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How do you save money for the NHS?

Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
This comes from the NHS Direct thread.

The NHS needs to change it's spending plans over the next five years so that it saves £20bn from current costs, so that it can reinvest elsewhere.

So the question is: Where would you make these savings?
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Comments

  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    I'm not sure how this would work, but something along the lines of scrapping all quantative targets and replacing them with fewer targets focussed on quality of patient care. I don't know how much this would save, but hopefully it would reduce the need for so many managing positions within the NHS. :chin:
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Don't do what my GP did and send someone to a hospital 40 miles away just for injections. I live 4 miles away from one of the biggest hospitals in the south west.

    Do we need all these admin and managers?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    The French system seems to run very well with minimal numbers of administrators. Example: my hubby tore the cartilage in his knee while we were temporarily resident in 2002. He visited the local doctor who, not being able to see the damage, initially prescribed rest and anti-inflamatories for the swelling. When these didn't work, hubby was sent for an x-ray ...

    1. GP tells us hubby needs x-rays. Tells us where the local x-ray clinic is and gives us the phone number. We book appointment (at a time to suit us).
    2. We visit x-ray clinic. The knee is x-rayed. X-ray doc shows us the plate and explains in the simplest possible terms that hubby has torn his cartilage. Hands us the plates and a hand-written note to our GP. We book another appointment with the GP.
    3. GP looks at x-ray plate and reads note. Tells us that hubby needs an operation to repair the cartilage. He types up a brief letter and thumbs through phone book for the number of the surgeon at the local hospital and tells us to book an appointment. GP gives us the letter to take to the surgeon.
    4. I ring the hospital. Surgeon's secretary very apologetic that he cannot see us this week as he is on holiday. "Will next week do?"
    5. We go to see surgeon (the only person so far who speaks a little English). He explains the procedure and asks if we are free next Monday to see the anaesthetist. He speaks into a little dictaphone, hands tape to secretary and says "see you next week".
    6. A pool secretary types up the letter from the dictaphone and hands it to us. We ask what we do with it. She shrugs and says we can either post it to the GP or take it to him next time we see him.
    7. Monday we see the anaesthetist. Wednesday hubby is taken in for day surgery.
    8. We leave the hospital with a prescription for anti-coagulent injections which have to be administered by a "district nurse". I go into the local chemist to fill the prescription and ask how I get hold of the nurse. The pharmacist very kindly makes the phone call and books a daily appointment for the injection.

    No one, except the surgeon, speaks a word of English and my knowledge of French was, at that time, very rusty. Hubby's French was non-existent. Yet, at every stage, everyone we met (the GP, the secretaries, the nurses, the radiologist ...) took the greatest trouble to ensure we knew what was going on and what we had to do next. However, responsibility for booking appointments and following up care lay with us. Apart from saving on admin staff, we booked appointments when they were most convenient for us (thereby not wasting time booking appointments that people cannot keep) and letters were handed to us unstamped (thereby saving on postage).

    When I mentioned our experience to my NHS colleagues, they were horrified. That would NEVER work in the UK, they said. You can't expect NHS administrators to type up "instant" letters on the spot - they would never get them done in time, and people here would never accept having to post their own letters or having to look up telephone numbers or book their own appointments ... :shocking:
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Thats a good point, and since everyone goes on about government interference in our lives, lets stop handing everything to people on a plate.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Free prescriptions in Wales seems a tad over the top.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    People complain about prescriptions, but usually if its not available over the shelf then its going to cost more than a prescription anyway.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    You will only save that much money by laying off staff. They need to identify jobs that aren't essential, what those would be, I don't know as I'm not a doctor. I think anything to do with smoking cessation would be a start perhaps.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Free prescriptions in Wales seems a tad over the top.

    That does seem a bit racist, why Wales?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Stop free eye tests in Scotland. Review the criteria for free prescriptions.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    sepumseeme wrote: »
    That does seem a bit racist, why Wales?

    Lol not really.... EVERYONE is entitled to free prescriptions in Wales. Whereas in England, most people have to pay apart from if you're exempt (set down by a certain criteria).

    I read somewhere that if Wales followed the universal prescription policy it would save £30m.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Lol not really.... EVERYONE is entitled to free prescriptions in Wales. Whereas in England, most people have to pay apart from if you're exempt (set down by a certain criteria).

