The NHS: At What Cost?

THE LONG LOOP SHELL GAME?

PolyClinics are like Building Schols For The Future for schools - a way of privatising what was public using PFI, except now the public is going to be funding PFI is it not?

Perhaps you could approach John Seddon for a non "run of the mill" perspective on how to reduce waste and inefficiency in the NHS:

https://www.systemsthinking.co.uk/5-3.asp

Potential waste of money related to human resource management are:
1) job planning for implementing consultants contract taken to the extreme, through detailed software based analysis and
2) monitoring hours of work of hospital doctors in training (twice a year detailed data collection, analysis etc.) is a time consuming and costly exercise which gathers minimal data (compliance with recording can be low) and potentially costs trusts in terms of monitoring units and definitely on doctors' time and analysis time.

These are not necessarily effective considering their original purpose and just wastes administrators' and clinicians' time. This is especially true for the monitoring of hours for hospital doctors in training, which is based on a system introduced in 1999 and with elements that have been superseeded by the European Working Time Directive.

The NHS is the biggest organisation in Europe, therefore there will be mountains of wasted money, not just in terms of the myriad bureaucratic managerialist job titles and functions, but also in activity costs and the wrong headed Thatcherite 80's style "market" philosophy.

Plenty of savings to be made, but not by politicians; maybe an opportunity for outsourcing to a Board of Governors who could take any potential flak, like the BBC.

And let's forget about patient choice and concentrate efforts on uniformly high standards of care and treatment everywhere. A LARGE fortune to be saved- and with no real adverse impact on the service.

The NHS is not fit for purpose. It provides too many services and has moved too far away from its founding principles.
The NHS budget should be slashed in half and the administration levels removed in rafts.
Also we should have an NHS which treats sick people not pander for their slightest sniffles and pains - People need to get a grip and take responsibility for themselves, so that when they are ill their will be resources left to treat the genuine.
Most importantly the NHS must stop treating foreign nationals who have no health insurance. No other country in the world would even provide emergency care for a British subject (or any other) if they had no insurance. Why should we?
Slimit down and lose all the foreign doctors, nurses and other NHS workers (which is most of them) - When they then go back home we can call that overseas aid and slash that budget as well.

Hospitals are where the big money is spent AND wasted.
Primary Care is in general very efficient and has a low cost per patient episode.
The creation of the NHS Market economy will result in supreme health inflation, just like in the US, e.g payment by results which encourages 'doing stuff', and code inflation on discharge summaries( to 'falsely'? make simple admissions look complex) which earn the hospital more money for them to use but also to waste....
A local hospital NHS Trust publishes large unrecyclable corporate-style brochures a few times a year to advertise its services to every local GP in the area...one per practice would be a waste..one per dr is a disgrace.
Patients also have a role to play. Statins are an excellent example. Pfizer's Atorvastatin got a legin to the market by uncercutting Simvastatin and Pravastatin on price. They're now off patent and cost the NHS pence instead of £20 approx per month as is the case for atorvastatin. MOST patients tolerate simvastatin and pravastatin well and if it's not tolerated thay can be switched to one that suits them. However, patients, although moaning about the shortage of funding for the NHS, become up in arms if it's suggested that they take a effective but cheaper drug. There are lots of examples like this, where if patients joined in the drive for efficiency rather than thinking of No1 only, huge pots of cash (to hopefully be used for good) could be released.
C.O.I. I'm a GP....still at work and will be for at least 2 more hours more today and will be working remotely from home tomorrow.....I could go on and on but back to work!

Nos 5

It can be difficult to ascertain if someone has genuine illness with something like chronic migraine which is very debilitating but not ostensible. Also when your not in terrible head and body (nausea) pain you're mostly very normal and fit. However your still chonically ill - your ability to live a normal life is limited by the things that will cause your migraine so you can live in fear of your own head - not knowing when you will be in terrible pain. The HNS treatment for migraine are triptans which in my case (I had them all) made me very much worse.

If I had any advice for anyone with migraine its to keep a very detailed diary - that is the best way to ascertain what is causing it. One thing to look for is *change* And my experience was that in the long run drugs (those available now) can make you worse.

My big beef is getting to see a good consultant. My doc just didnt want to know after I told him, giving me triptans made me worse. I did it all by research online on my own and I regret seeing my doctor.

Can you look into the following:
1 I believe it is true (your researchers can check) that World Health Authority for years has listed the NHS down at around the bottom of developed world with Romania etc for effective service to patients.
2 This is a massive issue considering the money spent compared to Romania on NHS! Why is this never ever discussed on BBC - why? I is odd that People believe the myth that the NHS is the best in the world. why?
3 Also, that hospital infections are huge in NHS hositals mostly to do with the NHS almost uniquely still having wards and with beds closer than ever!
4 Also, that patients are not pre tested for being carriers and then isolated - as other health systems do??? This being tantamount to willful 'manslaughter' on the part of managements and politicians who have chosen not to fund this £8 test, (do they have private health care for themselves? )
5 I don't understand why patients advocate groups have not brought in the Health and Safety executive re the infections scandal?? or is the NHS immune from this executive - WE NEED TO KNOW.
6 I believe France comes out around top usually. I spend a lot of time in France. My French friends find it incredible that we in uk have to wait for appointments with consultants etc as they do not.
7 Yet their net taxes are less than ours. they have a diffent way of funding via their National insurance payments going direct via not for profit insurance schemes so I am told ? where as our NI tax disappears into the general tax pot raising our taxes to around 50% in real terms - the most in Europe, and largely coming from people who have the lowest wages in our part of EU - we are known abroad for the UK's working poor.
8 So it is not simply the case of 'either the NHS or the American system' but rather why don't we just copy the best system at the top of the WHO list?
9 Most of all Can you get your team onto which country has the sickest people and why. I am told it is the Uk but don't know the facts. this would be very interesting as it obviously has a huge impact.
10 e.g. I spend time and effort looking after my weight and health so that I am rarely sick. I now resent paying into a communal system given that the majority of people are obviously not caring about what they eat judging by the over weight people I see everywhere - including on a recent visit to the flagship hospital UCH in LOndon where most of the nursing staff were over weight- except the Asian nurses.

ps I have just been told that most countries train double the number of doctors than the NHS and that NHS just pinch our staff from poor countries. Is this true?

Regarding the cost of running the NHS. May I suggest that the UK Govt creates a new contract with the pharmaceutical companies which states that as the Govt is spending over £2million through its Medical Research Council, there should be a substantial reduction in making payments to them, especially in view of the present economic climate.

the nhs should be an emergency, serious illness and children till 16 service. ivf and all the rest should be paid for by those who think they need it but won't die without it.

The NHS should be a service protected from health tourism.

also it should have a charter and so taken out of the hands of politicians and their 3 monthly new religions.

mental health suffers because politicians say there are no 'votes' in it. a charter would end that disgusting calculation.

the mercenary doctors had once more to have their mouths stopped with gold. their pay and pensions shouldn't rise for 20 years.

You could invite Professor John Seddon, the management thinker and public sector hero, onto your programme. He has a fresh and radical approach much admired across the public sector.

He would say that the only way to make the NHS efficient is to free it from compliance. This would save the cost of the people in central Government, employed to tell the NHS what to do. But the priceless savings would come if the NHS was free to do what was right for their patients - free from chasing 'Foundation Status', targets and other dangerous, wrong headed ideas. Chasing these wrong headed ideas costs money and lives - as evidenced by the Stafforshire Hospital case.

See big debate on this here

https://www.lgcplus.com/finance-and-partnership/walker-v-seddon-the-debate-goes-on/5004313.article

and

www.thesystemsthinkingreview.co.uk

The West Berkshire Community Hospital opened in 2004. The architects were on laughing gas when it was designed. There are doors on the first floor that open to roof terraces. These doors have no restraints, when open, and are propped with chairs. In the recent hot/rainy weather with blustery winds, all possibilities were enacted, including a barely mobile old chap unable to get back in without inside help. At least one ward has 3-ganged, viciously bright lights over the beds, such that it is all on or all off. If one wants to sleep and the other read or have visitors, individual accomodation is impossible. (I am informed these lights were retro-fitted, as it was found that in hours of darkness, the limited central lighting was not sufficient for attending patients.)

