloated government in general.

    • Nina Andreeva
      Posted August 9, 2013 at 7:02 pm | Permalink

      LL what are you bothered about? You do not even live here, you are a migrant into your secret location and presumably only go private wherever that may be too?

      • lifelogic
        Posted August 11, 2013 at 6:59 pm | Permalink

        Well I and my children fortunately rarely go to the doctors at all, but my relatives are mainly still in the UK. I would just like to see a far better system than the current NHS, merely for the sake of the NHS patients.

    • uanime5
      Posted August 9, 2013 at 7:11 pm | Permalink

      Yet more right wing nonsense. What about people who have serious medical conditions that require regular check ups? Under your system they’ll be heavily penalised. I suspect you want to introduce a fee so that the poor will no longer be able to use the NHS.

      Also being able to afford a haircut doesn’t mean you’re rich enough to afford a holiday.

      • Robert K
        Posted August 12, 2013 at 1:36 pm | Permalink

        The pity of the debate is how quickly it polarises, with phrases such as “right wing nonnense” taking their cue. It’s not right wing nonsense to ask for a sensible conversation about reforming medical provision in the UK. Nor is it nonsense to suggest that the NHS is deeply flawed. The point about arguing for a different structure is precisely because the existing one could be improved so radically.

    • Bazman
      Posted August 9, 2013 at 8:02 pm | Permalink

      As pointed out to you many times a fee for the doctor or hospital will be regressive and cause further problems with the nations health. Do tell us why it will not and stop ranting as an example. How often do you visit the dentist. Tell us how many times a year and why? Or shut up.

    • Bazman
      Posted August 10, 2013 at 2:05 pm | Permalink

      What if this charge delayed people from going to the doctor until the condition became more serious as it surly would and this could also lead to the spread of cont contagious diseases for the same reasons? Many men in particular delay visiting one until the condition is more serious without a together GP is the NHS gatekeeper and that slight cough or bleeding may be nothing or it may be potentially life threatening. The problem with your theory of being able to afford treatment because you can afford a holiday or a car as pointed out to you before is that these are paid for by work and how is it possible to work when ill. You assume many have spare cash just wanting. You need to address these questions before putting forward your simplistic propaganda yet again in a BBC type way.

  8. margaret brandreth-j
    Posted August 9, 2013 at 7:03 am | Permalink

    I have worked in approx 6 A&E departments and the same number of Medical Emergency Units. A&E’s are places where the workload is unpredictable as displayed by the footage yesterday of D Cameron visiting an A&E dept where there were many staff and no patients. I have found myself hanging about for hours with nothing to do, then at peak times e.g friday night, not being able to cope with the numbers of patients. Medical Emergency Units by comparison are usually overflowing continually. I have asked managers why they cannot allow staff to rotate between these units at changes in flow of patients to accommodate the workload. The usual reply is that it is ‘nothing to do’ with me as an agency worker ( even though my experience is probably more diverse and substantial) or ‘I am the manager’ or ‘one is under the remit of the surgical unit and the other is under the remit of the medical unit with their own budgets.’
    So where will the money go ?. A guess is to appoint management with high salaries to supply locum nurses and doctors for the establishment to blame when things go wrong and then say they are too expensive and from thereon use incumbent staff to provide a 6 line whip to ensure the locums are blamed and subsequently use money on legal representation.

    • Cliff. Wokingham
      Posted August 9, 2013 at 3:58 pm | Permalink

      Margaret,

      If you have worked within the NHS, you must know that when there is an important guest or VIP in the hospital, all the suits and hangers on appear from nowhere and suddenly put on their clinician’s uniform and want to be seen and photographed with that VIP.
      When I worked as a psychiatric nurse within the NHS, I was always amazed at just how many “new” staff would suddenly appear, dressed in brand new uniforms with the “bag creases” still evident on them once the visiting VIP arrived on the ward.
      These “new staff members” would want to be photographed or, better still filmed, pretending to work the computer or reading the patient’s notes, whilst the VIP stood next to them pretending to be interested……Have I became too cynical in my old age? 🙂

      • margaret brandreth-j
        Posted August 11, 2013 at 8:36 am | Permalink

        Yes , you are quite right , but that also reflects the real situation sometimes.