    I read somewhere that if Wales followed the universal prescription policy it would save £30m.

    Thats exactly my point, why do Wales get theirs for free is those in England have to pay?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    We pay more than double for ours than what Scotland do - they pay £3 and we pay £7.20.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    sepumseeme wrote: »
    Thats exactly my point, why do Wales get theirs for free is those in England have to pay?

    Oh sorry, my bad, got the wrong end of the stick there :p

    Yeah, I think NI and Scotland pay less than England too. Whatever happens, I think everywhere should have the same policy....
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Homoeopathy.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    This could do for starters (no pun intended):

    http://www.guardian.co.uk/society/2010/aug/27/nhs-obesity-operation-ninefold-increase
    http://www.dailymail.co.uk/news/article-1306912/Obesity-surgery-costing-NHS-32m-year.html

    I've included the Mail article as it attempts to put a price tag on it.

    So either stop operations for fatties, which I don't agree with, or tax fatty foods in the same way as fags and booze are taxed so they can pay for themselves.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    1. Free prescriptions in Wales is because NHS Wales have decided that it's a priority for them. You should note that this isn't something extra to English NHS services, it's instead of another investment.

    2. @Thuderstruck. Those operations reduce costs. Diabetes/Heart Failure for example. This is an evidence based intervention and it's not something you can just elect to have, there are loads of hoops to jump through first. That includes CBT, Dietetics.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    This could do for starters (no pun intended):

    http://www.guardian.co.uk/society/2010/aug/27/nhs-obesity-operation-ninefold-increase
    http://www.dailymail.co.uk/news/article-1306912/Obesity-surgery-costing-NHS-32m-year.html

    I've included the Mail article as it attempts to put a price tag on it.

    So either stop operations for fatties, which I don't agree with, or tax fatty foods in the same way as fags and booze are taxed so they can pay for themselves.

    I completely agree. We should also limit other needed operations that are through to over indulgance in other forms, i.e. drugs/alcohol.

    tax fatty foods in the same way as fags and booze are taxed so they can pay for themselves.

    Also, follow the goverments example and put pictures of colon cancer on the sausages just like the pictures of tumourous growths on packets of cigerettes, and pictures of people who have been hit by cars on the back of a bottle of bud that was caused by drink driving...

    ^joke.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    sepumseeme wrote: »
    I completely agree. We should also limit other needed operations that are through to over indulgance in other forms, i.e. drugs/alcohol.

    Smoking, sports injuries, vehicle accidents. You can add into that the majority of Type 2 diabetes cases, most heart conditions.... I could go on.

    If you start ruling out treatments on the basis of "self infliction" then you will catch much, much more than just those aspects of people's lives that you don't personally agree with.


    So far we have an idea which will save (at most) £32m but will cost more in treatment for heart failure and diabetes. We also have an idea of how to treat people quicker, which will also cost more in the short term because part of the rationing of health resources is waiting lists.

    Not much of a dent in the £20bn so far, is it?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    I'm not saying that you should exclude treatment on the grounds of self-infliction. I'm saying that where the root cause of it (eg. pies) is something that is known to directly cause obesity, where practicable, tax it. Road accidents are offset (don't have exact numbers) by road tax and fuel duty. Fags and booze treatments are offset massively by tax.

    Sports are a tricky one, as they do have beneficial effects: a fitter workforce = a more productive workforce. I personally don't know where to draw the line. However, what I do know is that it seems a little odd that fags and booze are taxed, and with reason, whereas fatty and artery-clogging foods are not, when they affect the nation's health in much the same way.

    Sure, the initial £32m on operations will be reduced, but we will also gain on tax revenues on Maccy Ds and Turkey Twizzlers.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Everyone regardless of income getting free scripts fr expensive drugs doesn't make sense to me but ...I benefit personally.
    But a shit load of money could be saved here.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Or just by making the Scots and the Welsh pay £7.60 like the rest of us. That amount for a course of medication doesn't seem unreasonable at all to me.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Or just by making the Scots and the Welsh pay £7.60 like the rest of us. That amount for a course of medication doesn't seem unreasonable at all to me.

    It isn't, and those who likely can't afford to pay get them free anyway. I don't have any problems with the prescription charges.