The concours that leads from the car park to the main entrance (fitted with 'in yer face' lethargic electric doors) is cluttered with massive canopy supports, benches, waste bin and railings, where knots of people, often old/infirm, with children or wheel chairs, try to predict the meandering approach of each other. The solar powered parking-ticket dispensers have died and are being given carbon-power.

A single paper towel is not enough substance to dry the hands totally. The nurses pull three or four for a quick dry.

The chairs in the wards, when supporting a bottom, can be slid without noise, courtesy of a plastic plug in each leg. But if slid with no load, they make a mind-bending staccato racket, that the nurses seem not to hear (though sleeping patients do) as they shove them for Marathon distances. Ironically, different chairs on a differnt floor surface, in the canteen, DO EXACTLY THE SAME. (The 'garden furniture' chairs outside, are breaking up and have been subject to bodgery - along with the tables. (They have just fited a sun canopy above the decrepit furniture.) Recently when the power was lost for some hours, the back-up generator refused to cut in. You had to take a friend with you to the toilet to hold the door open a little, as the toilets (unlike the wards) have no emergency lighting.

What all this boils down to is similar to the railways at their lowest ebb. There is a lack of pragmatism and common sense which, expanded across all aspects, must surely waste money.

one would think that any building that has a specific use would have a model of excellence by now. clearly not. because the for looneyliberalatzzi models of excellence are fascist repressions.

Pithywriter (#8) there are many threats to the NHS, but I remain to be convinced that fat people are amongst them. Contrary to what we've all been told weight is not shorthand for health. There are plenty of thin people who live what the medical establishment would consider an unhealthy lifestyle (and are never called on it), and just as many fat people who practice 'Health at Every Size' - the pursuance of healthy habits without prioritising the often elusive goal of significant weight loss - and nevertheless remain 'obese'. You'd be amazed how many of those overweight people you 'suddenly' see (actually they were always there, it's just more recently we've all been conditioned to notice them more) are probably that way as a result of medications for unrelated conditions or injury / disability leading to reduced mobility. Ironically, a not-insignificant number are stuck in a catch-22 where the NHS condemns them for being fat and denies them the procedures, ie knee and hip ops, they need to regain their mobility and improve their health.

I would suggest that before just unquestioningly buying what you're told to think about fat by the BBC and Government, you do your own research into the topic. I did, and it's eye-opening. Did you know that a recent US study found that those in the 'overweight' BMI category live longer than those of 'normal' weight, and that even being 'morbidly obese' (BMI over 40) is no worse in mortality terms than being slightly underweight? Or that weight is as heritable as height (about 75% genes, 25% environment)? Or that the the BMI, the measure on which the statistics that underlie the whole obesity panic are based, was invented by a Belgian in the 19th Century who specifically stated it should not be used as a measure of obesity in individuals - or children? Or that the cut-off for the 'overweight' category was lowered from 27 to 25 in 1998 in Britain and the US, pathologising an additional half-million people overnight (with the same tactic about to be employed in India)? When the BBC gives greater prominence to a study that samples 200 fat children as another that uses the US NHANES data, the biggest longitudinal dataset in the world, just because the former supports its 'line' on the so-called obesity epidemic, the degree to which vested interests and the desire for perpetuation of this massively profitable pseudo-crisis are affecting the propaganda we're receiving becomes clear.

If you're short of places to start reading, I'd recommend Gina Kolata's 'Rethinking Thin', Paul Campos' 'The Obesity Myth' or any of the excellent articles on this topic written by Rob Lyons and Basham & Luik over at Spiked magazine.

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I'm a Green Party County Councillor in Norfolk. I developed skills in project work and process improvement methodology at AVIVA and when I was presented with the above business case for change, I was astonished it had not been agreed to earlier.

In Norwich, they were treating dementia patients at Hellesdon and the Julian hospital. Due to regulations, they had to have minimum staff there for security purposes. All the stats are in the link above, but each Day Treatment Centre was operating at such an inefficient rate in terms of the balance of staff that had to be there and the patients that actually attended each day. On some days at the Octagon, only 2 patients attended, but a minimum of 9 staff had to attend to them!

Current day treatment between these two sites amounts to 210 places, located within 2.4 miles of each other in Central Norwich. The actual usage of these facilities is running at 42% of capacity, with a total of 82 patients attending (some of whom attend more than once a week). Only the Octagon provides these services for patients with dementia and its usage runs currently at just under 29% of capacity, which means that only 17 individuals are receiving the benefit of its services. Therefore the Octagon meets the needs of less than 0.1% of patients with dementia in Central Norfolk.

So moving the Hellesdon patients to the Julian hospital not only uses resources more effectively in terms of locations used, but also frees up resource in terms of staff members. Dementia sufferers can't travel easily by car as they often get distressed when they have to travel over 5 miles, so these patients currently miss out on care, and their carers on relief. Under the new system, the freed up staff can visit these patients. So the new efficient system not only uses resources more effectively, but enables staff to reach more dementia sufferers. Everyone is a winner; dementia sufferers, their carers and the tax payer alike!

NHS Norfolk run a lot of projects to determine how they can be more efficient. Isn't it time we looked at the whole set up to see if there are more quick wins like this?

I heard the EU's Working Time directive finally hits the NHS this autumn after years of planning/meetings to discuss the impact of this ..... but
is the NHS ready?

As others have said - contact Professor Seddon. He's good value as a speaker and has all the right things going on in his head...unlike those at the helm of the NHS. I've worked in it at a fairly senior level and the waste is tremendous, much of it being uncomplicated to get rid of too. Big wins include:

1) Get rid of the Strategic Health Authorities. They add no value, cost a great deal and often actually make things worse by fostering a perspective in local managers that is always looking upwards for compliance rather than outwards to where the patients are. Do the same with the auditors and inspectors.
2) Stop pouring money into IT solutions that aren't solutions to any of the real problems.
3) Ditch the GP contract - it only encourages bad behaviour, e.g. GPs won't do anything unless they get paid and they do things that aren't necessary because they'll get paid.
4) Get rid of tariff - it encourages bad behaviour, e.g. prioritisation of surgery based on which procedure is most profitable not which is most urgent or which was first in the queue.
5) Get rid of the dentists contract it encourages bad behaviour, e.g. why work Fridays when you've made 'your money' by Thursday?
6) Get rid of Continuing Health Care funding and the arbitrary distinction between medical and social need. Social Services departments and local NHS organisations the nation over spend their time and money arguing about who should pay for what instead of simply accepting that the public purse will bear the cost.
7) Rationalise the managment factory based on which roles actually improve the way that the work of helping patients works. Do we really need armies of 'information governance officers' et al?
8) Get the managment focussed on understanding what matters to patients, what demands they place & why, how to service those demands effectively. Stop the managers from going to meetings, writing policy statements, etc and focus them on doing something useful - improving how the work works by first understanding how it currently works. With managers doing something useful you can now get rid of all the people involved in 'change' and 'improvement'.
9) Put a stop to the commissioner/provider split that is being pursued everywhere. It is only adding costs to the mangment factory and creating local inspection and compliance - which does not improve quality it just inspects for it.

The list could go on ad nauseum. The NHS has lived in a land of plenty for a number of years now. It no doubt has challenges to face which will pressurise its budget - growing population, more older people living longer and the like - however, there is no understanding in the current NHS system (or social care system) of the true nature of demand being placed on it and therefore no clarity about its true capacity or revenue requirements. Activity is confused with demand and no distinction is made between the demands the NHS is there to serve and the demands that it gets because it has failed to do the right things for patients at the right time for patients. In my experience, the NHS is a broken organisation desperately in need of a fresh perspective and fresh management thinking. Until it has these its costs will continue to rise unnecessarily. Until it has these, if costs are cut then lives will pay the forfeit.