      • lifelogic
        Posted August 11, 2013 at 7:06 pm | Permalink

        One can rarely be too cynical I find. Even I would not have expected 9.11 to cause emails such as:- today is a day to bury bad news – but then that is politics for you.

      • alan jutson
        Posted August 12, 2013 at 8:45 am | Permalink

        Cliff.

        What you describe happens in many other businesses as well.

        The real workers with the real brains and skills, often get put to one side and ignored for the duration of such publicity.

        Notice also that the area’s are all cleaned and polished as well.

  9. Mike Stallard
    Posted August 9, 2013 at 7:28 am | Permalink

    It is becoming increasingly obvious that what is wrong with the NHS is their attitude. Nurses who can walk by someone in pain. Doctors who prefer to be out rather than in. Self serving managers and executives who know absolutely nothing about medicine and who have never bothered to visit their hospitals. Politicians who know absolutely nothing about medicine or patients or hospitals.

    If I compare the way that my daughter’s dog was treated by the Vets, with love, care and affection, when she was ill, or if I think of my dentist, working for money rather than to meet targets, I see that the NHS is very expensive, inefficient and quite often, yes, uncaring too.

    Having said that, when my wife was very ill recently, the NHS turned up trumps.

    • lifelogic
      Posted August 9, 2013 at 12:55 pm | Permalink

      Indeed they can on occasions be superb but in general the system will never deliver well, despite often some excellent and hard working staff.

      • Bazman
        Posted August 9, 2013 at 8:04 pm | Permalink

        The point being that the staff need more financial reward like cleaners do not?

    • Cliff. Wokingham
      Posted August 9, 2013 at 4:15 pm | Permalink

      Regarding nursing; I feel the profession has become just that; a profession rather than a vocation.
      When I entered nursing, it was because I cared and wanted to care. We had a clear career structure and everyone felt part of the ward team, from the basic domestic, right up to the ward sister and matron. We had Nursing auxillaries, State enrolled nurses and staff nurses and an all seeing, all knowing matron. Nurses were very hands on.
      Today, it seems to me, that most “nursing” duties are taken on by health care assistants, with the qualified staff just ticking boxes and doing paper work. Modern nurses, in my opinion, are more like administrators rather than nurses. Some seem too posh to clean up body fluids etc. I must point out that I was never a general nurse so my comments apply more to psychiatric nursing from my own work experience and observations. I am now retired but my former colleagues tell me not much has changed since my retirement and friends tell me that much the same is happening in general nursing wards.

      The move to use cheaper staff to carry out core functions is not restricted to nursing; we see it in prisons with auxilaries replacing officers, in the police, with PCSOs replacing police constables, in schools with teaching assistants replacing fully qualified teachers and within medicine, nurse consultants replacing doctors and even in the trades, we can see domestic installers replacing time served electricians.

      • margaret brandreth-j
        Posted August 11, 2013 at 8:46 am | Permalink

        Yes this is a problem too . Doctors won’t move bodily fluids either .At one time it was their responsibility to remove all the fluids they had been dealing with , but now “that is not my job” . They will watch staff struggling and stand there at the side looking helpless. There used to be teams.

      • alan jutson
        Posted August 15, 2013 at 7:31 am | Permalink

        Cliff

        Agree with much of what you say.

    • Nina Andreeva
      Posted August 9, 2013 at 6:58 pm | Permalink

      Mike sorry but it appears that you have obviously drank the Kool Aid, in that your perception of the NHS is totally out of kilter with you actual experience of it. Just remember that there is an agenda behind all the stuff you are reading in the press. A lot of (private sector companies ed) have burrowed their way into the NHS by providing specialist services and a whole lot more would like to do so, if the existing structure was knocked down. (Unproven allegation about an entrepeneur removed ed) I bet the American asylum seekers that I mentioned here yesterday were after access to the NHS because they could not get provision at home.

      • Nina Andreeva
        Posted August 11, 2013 at 8:30 am | Permalink

        JR you can delete this as I only just want to prove to you that all my stuff is sourced from reliable places and none of my comments are “unproven”.

