PM May's NHS cash boost promise prompts Keynesian Guardian editorial

[StringJunky]

7 minutes ago, CharonY said:

Ultimately, what sells are things that maximize convenience and minimize errors, as the latter can skyrocket costs in the medical field. While there have been pushes toward reducing carbon footprint, the increasing danger of resistant infections have pushed some to go the "better safe than sorry" route. 

There's always the yet-to-be-known pathogenic agents to consider and I think prions are pretty hard to get rid of. I think as long as using whatever is a clinical decision, it's the right thing to use.

Edited June 21, 2018 by StringJunky

[John Cuthber]

Essentially, washing up is unreliable and time consuming.
The economics are such that, even in an analytical chem lab (where patient safety isn't an issue) it's cheaper to use disposable bits and pieces , and it has been for decades.

So the kit which is designed to be used in hospitals is designed to be used with disposable stuff.
Trying to use reusaeable stuff would be the "inneficiet" way to do it, because that's not how the system is set up.
I suspect that adding  a political dogma induced layer of "internal market" may have made more difference to the costs- and not in a good way.

[StringJunky]

15 minutes ago, John Cuthber said:

Essentially, washing up is unreliable and time consuming.
The economics are such that, even in an analytical chem lab (where patient safety isn't an issue) it's cheaper to use disposable bits and pieces , and it has been for decades.

So the kit which is designed to be used in hospitals is designed to be used with disposable stuff.
Trying to use reusaeable stuff would be the "inneficiet" way to do it, because that's not how the system is set up.
I suspect that adding  a political dogma induced layer of "internal market" may have made more difference to the costs- and not in a good way.

Can you elaborate on the bolded bit?

[John Cuthber]

7 hours ago, StringJunky said:

Can you elaborate on the bolded bit?

Does this clarify things?

https://www.spectator.co.uk/2018/02/the-nhss-internal-market-is-an-expensive-catastrophe/

[Phi for All]

8 hours ago, John Cuthber said:

Does this clarify things?

https://www.spectator.co.uk/2018/02/the-nhss-internal-market-is-an-expensive-catastrophe/

Quote

But the NHS really started to embrace market principles with Gordon Brown’s ‘mixed economy of care’, which saw the health service open up to competition to provide services, creating a ‘purchaser-provider split’. 

This is what I was afraid of. "Mixed economy" = "Let's have more private profit using public funds!" "Competition" = "Enact laws to make it harder for the NHS to compete."

It makes as much sense to me as planting bamboo along with the vegetables. It's practically impossible to successfully regulate the different growth rates. 

[StringJunky]

37 minutes ago, Phi for All said:

This is what I was afraid of. "Mixed economy" = "Let's have more private profit using public funds!" "Competition" = "Enact laws to make it harder for the NHS to compete."

It makes as much sense to me as planting bamboo along with the vegetables. It's practically impossible to successfully regulate the different growth rates. 

What's social healthcare got to do with growth? That side can only lose in the face of profiteering.

[DrP]

On ‎21‎/‎06‎/‎2018 at 8:48 PM, John Cuthber said:

 

I haven't seen much evidence of corruption in the NHS

I was talking about the management of the funds that were pumped into the NHS that I was discussing earlier. One hospital given their wish list....   all the others given the exact same items from the first hospitals wish list regardless if the kit was required, already owned, or if there were better ways to use the money in other hospitals.  I can't believe it was incompetence that wasted all that money.

One example was a brand new oncology building that was sent a load of new kit it did not need as it already had it all...  the hospital down the road had a wish list for different kit (as it didn't have the oncology ward) but received the exact same kit list as the other hospital. They claimed it was a waste because they didn't need the kit (because the hospital up the road was the cancer centre, not this one) and that they were left totally unfunded for the A&E dept that was their focus.

Was this one of the most incompetent money management roll outs of all time or a scam to sell a lot of oncology kit to the taxpayer? I guess with a bulk by of all the same items they could save a packet without having to deal with each individual pesky hospitals requests to fulfil their actual needs. The shares in the companies that got the contracts would have taken an up turn and everyone would have been happy.... apart from the actual NHS and the people that use and fund it.

 

I'll tell you what else stinks!? I can't find any record of that Jeremy Vine documentary anywhere since it was aired on the BBC all those years ago. I've searched for reference to it and there is nothing.  Someone has deleted it or told someone to remove it and cover it up? Where is it? Vine was actually crying in the video saying that if the spending of the money had been even slightly targeted to what each hospital needed then it would have been an amazing boost to the NHS and exactly what it needed - we had the chance to make targeted improvements with a heck of a lot of money and it was wasted.  