Finally, protecting the NHS budget from cuts when the waste is so endemic is tantamount to saying the the problems of the NHS are too hard to fix therefore we shouldn't bother trying. This attitude is only going to store up a problem for later years and do nothing to improve the problems of today. It is time the governement and senior movers and shakers in the NHS stepped forward and acknowledged the need to change the way they think about how the NHS is run. There are people with the kneolwegde and the method out there that can help (Professor Seddon being such a one).

The NHS is fairly good. However, it could be improved I am sure. Although we are inclined to moan, most people with first-hand experience will say that they received good care from caring people. But there are many stories of people who had a really bad time, and there seem to be a lot that die or are damaged unnecessarily. I think the NHS tries to do too much, and it should be refocused onto essential care and support:
- A&E
- Geriatrics
- Terminal care
- Relief of pain and discomfort
- Maternity
I don't know how spending breaks down, so I can't judge how much could be saved by different strategies. Nevertheless I'm inclined to guess that we could save by eliminating unnecessary treatments, such as cosmetic treatments or fertility and AI. And I'd be inclined to charge people for self-inflicted problems - mainly drink-related A&E weekend treatment. I would also fine people for causing disturbance in A&E, assaulting staff, making nuisance calls to emergency services.

The Government has had years of obscene, inappropriate and wasteful spending. Every penny of tax payers money should be spent in the most effiecient way possible. Nothing should be wasted. If something comes under budjet, the spare money should be transfered to where it needs it, not wasted into the sector provided. No luxuries should be spent on until we have perfect healthcare and policing, transport and schooling. There should be No expenses, no £3000 furniture in the department of defence, and no wasteful spending at all until we have a healthy NHS.

Stop employing Locum staff.

chasethat (#21) The BBC reported some odd statistics about group vs individual practitioners without any breakdown of the two groups, and then let it be inferred that said difference was a tacit evidence for the advantages of group practice over individual practice. That's not how rationality operates Newsnight, but it is how 'edgy' politics works. Is that the idea these days - be a little edgy to provoke 'debate'? The problem is that the required evidence isn't presented in followup to permit informed 'debate'. Why not? It does look like the same erosion of the state that's being engineered in education via BSF and via PFI elsewhere. It's even being done to the BBC.

Whenever I read that money should be saved on the NHS it always worries me. Where will the savings be, cutting beds, cutting down on nurses, savings on food...nowhere is it ever said that the numerous Managers within the NHS should be cut down or even that their large salaries should be decreased. The fact that a recent swine flu patient has to be sent to Sweden is scandalous, why have we so little specialised beds, particularly for this recent patient?

It angers me that expensive fertility treatment and cosmetic surgey can be obtained under the NHS. Obviously where cosmetic surgery is required after serious injury that is another matter, but other types is really placing financial pressure on a service where care for the elderly and the terminally ill is lacking.

The NHS and the care of the elderly is deplorable and is getting worse and in this instance I do not think the media is over-publicising this enough. As a pensioner the thought of entering a geriatric ward, being treated as a child and manhandled fills me with horror and I am sure others feel the same way. The case of Margaret Heywood who tried to highlight this situation is very scarey - she was acting in the best interests of her patients and got little thanks for it.

The cleanliness of the wards is still after all the money expended still a very serious problem and no matter how many promises are made the figures are not good.

It is a major tragedy that there are those within the NHS - doctors, nurses and other staff who attempt to treat patients as human beings but there is an element who simply do not care and it would seem encumbent upon those who manage our hospitals to never permit this element to go anywhere near a patient who is suffering. How could any human being allow another to cry out for water/food or allow them the indignity of begging to use a toilet. It is a cruelty which should NEVER be tolerated.

For relatives to have to make diaries or stand guard over their loved ones in 2009 is a disgrace!

As for the layers of authorities, i.e. SHAs what good are they, but just allow for even more managers. NHS dentists are very few and far between and the constant interference into GP practices have added nothing to their efficiency, and now with the latest idea of putting surgeries into small hospitals (one is planned for our area) no thought has been given as to how the many elderly are going to get there and whether they will still be able to see their own doctor who knows them and their medical history.

Some changes and I say some which have been introduced into the NHS have been good, but in the main the caring and tenderness which was so common is now becoming quite rare - the NHS has become a business and those who are not worth spending money on, the old, the sick and the dying are ignored.

If you have ever had to stay in an hospital for treatement, it is clear that the whole service is a total and utter shambles. Inefficient and ill coordinated. I think savings can be easily made by simply improving the working parctice [simple structured organisation]. Total inefficiency at every level, from cleaning staff [who are not motivated at all and have no pride in the job they do, up to consultants] - for example consultants seeing patients criss-cross the hospital - why not simply see eveyone they need to do within a single ward them move one the the next instead of seeing one patient and returning two hours later to see the patent in the next bed !!!

NO Name Please !!!

In Jersey we have to pay approx £30 for a GP visit and £80 for an home visit. I cannot complain about this as it makes for more efficient GP practices with fewer time wasters in waiting rooms. We are able to apply for the right to free visits by going through the processes of means testing. This would surely produce savings in the NHS. My experience of English GP services is of very full waiting rooms and overworked doctors treating ailments for which a visit to the pharmacy would suffice.

I'm a GP in London.
This is from an article i'm writing for Keep Our NHS Public. I can provide references for everything i've quoted.

According to the WHO Committee on Social Determinants of Health:
"In middle-income countries, higher levels of commercialization are systematically associated with worse and more unequal health-care access and health outcomes (HSKN, 2007). In low-income settings, unregulated fee-for-service commercialization is particularly damaging to health outcomes. In terms of health equity, publicly financed health care, regardless of ability to pay, is the preferred policy option. (See Chapters 9 and 11: Universal Health Care; Fair Financing)"

There have been plenty of studies of health in the US comparing costs of different systems of health delivery and they show consistently that increased private sector competition drives up costs, particularly administration costs. (too many references to list here)

Administration costs and transaction fees in the NHS have increased from 5-6% in the mid 1970's to over 20% today. This is due primarily to the introduction of markets within the health service and a massive management expansion (there are now more managers than doctors and nurses). Before long it may reach the extraordinarily inefficient 34% common in the US for profit hospitals unless the privatisation agenda is abandoned . A fully publicly funded NHS could reduce administration costs to below 10%, saving the £10bn a year that's required, without any reduction in services, indeed services would improve without the duplication and inefficiencies that competition has introduced.

The NHS spent £350 million on external management consultants in the last financial year. More than £273 million of this was not related to direct patient care and equates to the cost of 330 fully staffed medical wards, each with 28 beds.

And the costs for IT have more than doubled to at least 15 billion so far with estimates that it might increase to over 30billion.

The PFI initiative means that for an investment of 10bn, private companies charge the NHS over £50bn in rental over the next 25 years. The PFI companies are borrowing money from the same banks that we own, and then we are paying their profits (rent) as well.

With these phenomenal wastes of money, its scandalous to suggest increasing private sector involvement, let alone closing hospitals or cutting clinical services.

Finally, another cost cutting option.

A few years ago I started a project with MEDACT to look at making the NHS sustainable. The possible savings for the NHS would be phenomenal if money was invested in making hospitals more energy efficient. The Royal Free in Hampstead invested in a combined heat and power plant and is saving over £1million a year with all savings going back into clinical services. There are over 1000 hospitals and clinics in the UK, representing a potential billion pound a year saving.

GP led health centres.
Every PCT in the country has been told by the DoH that they must build a GP led health centre. They have been given far greater funding than GP surgeries they are in competition with, having been given up to 7 times the amount of funding per patient.