    On a related note, I'm not sure quite how much this will save, but maybe a review of the exempt conditions? I know people who have underactive thyroids, or even diabetes and epilepsy, who are otherwise in good health and working full time, yet get all their prescriptions free. It would be fairer, IMO, if they only got medication related to their condition free, and paid the standard charge for everything else. I'm not sure how this would work on a practical level, maybe as simple as an extra box for doctors to tick on the form?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    It's really dumb for me to speculate really as I don't know where the NHS spends its money as it is.

    I see managers as a good thing personally, just think, 100 doctors 0 managers vs 99 doctors and 1 manager. The 1 manager can assign patients with ailments to doctors with specialities and so on, meaning all the doctors perform better. Obviously there is a balancing act here, 50 doctors and 50 managers is silly. But I think 10-20% on admin and managerial staff isn't unreasonable. I don't know how many the NHS has.

    I think political points are damaging though. We shouldn't see the NHS as a universal 'cure everyone' thing, but rather as doing the best we can with limited resources. Things like cancer are very emotive. How much does cancer treatment cost? Not all cancer treatment of course, some is very cost effective. But I've said it before: if you have enough money for one treatment, one being a cancer treatment with a 2% chance of success and one being an operation to fix someone's chronic IBS with a 98% chance of success... it comes down to making those hard choices.

    I think if it gets bad, all the NHS can do is cut back services.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    ShyBoy wrote: »
    I see managers as a good thing personally, just think, 100 doctors 0 managers vs 99 doctors and 1 manager. The 1 manager can assign patients with ailments to doctors with specialities and so on, meaning all the doctors perform better. Obviously there is a balancing act here, 50 doctors and 50 managers is silly. But I think 10-20% on admin and managerial staff isn't unreasonable. I don't know how many the NHS has.

    Don't see this argument personally. Speaking as one who has worked in the NHS, this isn't what "managers" do. Most are simply concerned with budgets and targets. And, if you need to be referred to a specialist, whose opinion would you rather trust: a medically qualified doctor with experience of the local specialist consultants, or a non-medical pen-pusher? Yes, there are admin staff who are employed to "manage" doctors' waiting lists, but having one person to assign patients for 100 doctors would likely cause a bit of a backlog.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Looks like Homoeopathy has recently got the boot: http://blogs.telegraph.co.uk/culture/tomchivers/100044581/homeopathy-dropped-by-the-nhs-and-about-time/

    Entertaining article, and good riddance.
    Dr Tom Dolphin of the BMA’s junior doctors committee described homeopathic remedies as “nonsense on stilts”.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Kaff wrote: »
    On a related note, I'm not sure quite how much this will save, but maybe a review of the exempt conditions? I know people who have underactive thyroids, or even diabetes and epilepsy, who are otherwise in good health and working full time, yet get all their prescriptions free. It would be fairer, IMO, if they only got medication related to their condition free, and paid the standard charge for everything else. I'm not sure how this would work on a practical level, maybe as simple as an extra box for doctors to tick on the form?

    In some cases, like mine it does work that way. I get HIV medication form the hospital plus fenofibrate, cetirizine, valociclavir, an anti - emetic, loperamide and diprobase as they treat conditions caused by HIV or the HIV medication i take free from the hospital. I get anti - depressants and a variety of analgesics and hypnotics from my GP which, if i had a job, i'd have to pay for. BUT HIV may well be an exception to the rule. There's an old piece of legislation from the 1800s which states that medicine is free for the treatment of sexually transmitted diseases.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Don't see this argument personally. Speaking as one who has worked in the NHS, this isn't what "managers" do. Most are simply concerned with budgets and targets. And, if you need to be referred to a specialist, whose opinion would you rather trust: a medically qualified doctor with experience of the local specialist consultants, or a non-medical pen-pusher? Yes, there are admin staff who are employed to "manage" doctors' waiting lists, but having one person to assign patients for 100 doctors would likely cause a bit of a backlog.

    I think you missed my point regarding the 100 managers vs 100 doctors thing - I was simply drawing a contrast between 100 doctors completely and utterly randomly taking patients in, and 99 doctors taking doctors in with a single manager saying to the patients 'see this doctor / group of doctors' to increase patient care. It's the value of management. If you believe the doctors are competent at managing themselves, that's great. But in the vast majority of organisations having competent managers improves their overall performance.