[Phi for All]

It's a real red flag to me when a social program is in trouble because they've spent funds unwisely, and the only political recourse is to give them more money. "Desperate" measures often reap profit for those suggest the need for them. Qverstocking equipment or trying to make a one-size-fits-all-for-convenience kit doesn't sound like a group focused on efficient healthcare, but rather a group looking to funnel more public funds to private vendors who equate "better" with "more". 

Still, I wish the US had your system. Your corruptions are tiny by comparison. I think involving private business heavily in publicly funded programs without heavy regulation is a mistake many democracies make. 

[CharonY]

5 hours ago, DrP said:

One example was a brand new oncology building that was sent a load of new kit it did not need as it already had it all...  the hospital down the road had a wish list for different kit (as it didn't have the oncology ward) but received the exact same kit list as the other hospital. They claimed it was a waste because they didn't need the kit (because the hospital up the road was the cancer centre, not this one) and that they were left totally unfunded for the A&E dept that was their focus.

I assume "kit" refers to equipment, rather than consumables? Do you have a report on this? It sounds weird that in the UK hospitals would not  put in their own requests. If it is an actually consumable kit, it would be even weirder.

[DrP]

2 hours ago, CharonY said:

I assume "kit" refers to equipment, rather than consumables? Do you have a report on this? It sounds weird that in the UK hospitals would not  put in their own requests. If it is an actually consumable kit, it would be even weirder.

I mean kit as in machines and refits yes, not consumables  -  I got all this from a documentary I saw a few years back presented by Jeremy Vine on BBC2 I think. I watched it with my wife. I haven't seen it since and have not been able to find record of it anywhere I am sorry   -  I'll search for it again. I suppose it is possible I imagined it but I am pretty certain that isn't the case.   I am not saying it was covered up or anything but it just seemed weird we couldn't find it again - although he does a lot of presenting so searching for the program might not be that easy from years back, sorry.

[StringJunky]

8 hours ago, DrP said:

I was talking about the management of the funds that were pumped into the NHS that I was discussing earlier. One hospital given their wish list....   all the others given the exact same items from the first hospitals wish list regardless if the kit was required, already owned, or if there were better ways to use the money in other hospitals.  I can't believe it was incompetence that wasted all that money....

I think this was symptomatic of an ill-acquired management trained in business techniques - as was common then - that had no clue as to the requirements of each hospital and instead treating each one as identical clones of a franchise.  Health administration on a universal healthcare platform, like the NHS, is whole different ball game.

Edited June 26, 2018 by StringJunky

[Phi for All]

41 minutes ago, StringJunky said:

I think this was symptomatic of an ill-acquired management trained in business techniques - as was common then - that had no clue as to the requirements of each hospital and instead treating each one as identical clones of a franchise.  Health administration on a universal healthcare platform, like the NHS, is whole different ball game.

If you've got politicians banging on about how some good old-fashioned business techniques are needed to get the NHS shipshape, just line them up against the wall and shoot them now. It will save you 60 years of bloodsucking corruption.

[StringJunky]

10 minutes ago, Phi for All said:

If you've got politicians banging on about how some good old-fashioned business techniques are needed to get the NHS shipshape, just line them up against the wall and shoot them now. It will save you 60 years of bloodsucking corruption.

Here, here!   I would just say "Look at America". I can remember Maggie holding up the US as an example of the way to go as a model of economic efficiency. The inflexibility and political aspirations of the unions at the time precipitated the change from a socialist outlook to a more capitalist one. The unions were terrible.

Edited June 26, 2018 by StringJunky

[Phi for All]

8 minutes ago, StringJunky said:

Here, here!   I would just say "Look at America". I can remember Maggie holding up the US as an example of the way to go.

One thing to look for: whenever a publicly-funded program gets an injection of "competitiveness" from a private vendor, they almost always have to kneecap the public program to get an even playing field so the private group can "compete". Private funding has to do everything public funding does PLUS make a profit.

11 minutes ago, StringJunky said:

The inflexibility and political aspirations of the unions at the time precipitated the change from a socialist outlook to a more capitalist one. The unions were terrible.