The US experience.
The US spends more per person per year on health than any other country as a result of greater administration costs, defensive medicine (over investigation and treatment due to fear of litigation), greater use of branded drugs and high-tech equipment and so on. New medical technology such as complex scanning devices and chemotherapeutic drugs tend to be a lot more expensive than existing treatments. The costs are continuing to rise as new treatments become available and an aging population needs more health-care. The costs of operating a market the costs of promoting and advertising insurance plans and providers facilities, of making contracts between insurers and providers, of accounting and invoicing for every individual treatment, of recording payments and chasing non-payments, of auditing and litigation are huge. In US public hospitals in 2004 administrative costs accounted for 22.9 per cent of total costs; in private non-profit hospitals they accounted for 24.5 per cent; but in for-profit hospitals they accounted for 34 per cent.
The US surgeon Atul Gawande recently examined healthcare in Mc Alpine a small Texas town on the Mexican border where the average per-capita healthcare costs exceeded the average annual income. The costs there were the second highest of any US town. The main reason was a result of financial incentives that drive unnecessary care.
Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllens extreme costs was, very simply, the across-the-board overuse of medicine.

@ ronseale: excellent points, even from a GP perspective. I'll try to find out more about Prof Seddon. Given the ubiquity of money as an incentive it'll be a challenge to replace it entirely. Few people (not just GPs) who've profited from financial incentives could be convinced of the case to be salaried.

My late husband was diagnosed with terminal lung and kidney cancer in 2004. In a period of six weeks, he was taken into hospital several times as well as attending oncology clinic. I always took a list of the medicines he was taking as well as a chart detailing times and dosage of these. Which the doctors always refered to. Never once was he asked if he needed more. Every time he was discharged, he was given more of the same medication, resulting in the fact that when he passed away I was left with a cupboard full of still sealed prescription drugs. These I took to the chemist who was, I suppose rightly adamant that even though these were still sealed they had to be distroyed. WHY can't the doctors ask patients if they require more medication before issuing more. After all in cases such as this, your own doctor says to phone them when a new prescription is required. If hospitals were to follow this precedure I am sure thousands could be cut from the NHS budget. It is not denying anyone anything, just ensuring that the patient has what is needed and not having a large amount of surplus.
Another urgent thing that needs to be addressed asap are those who use the NHS that have no right to. By this I mean those who come here from abroad to take advantage of our free health scheme, who are supposed to pay the bill of their treatment but who leave the country without paying. Many are people who have plenty of money but do not wish to pay. It has been said that there has been a member of a very rich arab country, who although he has been constantly asked to pay has not. An investigation needs to be carried out also on those from countries such as Africa, who regually fly in for repeat prescriptions on a previously diagnosed illness such as HIV, and then go back home and sell them on. We should not even be allowing this use of our health service. Maybe this government should look at charging countries for any treatment that those from other countries recieve. I cannot get free treatment in any other country I visit. I have to ensure that I have the required insurance. Even in EU countries. Unless it is an emergency.
By carrying out the above,it would save millions of pounds. Would this happen, I won't hold my breath.

I wonder whether the waiting lists actually cost the country a huge amount. For instance,whilst waiting 8 months for a relatively simple gallbladder removal operation,I had to be taken to hospital several times in the middle of the night in great pain. I also had to have time off work again and again.

As many would say the NHS is far too Top Heavy too many chiefs etc, What we should be doing is to have One NHS Scotland and one quango to run it doctors, nurses and the like should be back to what they do best Looking After the Sick. Further get rid of private companies that proffiteer from the NHS and bring the work in house these would free up £M's for front line services

It is incredibly simple, the NHS should be given special protection against legal action. I am sure that the savings generated could transform the NHS. The only problem is that it would require the Legal Profession to act against it own best interest. I am sure that there would be overwhelming democratic support, but Turkeys don't vote for Christmas.

Nurses should get back to nursing instead of their "career progression" into management or pseudo doctors, (drs.on the cheap)Nursing in the past was to care for the patient and not do all the other administrative tasks.
Bring back the Matron and pay cleaners the rate for the job so that Wards are kept clean.
Managers should spend less time in meetings/seminars.
Let the clinical staff make the decisions on need and priority instead of budget considerations.
Stop NICE & drug firms ripping off those who need expensive drugs.
Fine those who don't turn up for appointments or who tie up Doctors' surgeries with minor complaints, getting pills and not using them.
My wife worked in the Health service for 20 years and experienced a recent hospital operation where nurses did not know what treatment she had nor took the trouble to examine her or read her notes. Nurses were pulled off the Ward to do a "deep clean". Half the wards were empty due to cuts in nursing staff.

Such a precious resource, and loved institution, I have had recent cause to be thankful. Not employed by the NHS but a lot of working relationships with various bits of it.

Mostly reminds me of the Irish joke, person lost asks for directions to place B, reply from local, I could tell you, but I would not start from here.

Last year I was misdiagnosed by the NHS and had my life saved in Delhi India. In fact the health service there is far better than ours in terms of hospitals.
Since returning to London I would say I'm apprehensive about any visit to Chelsea and Westminster Hospital. One is treated suspiciously from the beginning, by people who can speak English, but do not comprehend a word of the language.
In fact, I calculate that about 75% of NHS time is spent on bureaucracy rather than health care.
In Delhi I have my cardiologist's mobile phone number.
In UK you must get an appointment with your doctor, who then informs the hospital, who then write to the patient, asking them to ring to make an appointment!
It is absolute lunacy.
As a child growing up in the 1960's in Worcestershire the idea of being better treated hospital-wise in Delhi India, to anywhere in UK, was quite rightly considered preposterous.
In 2009, from personal experience I can tell you the opposite is true.

I think a great deal of money could be saved by refusing treatment of certain individuals. For example,refuse hospital treatment to people who have smoking related illnesses who continue to smoke. No more funded 'fat clubs'/subsidised gym memberships & healthy eating vouchers for fat people. If they eat until they are obese then let them take responsibility for the cost of getting thin again. Why should an alcoholic be given a costly liver transplant that could go to a child or other deserving person? Forget NHS funded fertility treatment too, if mother nature decided you weren't having kids, live with it, mother nature didn't give me a beautiful face but I don't expect the NHS to pay to fix it so why should infertility be funded? It's not an illness and not lifethreatening so should not be NHS funded.Anything other than A&E should be denied to overseas patients unless they pay. I am not able to get free hospital treatment in other countries so why should people come here and get it? Finally, get rid of all the pen pushers. You need doctors, surgeons, matrons & nurses with a manager per practice/hospital & medical secreataries so the medical staff can take care of the patients instead of wasting time on paperwork and someone on the government allocating the budget, anyone else is surplus to requirements

You asked for a few suggestions:
1) Install Matrons with real disciplinary powers into every hospital. MRSA and similar would soon be eliminated as nurses would be required to ensure cleanliness, and not privatised contract 'cleaners'
2) Ring fence NI payments to ensure (like they do in France) NI only goes into health care
3) Reduce 'choice' - a mere paper exercise. If you have good hospitals you don't need it
4) Reduce the number of visitors into hospitals, cut out the shops (Southampton General is like a motorway service area). This would reduce transport of infection.
5) Encourage doctors to prescribe self-help (e.g. exercise regimes, correct diet, 5 fruit/veg a day) to reduce drug dependency - and cost. Get patients to monitor and report back on these regimes
6) For alcohol related A&E get the names of the retailers and charge them the price of the care. I believe in Canada you cannot stand and drink in a club/pub you have to sit down; it reduces binge drinking.
But then cynical reality hits - it's the simple things that are all too difficult, isn't it?

The easiest way to save NHS and the tax payers money is keep politicians out of it.

The reason there are so many NHS managers who are unable to focus on improving patient care is because of the bureacracy created by the endless performance monitoring reports generated for the government, continual meaningless targets created by the politicians based on quantity not quality or safety, constant moving of goalposts and promises of funding if the right hoops are jumped through by preparing bids only to change the information requirements after submission.
Just attend some public Board meetings for primary care organisations and hear the frustration of board members trying to represent the best interests of their population only to have a politician pull the rug from under them at the last minute.

