You've got to remember that MRI machines are not automatic. You need radiographers to operate them, radiologists to interpret them, porters to transport patients, and more electricity to run them and the computers.

On top of that, there's bugger all point scanning someone if nothing happens over the weekend as a result. If all the scans are saved to be reviewed during the weekday, Which then has the knock on effect of more work, more delays etc.

If on the other hand, you expect radiologists and all associated staff to work over the weekend, you need to give them compensatory rest (European working time directive) which means fewer staff on during the week. Unless you hire more staff which, at a time when the NHS is trying to save money, isn't going to happen.

A well managed state run enterprise can do as well as private companies. The UK electricity and gas boards were as good as anything that we have now, if not better because they built spare capacity. Private energy generators only invest enough maximise profits with no allowances for extra demands like a severe winter.

There could be designed a better system for all concerned but the current deals that guarantee rewards no matter how bad just tarnish the entire market solutions. Why not bring private managers in to run hospitals without outsourcing. Allow them to take a management fee and a percentage of any surplus. These fees could be lower overall as the managers would not need to put up much money. So could have shorter tougher contracts.

Yes, but capital and financing costs are also greater than just those of the machine. None of which matters because it was just a disposable example. The truth is that if the NHS has spare capacity going unusued for whatever reason, that's wasteful. If the NHS can't address waste through internal measures for any reason, be it political, logistical bureaucratic or whatever, that invites private competitors who feel that they could. If they can, and if you can't, then perhaps they should.

You still need some excess capacity in A&E. If after an incident like a train crash and peopled died because there were no beds that would mean that the government would look incompetent. Obviously for elective surgery they can run at much higher capacity load. It depends on the unit. As for wasted capacity it can be lower cost ie empty unused wards that can be activated rapidly can give flexibility at a much lower cost overall.


Sent from my iPhone using Tapatalk

You still need some excess capacity in A&E. If after an incident like a train crash and peopled died because there were no beds that would mean that the government would look incompetent. Obviously for elective surgery they can run at much higher capacity load. It depends on the unit. As for wasted capacity it can be lower cost ie empty unused wards that can be activated rapidly can give flexibility at a much lower cost overall.


Sent from my iPhone using Tapatalk

WTF?!?!?

The NHS cannot run at 100% capacity otherwise there would be no headroom. As stated, during times of crises you need extra capacity. TBH it is already very close to full capacity the majority of the time in terms of beds/staff/equipment anyway, which is why during say the winter, patients often languish in corridors.

Then it doesn't have spare beds/staff/equipment, in which case the capacity must be expanded as efficiently as possible. Business as usual may not be the most efficient possible way of doing that, so quelle difference.

We both know perfectly well that the NHS is wasteful in some circumstances. I imagine also that we both agree that this is often overstated by those with an axe to grind; nevertheless it is indisputable that cutting waste wherever that may be frees up resources that can be spent on good things we both want more of.

Assets being purchased and then not used to full potential is just a thing that I presented as an example of that sort of general stuff. If you try to bog me down in exact details for a general point I will only change it and focus on some other aspect of waste, which will again only be a general example and so will be equally disposable to me. So unless you feel that the NHS is not wasteful in any regard, there is nothing for you to fight me on here.

Wards that have beds, no staff, but can be activated rapidly with staff at short notice can give sufficient flexibility for most if not all events.


The first place to look is at the management. Artwork for executive offices and large salaries that could be slashed without any impact on service. Then contracts with providers. Having spent a month in a hospital some years ago I saw huge potential for efficiencies in drug dispensing.


Yes but hospitals can share the costs of a MRI machine. It may not be used daily by one trust, but by a number and even hired to private can ameliorate the costs significantly. The biggest waste that I know of is food. If the food were prepared locally and not simply reheated the chances are that it might be eaten rather than left and thrown away. It would also help if there were additional assistants brought in to help the elderly eat. If they starve in hospital then the hospital is creating blockages. It would be simpler to get people in to help them eat and maintain body strength than leave them to it and deal with the consequences later. IV drips are much more expensive to administer to keep someone alive.

Maintaining small specialist units all over the place that perform complex surgery on a very small number of patients who subsequently die because the small units weren't shut down and consolidated is another example. It wastes lives as well as money and the NHS has been told to stop it decades since, but yet persists. Politicians don't want their names associated with hospital or unit closures, so professional clinical advice gets ignored.

The NHS could be reformed in many ways, but allowing temporary political masters to direct long term strategies that will inevitably either be paid for by their successors or obliterated by new policies is not the way to start. It's better to give them a long term budget, a board of directors, and a committee in the House of Commons to report to every few months. Then let the NHS untangle itself without undue interference.

None of us is old enough to remember a time when the NHS wasn't being urgently reformed to save it from itself. That fact suggests that none of the previous reforms have done a lot of good. And that in turn indicates that the first place to look for a solution is to the failings of that very process, which itself is notably unreformed thus far. Without that task taken in hand, I see little merit in focusing on the particulars of any proposed reform - they all have failure built into them.

This. Arguing between the solutions we've already tried before is pointless, they've all failed. And as much as we may talk about efficiency and good governance, the bare fact is the NHS will spend every single penny it is given. The NHS will never cost less because medical care of a large population is an insurmountable burden. It will just possibly provide a better service for the money we collectively give it but that's about all.



When I was in hospital after my car crash, I had regular x-rays to see how well the various smashed up bits of me were putting themselves back together. Quite frequently when sat waiting my turn I would see other patients with their medical folders waiting for examination along with me and their folders were patently from the local private hospital rather than the institution they were sat in. I did wonder what they thought, after having shelled out all that cash, finding themselves queuing with all the non-paying proles.

Equally, some years later, I had to go for an ultrasound examination for another condition. That happened at the local private hospital, paid for by the trust I was with. So I think it does work both ways, at least with diagnostic equipment.

Jon

Erm... how exactly?

Labour do not have a majority - otherwise they'd be in government.

There was a significant portion of the Tory party who weren't at all happy about the proposals and it's passage through the house was far from smooth. Labour however pretty much failed to put any more than half-hearted pressure on the back-benchers to stand up to the whips office. They also didn't make enough of the fact that this was something the liberals had said they were against in their manifesto.

Basically, the bill was a cracking point for the coalition but labour failed miserably to stick a crowbar in it and pull. If they had, it would probably have been the bill or the coalition and nobody thinks the Tories have enough principles to sacrifice power, even over that bill.

They could have stopped it, if they'd worked hard enough. They didn't.

The only thing I know about waste in the nhs (despite the fact that my wife works in commissioning) is when I had physio and saw a copier unplugged in a corridor once a week for 12 weeks. It's the same copier I have in my office. And I got a good deal on that copier at £375 a month.

I was and still am very concerned that my local hospital is spending that much money on a copier that is unplugged and unused. Who the [LIFTED] was in charge of that decision?

What exactly is it you think the LibDems said they were against?

Because I've read the 2010 manifesto just now and I can't see a reference. The nearest I can find is, from page 43,



However all that says is that any current imbalance in favour of private companies will be got rid of; it does not say that private sector involvement would be got rid of.

Moreover it was Tories that promised not to introduce major top-down reforms; I can see several proposed major reforms from the LibDems.

maybe if we stopped NHS tourists the NHS would be fit for purpose
management are really something else (my opinions are known on management)

http://www.bbc.co.uk/iplayer/episode/b0 ... _Tourists/

unless the law changes there will not be a NHS ...