        Reply Establishing a link between an entrepreneur and the NHS does not mean there is anything amisss in the relationship or that it will lead on to something you do not like.THe article you linked to does not prove the allegation.

      • margaret brandreth-j
        Posted August 11, 2013 at 6:31 pm | Permalink

        Yes Nina, been in positions and am in a position where the existing structure is being knocked down. My situation is Living proof. If it isn’t legalities, it is Insurance. They all want a piece of the cake , but this taking from all round roles and claiming ownership of parts of it has been going on since I started in 1968. Specialist services though, for instance in oncology are very necessary and in Manchester are voluntary services.

  10. Iain Gill
    Posted August 9, 2013 at 8:41 am | Permalink

    Personally I would be taking strain out of the system at the other end. I would offer those who have been waiting the longest for elective treatement cheques to go private. Over time I would reduce the amount of time the NHS has to keep someone waiting before they are given a cheque to go private anyways. I would be counting the time from first GP consultation too. Let them take these cheques to Belgium or whatever too.

    And by giving cheques directly to spend on their operation you can be sure some sensible market pressure would enter the equation where waits, dirt, rudeness, and so on will feel the market pressure of patients going elsewhere.

  11. frank salmon
    Posted August 9, 2013 at 8:51 am | Permalink

    The NHS is a socialist construct. This inevitably means rationing. We will always have rationing with the NHS. We will always have underprovision of a ‘free at the point of use’ service. No amount of extra money will be ‘enough’.
    However, let’s hope the money doesn’t go on higher pay or more admin….

  12. Bert Young
    Posted August 9, 2013 at 9:29 am | Permalink

    The huge NHS cannot be managed by politicians or other outsiders who are brought in because of their , so called , independent judgement and superior management skills . Medical practice and administration requires insider knowledge and substantial experience – backgrounds that can , at least , be recognised and respected by those in the profession . The decisions reached by centre management have to be implemented by front line staff who must recognise the worthiness and credibility of the recommendations otherwise they will ridicule and have no heart or enthusiasm in what they do . A closer look should be made of the way the John Radcliffe Group in Oxford is run and managed ; there is a qualified medic and administrator as Chief Executive who brought to his job a credible background recognised and respected by his staff ; the result is not perfect but substantial change and progress has been made since his appointment .

    • Longinus
      Posted August 9, 2013 at 4:14 pm | Permalink

      Contrast with the Australian Physician brought in as CEO to reduce staff headcount at Addenbrooke’s Hospital in Cambridge.

    • margaret brandreth-j
      Posted August 11, 2013 at 6:22 pm | Permalink

      And many 3 month contracts for outsiders.

  13. Denis Cooper
    Posted August 9, 2013 at 9:46 am | Permalink

    It is reported today:

    http://www.scotsman.com/news/scotland/top-stories/scotland-s-population-reaches-highest-ever-level-1-3035667

    that the population of Scotland has reached a record high of 5.31 million, and this is to be treated as good news.

    But “the rate of population growth has halved compared to recent years and there are fears it is now too slow to keep pace with major European economies”.

    However, welcome reassurance on that latter point from Scottish Government external affairs secretary Fiona Hyslop, who said:

    “… the population rise continues “in the right direction” to achieve its target of matching European growth levels over the period 2007 to 2017.”

    And apparently “providing services to deal with the growing population was not an issue”, insisted “local government body Cosla”.

    I’m not Scottish and nor do I live in Scotland, but I wonder how many people in Scotland read this and agree with me that the lunatics seem to have completely taken over the asylum – and not only north of the border – and maybe ask themselves:

    “When was it that we agreed to a target of matching European population growth levels, if necessary by not only allowing but actively encouraging mass immigration?”

  14. Robert K
    Posted August 9, 2013 at 10:03 am | Permalink

    How about looking at it the other way around. There is huge demand for A&E services. Some of this is because there is no 24-hour GP service. There is also a huge amount of money chasing the out-of-hours and emergency areas.
    How would Tesco and Sainsbury handle things if they were running GP and A&E Services? Each town would have competing surgeries and hospitals eagerly serving their customers in the most cost effective and innovative way. If one of those companies chucked hundreds of millions at a project and the money vanished, the project would be shut down and the person responsible would disappear from the payroll.
    It’s time for the old shibboleth decrying “privatising the NHS” to be ditched and for there to be a proper conversation about how best to serve the needs of “patients” – who in fact are customers who bring with them sometimes huge amounts of money.