People complain about GP access without realising that this is because the government introduced targets for patients to be seen within 24 hours which the GPs responded to by offering same day appointments, then the politicians changed their targets to pre-bookable appointments, then changed the targets again to a combination. All this has achieved is to confuse patients, mess around with access with the attitude of "one size fits all" instead of being able to respond to the demographics of the local population and frustrate the GP surgeries to the point that they've given up trying to please everyone and instead pleasing no one. The result - practices are incentivised for their appointment booking system regardless of the level of service/quality of care they are providing. An example of this is practices who have received points under the patient access areas of the contract but have a high level of complaints.

Now we have an immense expense to the taxpayer as a result of a national pandemic panic resulting in a mass distribution of a drug with nasty side effects for a viral infection that is milder and less fatal than seasonal flu. Would this be due to government stockpiling of a drug?
I realise I am sounding very political now but I am an NHS Manager who is passionate about improving patient safety and quality of care and is continually frustrated by the constant interference that all of us in the NHS have to suffer when we are just trying to do our best.

Save money - how about get rid of the politicians and allow us to get on with our jobs instead of constantly reorganising us - why do you think the private sector doesn't re-structure every 5 years?

If the government forces the NHS to properly account for where it spends its money then this is no bad thing. The NHS has wasted billions through bureaucracy and putting in far too many level of management. Being forced to streamline and account for its spending could actually free up billions even if spending is cut.

I think it is universal that we all wish to keep the NHS and are happy with the care we receive. The problem is that we have this and similar debates when the NHS and The Department of Health should be "learning organisations" fixing problems before they occur and certainly before they become crises. It has to undergo a real world cultural change in management.

We can introduce the success of the private sector without privatisation but simply by introducing a FTSE 100 executive structure. But this would only work if it was done with every public sector body as if is wasn't they would only be working to best practice to subsidise resource demands elsewhere.

Lord Darzi, excellent in his field, should quite simply have declined the job of Health Minister after taking Plato's advise "if you have a medical problem see a doctor" (no point talking to the green-grocer about a medical problem). Similarly, if we have a management culture problem in the NHS we don't want a doctor we want a manager or is Plato wrong? Should we visit our local garage for advise if we have back pain?

I am giving sound advise to make the NHS perform and run like clockwork on any new budget, otherwise I need to be corrected because I have told so many people that "if you have a medical problem see a doctor" and that generally means "if you have a problem see a professional and not an amateur".

I have one rider from another great philosopher, Popper, "only make piecemeal changes to traditional social structures, rather than radical changes, and trial and monitor these changes locally before rolling them out nationally". Not following this rule has been the major mal-management practice bedeviling the NHS over recent years.

I saw nothing new or problem solving in any of the debate on Newsnight tonight.

Regards,

david Lilley

Two major changes have taken place in the NHS over the last 20 years, i.e. (i) introduction in the 1990's of Trust status (a Tory policy) and the pseudo internal market where individual trusts charge each other for services, supposedly to generate efficient private enterprise methods. Result, increased administration with costs offset by reducing front line services. (ii) 1997 - onwards, Labour continued with Trust status and created hugely inefficient large scale trusts with a colossal increase in administrative overheads, e.g. business consultants, marketing, risk management from the banking sector, analysts, statisticians, board room presentations, in other words, "Style over Substance". A bureaucrats dream! It has now reached the point where bureaucracy is literally stifling the actual business of delivering patient care, but the managers will not admit it in public, since it places them and their quango departments at risk. Do you blame them? Would you put a £100k p.a. job at risk to make the NHS better? I think most people are prepared to pay a top surgeon £100k, but what about a bureaucrat? The NHS managers are well meaning people, but they over estimate their worth. A prominent Tory politician has criticised wasteful bureaucratic practices and has used the phrase, What less can you do, but do they have the guts to deliver? I can think of a more fitting phrase, i.e. for all the good you are doing, in the name of God, go. I agree with the blogger, unounos, i.e. billions could probably be saved by reducing the "Arms Length" administration, and investing some of it back into "Front Line" services.

1. The NHS needs to say no more often. I've had to go to AE departments twice recently. On both occasions I was amazed by the number of people who wanted something for a sore ear; had a nasty cold; or in one case came every year for a check up. The vast majority were neither accidents nor emergencies.
2.The NHS should do less; we need to make hard choices about what services the NHS should offer.
3. Stop reorganising it!

I have had personal experience of the NHS 3 years ago I was in and out of a large hospital my consultant was brilliant and looked after me very well. During my long stays I noticed that patients for one doctor could be on the other side of the hospital so they spent a large amount of time getting from one side of the hospital to the other. WHERE saving can be made where do you begin get rid of the many layers of management, bring back the old ways people who are not from private companies doing food,cleaning. I caught during my 5 stays MRSA and CD with this I was given the last rites. The two wards that I stayed on were filthy. Bathrooms with exrement on them. shared toilets male and female if you informed the staff that there was dirt on the floor they looked at you and said it was not their job to clean it. The cleaners coming around flicking here and flicking there HOW is this cleaning. Years ago my mother worked in hospitals as a cleaner and she daily was on her knees scrubbing the floors skirting boards and hospitals were cleaner then. My father is now in hospital 3 weeks ago they found a shadow/clot/growth in his heart that is what we have been told but the doctor who can do the procedure to look at this is on holiday and there is no other doctor in the area who can do this. My father is on bed rest in a ward he cannot do anything without a nurse being with him. He is taking up a bed and has asked to come home because all he is doing is sitting in bed he can do this at home. NO they say too dangerous you could die DIE if he is this bad DO SOMETHING. We have also been told that if he did come home when he goes back to the hospital he will go back to the end of the list what a joke. My experience as you can see is mixed but mainly bad. Get rid of all the new it systems, managers, private companies bring back the old school it worked better. I just hope and pray that my father can hold on until this doctor returns back from his holidays in 2 weeks that means that he would have been waiting 5 weeks for a consultant to see him. What a joke I understand that doctors need holidays but WHY is there only 1 doctor who can do this particular procedudre.

Abolish Primary Care Trusts. They add no value to the patient experience. Giving prescribing rights to professions working in the community (Health Visitors, Community Nurses, Midwives etc) would reduce the demand on GP's and could provide an opportunity to reduce the number of GP's significantly. GP's could then become community consultants. This would reduce the wage bill and improve access.

The only thing I NEED to say is that money should be spent on the first natural thing cleanliness!! if you can not keep a place clean (most Hospitals are not clean bacterium free you do not need fancy equipment to solve problems you are creating with MRSA and other bugs. For crying out loud sort it out!! pay the most important people in the Hospital good money for the good job they do and let them do it "Cleaners not the Doctors!" what is the point of having fancy equipment and fancy operating theaters Super Doctors and the best of everything if you are operating in a unclean environment ? surly the most important thing is cleanliness!!
not equipment?? The ban in some Hospitals on BLEACH or other antibacterial products is mad!! totally mad!!
pay more for cleaners and less on fancy equipment & drugs simple!!

It is very simple. Cut out all those useless managers running round from one useless meeting to the next and telling the real workers, doctors, nurses, medical technicians, secretaries, receptionists, porters, etc., how to do their jobs!

Money can be saved in all sections of the Health Service. The large severence packages including pensions for senior posts, these contracts should be re-drafted, especially in cases of under-performance, negligence and misconduct. My wife is a Senior Nurse and comments on how cleaning standards on Wards could be further improved by bringing private cleaning contracts back under Ward control. Efficency savings would mean trained nurses could devote more of their time nursing patients instead of cleaning areas missed by private cleaners and imroving hygene. Money can also be saved on many non urgent care areas such as cosmetic surgery and fertilisation procedures where these could form part of a private medical insurance. Health tourism is also a large drain on the NHS nationally. The biggest savings however could be in the non medical mid-management areas of Trusts where administrative jobs could be incorporated by Matrons and Ward Sisters such as Bed Managers who do not work weekends so Ward Managers do it anyway. However a big mistake would be to cut Nursing and Doctors posts, since they already work portions of their day unpaid - should they work strictly to contract, then the Health Service will suffer greatly. Finally, how we look at funding GP surgeries and Health Centres needs urgent attention, efficiencies and money go hand in hand, and whilst our GP's do an excellent job, they are let down by Civil Servants who operate in committee's and have only vague understanding of how things work day to day in a GP practice.