    I couldn't say whether the NHS has too many or whether they're all just incompetent pen pushers who are only concerned with targets that do nothing to increase patient care. But in that case, you can only blame the government for hiring a whole organisations worth of utterly incompetent and ineffectual staff, rather than getting a few decent ones.

    A well documented problem with bringing professional managers into healthcare is that the doctors themselves are more qualified - they went to university longer, are likely more intelligent, and so simply don't want to be managed by people they see as inferior. But if you can get one guy or girl who can very smartly allocate the extremely limited resources of the NHS it can make a huge, huge difference, more than a just an extra doctor. If that guy or girl happens to be a doctor too, all the better, but I think it would be folly to restrict the search for exceptional management to those simply with a medical background, as most exceptional managers round the world probably don't have a background as a doctor.

    It's not about throwing money here, or there, or making cuts here or there, it's about being smart with the limited resources we have. We only have so many hospitals and doctors and nurses for virtually an unlimited demand for healthcare. The population is only getting older. I think it would be completely wrong if we weren't getting the best people around the world we could to come in and think 'smart' about the problems.

    It would seem the reality you have portrayed that they just turn up to work to write numbers in books is just sad in that case, when we have such a need for great and efficient management to have just hired a load of desk jockeys who haven't got a clue. But surely then the problem is not the concept of good management, but rather the utter failure of the government and the NHS to recruit anyone effectual into that role.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    ShyBoy wrote: »
    I think you missed my point regarding the 100 managers vs 100 doctors thing - I was simply drawing a contrast between 100 doctors completely and utterly randomly taking patients in, and 99 doctors taking doctors in with a single manager saying to the patients 'see this doctor / group of doctors' to increase patient care. It's the value of management. If you believe the doctors are competent at managing themselves, that's great. But in the vast majority of organisations having competent managers improves their overall performance.

    I couldn't say whether the NHS has too many or whether they're all just incompetent pen pushers who are only concerned with targets that do nothing to increase patient care. But in that case, you can only blame the government for hiring a whole organisations worth of utterly incompetent and ineffectual staff, rather than getting a few decent ones.

    A well documented problem with bringing professional managers into healthcare is that the doctors themselves are more qualified - they went to university longer, are likely more intelligent, and so simply don't want to be managed by people they see as inferior. But if you can get one guy or girl who can very smartly allocate the extremely limited resources of the NHS it can make a huge, huge difference, more than a just an extra doctor. If that guy or girl happens to be a doctor too, all the better, but I think it would be folly to restrict the search for exceptional management to those simply with a medical background, as most exceptional managers round the world probably don't have a background as a doctor.

    It's not about throwing money here, or there, or making cuts here or there, it's about being smart with the limited resources we have. We only have so many hospitals and doctors and nurses for virtually an unlimited demand for healthcare. The population is only getting older. I think it would be completely wrong if we weren't getting the best people around the world we could to come in and think 'smart' about the problems.

    It would seem the reality you have portrayed that they just turn up to work to write numbers in books is just sad in that case, when we have such a need for great and efficient management to have just hired a load of desk jockeys who haven't got a clue. But surely then the problem is not the concept of good management, but rather the utter failure of the government and the NHS to recruit anyone effectual into that role.

    the problem people have with management is that in the public and retail end of private sector, that it turns into backseat driving, making staff tick the right boxes in regards to targets, not actually improve their 'team' so to speak, there's a subtle but important difference, one trusts their staff to do the right thing and one always micromanages

    http://www.guardian.co.uk/commentisfree/2010/aug/31/why-our-jobs-getting-worse was quite a good sum up on it

    from the personal angle, in my job my line manager does the same job as me but with added book keeping responsibility for us, and our boss over that is the head of department (secondary school), my pay is low for the skill level required (handling chemicals and dealing with children when we're untrained in it) but i'm generally happy as barely anyone keeps check on us, apart from if anyone makes a complaint about our service to the department and teaching staff, which virtually never happens because we take pride in our work, without having a massive whip behind us lol
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Cutting bonuses for doctors and high-end nurses? Reduce the use of agency staff by being smarter?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
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