    • peter davies
      Posted August 9, 2013 at 1:41 pm | Permalink

      In Germany 90% of hospitals are private – the Netherlands I think all are yet they don’t seem to have these issues. This public vs private thing spouted by those on the left is total nonsense

      • uanime5
        Posted August 9, 2013 at 7:17 pm | Permalink

        In the USA all hospitals are private and until Obamacare was introduced millions of people didn’t have access to medical treatment. So despite the denials by the right private care is often very bad for the average person.

        Given that no private hospital in the UK has an A&E department this tells you all you need to know about what serviced would be offered if all hospitals were privately run in the UK.

        • Robert K
          Posted August 12, 2013 at 1:48 pm | Permalink

          The US system is far from ideal – I wouldn’t wish it on the UK. On the other hand it is also where the most innovative and pioneering medical research is going on, so something must be working.
          On A&E, just for a moment put affordability to one side. Then ask this question: would there be a national furore over four-hour plus waiting times if A&E services were provided privately? Of course not. No privately run service could get away with such poor provision in the face of such high demand.

      • Bazman.
        Posted August 10, 2013 at 2:54 pm | Permalink

        You are going to drop on us the same problems with privatised transport, utilities, airports, banks etc with our health and get the result that dentistry has seen. No you are not and most of the population with any sense see this fantasy. Banking crash i9s one thing a health crash quite another. Don’t tell us the NHS is already collapsing as it will not wash.

        • margaret brandreth-j
          Posted August 10, 2013 at 6:54 pm | Permalink

          hear hear

    • Nina Andreeva
      Posted August 9, 2013 at 6:48 pm | Permalink

      I would not have used the example of supermarkets considering the amount of times they have been accused of operating as a cartel, selling horse meat off as beef etc. If you want to privatise the hospitals and pay through a social insurance system, you need to remember the profit motive can also get out of control too. As I have commented here before, looking at Singapore as an example, you can have an abortion if you simply do not like the babies sex, procedures are often routine that here would be considered to be only used in the most extreme of circumstances (and you get billed accordingly) etc. So be careful of what you wish for.

      Reply There is no evidence of cartel behaviour by our supermarkets, which are very competitive.

    • margaret brandreth-j
      Posted August 11, 2013 at 6:24 pm | Permalink

      Hey in all this remember the NHS staff , private staff and people working in hospitals and practises are also the public and patients. We also suffer whilst serve.

  15. ian wragg
    Posted August 9, 2013 at 10:06 am | Permalink

    Here where I live the local hospital according to this weeks paper will run out of money before the end of the year. Brand new facility on PFI who’s payments are bankrupting the trust.
    I was in A & E to collect someone recently and it would appear that about half of the queue was not entitled to treatment and it was just being used instead of GP’s. One (adjective left out ed) lady with a cold was telling the receptionist she had pneumonia. I was amazed and a little angry that my taxes are paying for this.

    • Longinus
      Posted August 9, 2013 at 4:15 pm | Permalink

      One (adjective left out ed) lady with a cold was telling the receptionist she had pneumonia. I was amazed and a little angry that my taxes are paying for this.

      Now you’re getting it.

  16. Mike Stallard
    Posted August 9, 2013 at 11:14 am | Permalink

    It seems to me that the whole problem is one of attitude.
    Nurses walk past dying and starving patients.
    Bosses – sorry, Management – never ever visit the hospital wards over which they are in charge.
    Politicians have simply not got a clue as to what is really going on and they have to work through a massive uncaring, selfish bureaucracy anyway.
    The Chaplains – who used to act as sort of Ombudsmen – seem to be well out of the picture.
    It makes me very afraid, actually.

    Having said that, when my wife was very ill recently, the NHS turned up trumps.