I can do little better than refer everyone to the excellent book "NHS plc" written by Allyson Pollock. It covers most of the changes over the last thirty years - and the damage that these have done. The shift from planning to commissioning healthcare has been hugely expensive. I worked for the NHS during all of those thirty years and can remember how the old NHS was starved of resources. There are some improvements now but a terrible price is being paid for them and many services which were originally provided have gone. Had the old NHS been funded properly, and the endless management reforms not taken place, current services could have been so much better.

Politicians and our whole political system has failed us on this and other public service issues.

The general public are a massive drain on the resources of the NHS. People who are genuinely ill deserve treatment, and I am proud to work for the NHS and provide treatment to these people, but I am more concerned about people who, for example, call an ambulance because they have a sore throat, or go and clog up A&E because they have a papercut. These people have no concept that they are wasting time, money and resources. People are starting to believe that is it their RIGHT to be seen immediately because "they pay their taxes". I find this attitude extrodinary and people who are persistant timewasters should be charged a (albeit) nominal fee so that healthcare workers can get on with treating people who are actually sick. This should also apply to people who persistantly fail to show up for pre-arranged appointments.

Education is vital and a change in the culture of our society needs to come about pretty quickly before we run our health service in to the ground.

That being said I also have strong feelings about the apparrent problem of the NHS being at the mercy of the whims of whatever government happens to be in power at the time. This invariably leads to short term 'miracle cures' - ill thought-out planning and high expenditure, leading to constant administrative changes, low morale, confusion and lack of consistency of care. For the NHS to survive maybe it needs to be distanced from the government and run more like a big business?

Did I really need fresh bedding everyday during my 3 days as an in patient? No exposed wound or soiled sheets - as the "orderly" said all bedding changed everyday come rain come shine!
Reducing to every other day would halve cost.

Trish Chester

Too much money gets wasted due to fending of the continual so called in depth analyses by the press and media including the BBC. The NHS can never be a "perfect" organisation and as long as peoples perception of what they want from it does not match how much they are prepared to spend on it. Let the NHS breathe and give its management the room to manage without continually well poisoning. The NHS is of course an easy target for journalists to muck rake and to take less than a balanced view, you do us no favours.

First of all, at all airports and entry points, whilst checking other documents, make sure foreign holiday makers have got health insurance the same way that British holiday makers have to.

Second of all, get G.P's to open again at weekends-i can gurantee you that 50% of all admittances at hospitals at the weekend would go to a G.Ps surgery if they could which will reduce waiting time for more serious patients as well as meaning doctors and nurses could make more efficent use of their time instead of checking things that a GP could quite easily deal with

Thirdly, any people suffering from aliments related to obesity such as back pain, if the doctors recommend that losing weight will help them then over a 6 month period they MUST show evidence of weight loss before receiving further treatment-similar guidlines will apply to people with diseases stemming from smoking, drinking or drug use-this will not only imrpove them health of the population in general but also stop the NHS wasting time and resources giving medication adn performing procedures on people who evidently dont't care enough to help themselves

Finally-reduce the amount of paperwork that the staff have to complete, again so that they can make a more efficent use of their time- one way to do this would be the reduction in contact with child services-my son was in hospital with a stomach bug and was released with no concern from the doctors-howver four days later i received a letter form child services saying that they had been informed of his admittance and giving me contact details-if he had gone in with an injury of some kind i could understand the need for a nurse to sit and type in my sons details and symptoms and then forward them to child services but as it was a stomach bug-something no parent can cause or control i fail to see how that was asn effective use of anyone's time

Oh you won't beleive the money wasted in the NHS ....

A friend of mine was contracted to completely kit out a Hospital with cat5 Computer cabling. When he finished the big job - they told him that they still had some money left in the budget and asked what they could spend it on because they had to spend it to get the same level of financing next year. He replied - there is nothing - you are all up to date. So they contracted him to pull out ALL the cabling and replace it with a higher grade cable (CAT6) - at about £40-£60 per socket multiplied by about 100 - you will know how much money they WASTE EACH YEAR!

I also work next to an NHS Office - the decked the whole place out with the lastest door entry, chair lift, electric doors, airconditioning etc etc - And then moved out because they could not afford to stay there!

HELLO!!

The new companies moving in are so grateful for the NHS's donations that they made!

ALL the Government departments do this to - they don't worry - as WE ARE PAYING THE BLOODY BILLS !!!

I have been in and out of NHS hospitals my whole life and i think the NHS is a fantastic institution that this country should be very proud of. Though how long that will last should the Conservative Government take power i do not know.

there are many ways that money could be saved within the NHS one of which is early intervention for people with disabilities. For instance it costs the NHS over £4,000 every time somebody is hospitalised with a pressure sore (those that are infected can be 10 times that) yet a different tailored to use cushion on a wheelchair is only £300 and can prevent pressure sores.

Cross Departmental working would also improve cost effectiveness - for example a riser on a childs wheelchair costs around £1,000 and yet is not given as it is not deemed to be clinically essential. Though if given can prevent the DCSF from having to supply right height desks in each classroom at a cost of £3,000 and that is just one saving of a riser.

i also believe that the state should pay for doctors and nurses to take their training with a contract that will give the state 8 years of their working lives at a reduced wage. This will open up the option of medicine to all walks of life - not just the priveleged. And the state should stop paying for useless degrees like ice-skating, starwars and Dr Who.

But to finish i am nearly 40 and i have spent many nights on many wards throughout the country having many operations and i have no serious complaint to make about the NHS - it's fantastic and has certainly done me proud.

Thank you

At one time people joined the NHS as a vocation now it is only considered by the majority as good pay for little work, I suggest that 25% of all nurses be retrained as cleaning staff and the other 75% should actually do some work instead of sitting drinking tea.

I don't think the NHS should be protected from cuts. The government has blown my money on it in an idealogically based splurge over the past twelve years. Yet it is now more difficult for my family and friends to see an NHS doctor than it was before labour came to power. The government has brainwashed us into equating expenditure with service: it is very easy to spend our money on the NHS but much harder to get actual improvements. My impression is that much of the funding as gone on bureaucracy, red tape, unnecessary projects and excessive increase in GP's salaries.

NHS and other public sector groups should look at employing staff from the private sector, all their jobs require NHS experience. They are currently paying DHL to do what I suggested they do 12 years ago. Other basic commercial operating practices are also missing.

They should not hold business meetings in public cafes and restaurants. They should not tell suppliers how to contact non commercial staff, it is equivalent to signing a blank cheque. They should have an environmental policy that includes travel costs for staff and patients.

I do think that the NHS management are top heavy and need cutting.
Also save millions by charging people who are not entitled to our health services, there are many, many cases.
Why is it when seeing some consultants, the wait could be months, but if seeing them privately its days.

Simple ways to cut cost:

-A and E should never be free for people who are injured during incidents involving alcohol. If you're drunk, get into a fight or have an accident, you should pay A and E. Tax payers should pay for legitimate accidents and emergencies.

-Procedures involving pregnancies should never be free. You made the choice to become pregnant, tax payers money should not cover it.

-Clampdown on GPs prescription. Too many GPs prescribe drugs to please their customers and keep their clientele. Taxpayers should not pay for that. Prescriptions should be heavily monitored and GPs fined in case of abuse.

-Obesity related issues should never be free, people decided to eat too much and do too little, it was their choice, not the taxpayers responability.

To save a vast amount of money, get rid of all the "little grey men" management tier. They have no contact with patients, (and as little as possible with staff) earn huge salaries, and make ridiculous decisions that spend vast amounts of money. ie All the windows were replaced with double glazing costing millions - the windows were of the push-out type, and a depressed patient jumped from one. Then all windows had to have a bar fitted to stop them from opening more that the designated amount (even on the ground floor). This in old buildings with very poor ventilation anyway. A few weeks after this was done, two men were sent round to check that all had been done to the correct specifications. One to measure, one to hold the ladder...

A dishwasher costing £4000 - nobody could work it.

A maintainance contract given to one company giving them carte blanche to charge what they want, and the work could only go to them. Asked for a quote to replace one kitchen cabinet - £680! Needless to say, it didn't get replaced.

I could go on... it really is the most appalling waste of money, and all long-term workers are so used to it, they don't even react anymore. And this is just the tip of the iceberg...

My father had a cataract operation done privately by a surgeon, an anaesthetist and three nurses. The next year he had the other eye done but on the NHS this time - same surgeon (who also did the local anaesthetic), but with just two nurses. How about doing away with the surgeon and one of the spare nurses?

THe population of the UK is increasing both in age basis and simple numbers. I.e. there are more of us and we are living longer. Health Services should have been monitored and tailored to the regions they operate in. How much money is wasted on administartion i.e. cancelling appointments , transferring information and patients between hospitals, this should only be done under special circumstances not a regular as it is now. Also food is being wasted despite this order 2 days in advance service as quite often you will get a meal that was booked well before you actually come to stay in hospital and then they have to find something else for you. If you know that you are coming in for treatment and not an emergency why do they not ask you for your food request in advance.

Why don't we pull out from hosting the olympics and divert all the money we would have wasted on that to the NHS?

As a junior doctor working in a large trust, I feel very torn by much of what ive read on here. Many people seem very 'anti-NHS', or believe it should only provide basic services e.g. A&E etc. That is all very well and good for those of us who can afford health insurance, but a large segment of society would be utterly precluded from anything but the most basic of health care if this system were put in place. However, I do see the downsides of the current system and the economies that must be made, so there are some difficult choices ahead for those in power. Sadly, I have a feeling that all the rest of us will see of this is the glossy version of the truth, as politicians seem to have a bad habit of attempting to make cuts sound like investment.

From my experience of working within the NHS I have a few practical suggestions (not that anyone with any sway will listen to me, I mean, what would someone like me, in the front line, actually know??):

1. Energy efficiency.... why oh why in the hottest week of the year, only a few weeks ago, was the heating on in my hospital??? It was so uncomfortable for staff and patients and such a waste of money!

2. There seem to be so many managers, who in fact are not managing anything other than keeping themselves employed. Two examples:
a. At our trust there is on-site accommodation, recently. Up until a year ago first year doctors were entilted to free accommodation on site as part of the contract. Since this has been removed, the trust now charge about £450 a month for a room in a small two-bed shared apartment. This is way over the market rates for the area (which would get you a decent two/three-bed apartment to yourself for that kind of money). So the flats sit empty. The trust has a contract with the private firm who built the flats to pay them every year for it. Apparently this is regardless of how full it is. I understand that there is only a hand-full of people signed up for a room from this August, so this must be costing the trust a fortune. Maybe they should sack whoever set up the whole fiasco in the first place and recoup some of their money!
b. Targets are not popular across the NHS, and sadly seem to have invaded every level and become the new 'thing'. In my hospital we have targets on how many patients we should discharge from each ward each day.... as if such a thing can be 'targeted'!!! People are ready to go home when they are well and there is a safe environment!! Of course, we need to be aware of the pressure on beds and ensure people are discharged in a timely manner.... but there is an obsession with 'morning discharges' i.e. getting someone home before midday. In order to do this we should apparently 'predict' that they will be able to go home about 24 hours beforehand, thus making all the necessary arrangments with medications etc. Sorry guys, I must have missed the 'crystal ball' module at med school.....

3. Invest in community hospitals.... At any one time on my ward there are a number of elderly people, who at the end of their medical illness are unable to return home and need to go into some kind of residential or nursing home. Organising this takes time, and depends on lots of assessments by social services etc, and also input from their families about the right place for them. I have one patient in particular who has now been with us for TWO MONTHS since she was deemed 'medically fit' i.e. could go home if it would safe. She is STILL waiting for a residential home placement, and, through no fault of her own, is taking up an acute medical bed. This is very expensive and worsens bed pressures. The number of people over the age of 65 is going to increase dramatically over the next 20 years.... community hospitals are less expensive to run, as patients dont need to see a doctor every day, and need less nursing input. More should be made of them.

4. Pay us for the work we do.... I know someone else on here was suggesting that hours monitoring is a waste of money. It certainly is, since no-one appears to care or do anything about it. In one of my jobs the work load far exceeded the number of staff, and we all stayed late, often very late, to get the work done. We MUST have been working longer than our contract pays us for, but as its averaged out across all the people at our level, of course the 'average' wasnt so bad. All we did get was a rap on the knuckles for working 'too long', and a new system which means we need permission from our consultant to stay later than 5pm! This is complete nonsense and ignored by everyone, it just ensures that next time we're monitored for hours, we can't put down we stayed late or we'll be in trouble for not 'getting permission'! The NHS has relied for years on the good will of its staff, on doctors and nurses coming in early and staying late. They certainly dont hve my good will anymore, I'm 'not allowed' to stay late to finish my work and I'm certainly not paid to do so.

Savings could be made in the NHS in the following way by allowing Doctors and Nurses to manage their own day to day procedures with very minimum admin.Do away with PPI not cost effective in leasing arrangements.No to Private Health Companies they are only interested in profit and their share holders. The USA has started to revue its Health system realizing that it does not serve all its people

In 2007/2008 the NHSin Scotland spent £39 million on stopping smoking projects,
I should think that England spent the same if not more, so we are talking in terms of £80 million plus, this is not a good use of Funds, as the results are very poor, out of 50,121 people who tried to quit, after a year only 8% were still not smoking, that is 4,009. So each one has cost the health budget in Scotland £9,728.
Surely that money could be put to far better use, Better wages for Nurses for a start, to renovate some hospitals that fall far short of the 21st century.
Nicotine replacement therapy is a non starter, would you give an alcoholic booze , or a heroin addict heroin as a treatment. I think not.
So stop the costly advertising that everyone ignores, let those who wish to stop using NRT go back to paying for it themselves, surely that is a better incentive to quit.
Go back to being a Health care provider, not a nanny nagging on about lifestyles and personal choice

The NHS should not waste any more money paying for hospital chaplains. This money would be better spent on doctors, nurses etc. If religious interest groups want to comfort the sick and dying then they should do so but out of their own wealthy pockets

Getting rid of hospital chaplains, as one poster suggested is a good idea. If a patient has spiritual needs phone the mosque, temple, church etc and get their staff to come in. Save a fortune.

However;
55. At 2:25pm on 28 Jul 2009, trw2360 wrote:
At one time people joined the NHS as a vocation now it is only considered by the majority as good pay for little work, I suggest that 25% of all nurses be retrained as cleaning staff and the other 75% should actually do some work instead of sitting drinking tea.


trw2360 seriously underestimates the amount of tea to be drank. Last week I worked 14 hours overtime and was oncall for 3 nights in addition to working 37.5 hours. Someone has to drink all that tea, or maybe I should retrain as a cleaner?

Dear Newsnight I just watched the debate - it was useless! Just more of the same. Why didnot newsnight go to Europe for us to show better ways of doing health care. WHO says nhs is bottom in the EU so I am not imagining this;
1 I admire Darsy but... We should just copy the French system. I spend a lot of time there and have never heard anyone of my french friend say anything untoward about their health care.
2 I mentioned to a french friend that my son was having to wait some months to see a specialist about a skin condition, she was genuinely shocked and surprised as they just go along to their consultant immediately. And it is available to all, with some minimal charges that their National insurance refund.
3 I had German and Dutch language student lodgers who promised each other that they would see each other back to their respective homes should either become ill they had heard such bad things about our NHS .
4 I mentioned to a french language student of mine that I had an unusual pain in my head. She said why don't you go and get a scan. apparently she would easily be able to in her country... It was sunday so went to A and E but gave up the wait having found out from the triage nurse that my vital signs were ok.
5 And why do we Brits accept open wards when all other countries now have separate rooms for their patients ( to give privacy and rest and prevent infection spreading) This is a scandal.
6 and why did not the interviewer ask those four 'suits' if they have private health care as part of their salary packages - what's the betting? I cant see Gordon Brown queuing up in A and E for anything or having to wait weeks to see a specialist. This is how I would have done the interview.