    • Longinus
      Posted August 9, 2013 at 4:11 pm | Permalink

      You forgot the Doctors, they’re either planning retirement or emigration.

  17. peter davies
    Posted August 9, 2013 at 1:37 pm | Permalink

    Tories and Labour alike have had their failures and issues with the NHS which shows that it is its construct above all else that is the issue – its size and the fact that it is a “socialist construction” which will always make it recourse hungry and inefficient no matter how much money you give it.

    Even when New Labour were able to throw huge funds at it – it did not correspond with better performance relative to the amount of money it was given.

    Everyone needs to accept that the NHS is far too big and cumbersome an organization to manage and come up with a more structured – workable and accountable model starting with the money following the patient.

    The GP model calling off services in England is a good start – it will be interesting to see how much the system improves once it has bedded in and if Scotland and Wales follow suit – if a well resourced GP has the discretion and funds to send a patient where he/she needs to go and when they need with no queues surely this has to be good.

    There are excellent parts of the NHS, but there are also too many poor parts – I hope the new model in England exposes to poor parts so they either get sorted out of closed so Wales will follow suit (though I doubt it given the ideology of Welsh Labour AMs) and Labour don’t come in and change it back again.

    • Iain Gill
      Posted August 9, 2013 at 2:56 pm | Permalink

      Re “The GP model calling off services in England is a good start” only if you are lucky enough to have a decent GP or an ability to move to a decent one. Those stuck with less good GP’s will suffer even more.

    • uanime5
      Posted August 9, 2013 at 7:24 pm | Permalink

      The system you’re describing bears no resemblance to the one being implemented.

      Firstly fund are going to a GP consortia, rather than an individual GP.

      Secondly dividing the NHS budget among thousands of consortia means that they’re not well resourced compared to the NHS trusts. It also means that a single major accident can wipe out the entire budget of a consortia.

      Thirdly many consortia are run by private companies linked to private hospitals, creating a major conflict of interest regarding where they send patients.

      Fourthly unless the GP is magically creating hospitals and staff there will still be queues.

      So don’t expect Wales or Scotland to copy a system which offers more risks than the previous system.

  18. uanime5
    Posted August 9, 2013 at 4:18 pm | Permalink

    Perhaps the Government should look as which A&E wards are performing the best and try to figure out why. I recommend starting with A&E wards that are performing well despite having a high volume of patients, rather than those performing well because they have very few patients.

    • Edward2
      Posted August 10, 2013 at 7:36 pm | Permalink

      Great, thanks for that Uni
      What would we do without your analytical comments which never state the obvious.

  19. Andy Baxter
    Posted August 9, 2013 at 4:34 pm | Permalink

    £500 Millions:

    It would pay for another 3,250 senior managers and chief executives…….and that’s exactly what it will be spent on!

    The NHS is past it’s sell by date, it’s a behemoth with a gargantuan out of control appetite for cash and still considered THE sacred cow of all time that no politician of any persuasion has the guts to tackle the Augean task of cleaning it out and making it fit for purpose.

    Meanwhile dedicated staff will labour under immense stress, and patients will suffer and die while fat cat managers and chief execs will milk it for all its worth.

    throwing more cash at it is criminal and wasteful. someone with the brass cahoneys needs to be given the power and have the will to take control and steam roll through it cutting the fat and weeding out the wasters while installing practices, culture and staff that are dedicated to its success.

    it will never happen until…….more cash taken from taxpayers under menaces and borrowed without consent will be the only answer ministers will plump for because its easier to do just that than tackle the real problems.

    do the algebra re £500M on fat cat pays;

    http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-chief-executive-pay-has-jumped-by-45-2281792.html

    http://www.telegraph.co.uk/health/healthnews/8485113/NHS-fat-cats-earn-more-than-David-Cameron.html

    http://www.telegraph.co.uk/health/healthnews/10009054/The-8000-NHS-staff-on-six-figure-salaries.html

  20. forthurst
    Posted August 9, 2013 at 4:34 pm | Permalink

    It would be beneficial to study the German Health system because it is funded by PAYG statutarily mandated insurance premiums paid by employee and employer for the 85% of the population that does not have private insurance.