There are too many non-medical staff employed.
When I was last in hospital a group of six in green blazers seemed to wandering aimlessly about the place doing nothing but talking and laughing. Do we really need people doing that?

#69 I would endorse everything that pithywriter says. I'm in the same position and have friends and relatives in France, their health care is excellent. And something I have noticed, having had old people in hospitals, how caring and considerate their nursing staff are, and in the main french.

The anti-smoking campaigns run by the NHS are a waste of money.

In the last financial year the Treasury raised £10.2bn in Duty and VAT from the sale of tobacco and tobacco products. In June researchers from the University of Oxford Department of Public Health estimated the cost of smoking to the NHS at £5.2 bn, which means that there is an actual Smoking Tax Credit of £5bn.

Add to that the £60bn each year in the unpaid state20Pensions of the 12 million adult smokers in the UK who die 10 years earlier than non-smokers, and the Smoking Tax Credit increases to £65bn.

Cancel the anti-smoking campaign and use the funds to treat our investors (smokers).

A good friend of mine works for the NHS and I can tell you for a fact that if a health tourist turns up at a hospital they are asked if the have health insurance but they are not asked to provide it. They simply give their name and address (which can not be checked) and are given medical treatment. If they say they do not have insurance they still receive medical treatment and a Bill is sent to there address which at no point do they have to prove. We are the only country to allow this. I travel extensively and have to have medical insurance. The one time I needed Medical treatment in the USA I had to provide the appropriate documentation and my passport before they even started taking down my details. How many Millions does this cost the NHS every year!

I believe treatment should incur charges when vanity or stupidity lies at the root of it, such as injuries occurring while drunk, plastic surgery for things like boob jobs or straighter noses.
Similarly when a woman's popping out her 5th child into this already crowded world, why shouldn't she pay for the privilege of all the midwives, doctors, medicines and use of a hospital bed?
That would make for a more responsible society when they realise the taxpayer will not pay for their bloodied noses after that night out in the pub, or for their smug irresponsibility in getting pregnant for more children than the world can support.
Repeat after me: we are NOT RABBITS.

The NHS spends around £10 billion each year on drugs, many of which probably create secondary and expensive problems either via side-effects or misdiagnoses.

Self-preservation fades in light of marketing hype and misaligned faith. We accept prescriptions with little question and allow powerful drugs to be administered often on the advice of a single professional.

I therefore propose a mandatory second opinion where the cost of treatment by drugs exceeds a pre-determined limit (say £200).

The NHS needs to take a leaf out of the Motor industry book and implement Kaizen or LEAN at all levels in its organisation. The essence of this method of quality improvement is enabling small groups of staff to come together to devise, try out and implement changes in practice which eliminate waste and improve workflow. It is being tried in many Trusts but perhaps not in a joined up way. (The NHS Institute for Innovation and Improvement is promoting these concepts, but I never hear it mentioned in the media or in interviews.)

Darzi told us its all about Quality and measuring quality. In my field - laboratory medicine - we have being doing this well for half a century and we are the only part of the health service which has an ISO standard (15189) against which laboratories have to be accredited. Other parts of the NHS could learn from this experience (I mentioned this at the end of a Newsnight programme in Leicester last year).

But we have to measure quality properly - not by bean counting against targets, but by assessing real patient outcomes and their true costs and benefits.

The NHS must become much more evidence-based - so much of what is done has poor historical evidence, and even when good quality evidence is produced, best practice may not be rapidly disseminated. Again in laboratory medicine the Royal College of Pathologists is leading the way with an initiative to examine the evidence for new diagnostic tests before they are put into use.

Above all, though, we need the general public to be much better educated and informed about how to keep themselves healthy and how to use NHS resources properly. This is the only long term solution to spiralling demand. The concurrent and related obesity and diabetes epidemics are the prime examples, together with increases in alcohol-related disease. These preventable conditions have the potential to bankrupt the NHS.

Dear poster Brainstrust: Your green blazers sound like voluntary workers to me; they primarily stand around and help people find their way around the hospital. We also have WRVS workers - voluntary. No savings there, I'm afraid!

The NHS spends £40 million a year on providing religious services in hospitals. This could fund approximately 1,300 nurses or 2,500 cleaning staff. Why not make the Church & other religious organisations pay their own way if they wish to have a presence in hospitals. Let's face it they are rich enough.

When the NHS was first set up it had very noble aspirations to help those who were sick and could not afford medical treatment. Life is much more complex now and the NHS is trying to do too much and try to meet the needs of too many people. Even if every penny of taxation was used for the NHS, it will always demand more. The management structure is too complex,unfocused and inefficient. Too many services are being provided and we have lost sight of what the NHS was set up to do in the first place. But, above all, it has created a dependency culture in the nation, so removing responsibility from people to look after their own health by adopting a healthier lifestyle - after all, why should they if the NHS will pick up the pieces.

I completely agree with everyything Leeslaughter has commented on.

Having worked for an NHS department it's clear where the problem lies, too many managers and too many greedy ones at that. The ground level staff care about the NHS and health care. The managers care about what they can get out of it for themselves. Also, do away with the approved suppliers contracts and allow each department to buy from the cheapest supplier. One case I came across was someone getting into trouble for buying a bucket costing £1 from a pound shop when they should have gotten from the logistics provider costing 10 times as much.

My son and his wife moved to France 2yrs age. His wife is French and was 6mths pregnant. The hospital asked for a 2,000e deposit to cover her health care. They then had to pay when she went in to have our grandson. The residue from their initial deposit was returned to them after 18mths. Our grandson had an accident when he was 1yr old and as the families papers had not been processed every visit to the hospital ended with a bill.
Look at how our system works.......
We all have national insurnce nos and medical cards, why do we have them? Is there a connection between them and our healthcare system? If not why not?

Too late for your programme on July 27th, but still ...

You asked if areas like education and defence should be cut to help fund the NHS.

This government, with Opposition support, chose to go to war in Iraq and Afghanistan, with no regard for the priciples of the 'just war', nor the history of past unsuccesful interference by GB in both those regions, and how these wars were to be conducted, paid for, and wound up. The army was thus pitchforked into impossible positions, and further undermined by having its resources cut rather than reinforced. In the last 3 or 4 years the size of the army has been cut; the regimental system, unique to the British Army, and the thing that made it the best in the world, has been destroyed; life-saving and battle-winning equipment has been denied to the fighting forces; soldiers are expected to work an 18-hour day for weeks on end, and to be away from their families most of the time. I know one soldier for whom the last straw was the behaviour of his daughter, asked at school to draw a family tree, which she showed him on one of his rare few days of leave. To his surprise, he saw that he was not on it. "Why should you be?" she asked him. "You're never with us!" And medical care for wounded personnel returning to the UK has been down-graded from excellent to shameful, by the closing of the Service hospitals that used to give excellent care, so that now the injured have often to wait for treatment in long NHS queues, as if their injuries were just the result of chance and in no way the special responsibility of the government, and are often treated in hospitals where they are regarded by other patients and staff as if they are criminals.

Now to add further insult to injury, it is suggested that the army should be deprived of yet more funding - while still being asked to do more and more - so that the NHS may grow ever fatter.

The NHS does great work but is badly and wastefully managed - far too many managers, not enough medical people, too much political correctness at lower levels so that it's more important to have employees of the right race or sex than ones who are best for the job.

I was waiting in a hospital ward a few weeks ago, while someone was cleaning a wheelchair, by wiping a cloth in a perfunctory and zigzag (rather than to and fro) way across its back and seat, and dabbing at some of the other parts such as the arm rests. This is when there is supposed to be a major war against dirt in hospitals. If a soldier looked after his equipment so badly, he'd probably be on a charge.