    As I reported the other day, from the ‘Make me a German’ BBC docu,
    the employee’s contributions as proportion of salary which funds his and his dependents’ care:

    (income tax 6.74%) (non-working wife two children)
    health insurance 8.20% or 15.50% including employer’s
    (pension 9.45%) plus employer ?
    (unemployment 1.50%) plus employer?
    Long Term Care 1.02% or 2.00% approx including employer’s
    Accident 0.00% Employer only ?

    Surely it is better to specify what each individual and employer is paying for healthcare and other benefits and deduct it explicitly than to simply collect money from different sources and then fight over where it is allocated, with the occasional grand gesture of throwing money at a problem such as overstreched A&E depts?

    We would not be able to get the same standard of healthcare as Germany if we allocated the same proportion of GDP per head because we are not as good at adding value as the Germans so are GDP per head is lower; if you were one of the 700,000 thousands patients treated at Heidelburg University Hospital(s) you would be unlucky to have your healthy ovary removed instead of your diseased appendix by ‘surgeons’, because the acceptance rate for medical students is only 3.6%.

    The NHS, although containing some high quality staff is neither safe or efficient to an unacceptably high extent largely because of problems associated with organisation, management and recruitment. Why not study a system that works rather than engaging in gesture politics with one that doesn’t? I know that gesture politics is the way are politicians do things, but it doesn’t work, does it? If we are to emulate the Germans’ success, it simply means not tolerating the second rate.

  21. Javelin
    Posted August 9, 2013 at 4:35 pm | Permalink

    YES employees and close family at the Care Quality Commission get the option of 24 hour GPs and can jump the NHS queue to go to a private hospital.

    Here is the FOI to prove it!!!

    How can the very people who check on our NHS get a extremely cheap option of quasi-health insurance. I presume all the NHS managers have the same scheme. It’s a massive a scandle.

    Response issued under the Freedom of Information Act 2000

    Our Reference: CQC IAT 2013 0769

    Date of Response: 9 August 2013

    Information Requested:

    “Could you tell me:
    (1) how many of your staff are currently signed up to Benenden Health care through their employment
    (2) what percentage of staff receive it
    (3) what benefits they are receiving – for example 24 hour doctor access and access to private doctors and
    (4) if senior management receive any form of private health insurance through their employment and if so what benefits do they receive.”

    The Information Access Team has now processed your request for information.

    We can inform you that The Benenden Health Care option is available to all staff as part of the employee benefits package. However, membership is agreed directly between the organisation and the person, dependent upon the type of cover they choose, and payments are made by direct debit (or whatever other method is agreed). Payment is not deducted from their salary. Therefore, the information you are requesting is not held by CQC.

    As this is a private agreement between the person and Brenenden Health Care, and as any agreements are paid for privately, CQC does not hold records of who has accessed this benefit.

    I can also confirm that no CQC employees receive any private health care insurance as part of their terms and conditions of service

    We hope you have found this information useful.

  22. Acorn
    Posted August 9, 2013 at 5:04 pm | Permalink

    JR, I assume that you know that when it comes to reducing the size of the public sector, privatising “education” and “health” departments, would reduce the public sector headcount by circa 55%. You could lock the budget for those two at the current £212 billion and move to an education voucher system, that could be spent in any school, public or private. Health could be founded on a basic state funded insurance plan for everybody (A&E to Pregnancy); useable in any hospital / clinic, public or private. The user pays for bells; whistles and a la carte menus in both cases. (Guess where I have been drinking and jawing today).

    Psssst, (look at the alarmign Greek enemployment figures ed) http://www.statistics.gr/portal/page/portal/ESYE/BUCKET/A0101/PressReleases/A0101_SJO02_DT_MM_05_2013_01_F_EN.pdf .

    .

  23. Peter
    Posted August 9, 2013 at 7:04 pm | Permalink

    Sadly more tinkering. We will be back at square one again within a few months.

    Much better to allow those who can afford their own care to opt out in return for lower taxes.

    This would leave a basic service, which would be under a lot less pressure.

    The current model is unworkable, as any “free” service always faces a mismatch between supply and demand and so will be in permanent crisis.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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