Or... OR... since the efficiency experts of the 60s and 70s ran out of ways to reduce the bottom line, in the 80s and 90s the intense desire for cheaper labor and automation led many industrialists to invest in breaking up unions that demanded consistent compensation and beneficial workplace protocols. In the US, this led famously to the decoupling of productivity and middle class wages, which has caused so many of the problems we see today.

[StringJunky]

29 minutes ago, Phi for All said:

One thing to look for: whenever a publicly-funded program gets an injection of "competitiveness" from a private vendor, they almost always have to kneecap the public program to get an even playing field so the private group can "compete". Private funding has to do everything public funding does PLUS make a profit.

Or... OR... since the efficiency experts of the 60s and 70s ran out of ways to reduce the bottom line, in the 80s and 90s the intense desire for cheaper labor and automation led many industrialists to invest in breaking up unions that demanded consistent compensation and beneficial workplace protocols. In the US, this led famously to the decoupling of productivity and middle class wages, which has caused so many of the problems we see today.

Do you think unions were the same though between the US and UK. Our unions at the time were pretty hard left, even by UK standards.

[Phi for All]

1 minute ago, StringJunky said:

Do you think unions were the same though between the US and UK. Our unions at the time were pretty hard left, even by UK standards.

Probably not. Like any organization, a union is subject to pressures from within and without. The ideal goal, imo, should be stability and safety wrt the workplace and its compensation. In the US, union workers were able to participate in the economy more robustly than the rest of the working class. 

Sometimes I wonder if some union leaders went too far left on purpose in order to help facilitate union busting. Many modern practices mask efforts to keep workforces from unionizing.

https://en.wikipedia.org/wiki/Union_busting

Quote

Nathan Shefferman published The Man in the Middle, a 292-page account of his union busting activities, in 1961. Shefferman described a long list of practices which he viewed as tangential to union avoidance activities but which his detractors have labeled as support operations for these activities. Among these were the administration of opinion surveys, supervisor training, employee roundtables, incentive pay procedures, wage surveys, employee complaint procedures, personnel records, application procedures, job evaluations, and legal services. As part of his union busting strategies, all of these activities were performed with the goal of maintaining complete control of the work force by top management. Shefferman's book not only provided the concepts that animated all future union busting techniques, he also provided language that pro-labor supporters believe mask the intent of the policies.

 

[CharonY]

3 hours ago, StringJunky said:

I think this was symptomatic of an ill-acquired management trained in business techniques - as was common then - that had no clue as to the requirements of each hospital and instead treating each one as identical clones of a franchise.  Health administration on a universal healthcare platform, like the NHS, is whole different ball game.

It would be really strange if it was done that way. Even with inept management, instrumentation requests usually comes from the units, not from the top. In really top-heavy systems the request would got through many, many  levels with a lot of requirements  and paperwork (e.g. ensuring that equipment is needed, is compatible what is there, is the cheapest available etc.). As a result there are often huge delays, or the equipment may not be ideal (e.g. because one had to get the cheaper one as the request did not outline all the requirements for tendering).

There may be rare situations when stuff suddenly comes in (e.g. donations), but I would think it was really strange if it happened on a routine basis. As such I am really curious about reports of that level of mismanagement.

[StringJunky]

19 minutes ago, CharonY said:

It would be really strange if it was done that way. Even with inept management, instrumentation requests usually comes from the units, not from the top. In really top-heavy systems the request would got through many, many  levels with a lot of requirements  and paperwork (e.g. ensuring that equipment is needed, is compatible what is there, is the cheapest available etc.). As a result there are often huge delays, or the equipment may not be ideal (e.g. because one had to get the cheaper one as the request did not outline all the requirements for tendering).

There may be rare situations when stuff suddenly comes in (e.g. donations), but I would think it was really strange if it happened on a routine basis. As such I am really curious about reports of that level of mismanagement.

This was the 80's or 90's.

[iNow]

Meanwhile, the US continues to show the power of the FREE MARKET!! to drive healthcare costs down way way way (abso-freaking-unreasonably-lutely way way) UP!

https://www.vox.com/2018/6/28/17506232/emergency-room-bill-fees-health-insurance-baby

Quote

A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill. <...> They owed the hospital $18,836 for the 3 hour and 22 minute visit, the bulk of which was for a mysterious fee for $15,666 labelled “trauma activation,” which sometimes is known as “a trauma response fee.”

<...>

American hospital bills today are littered with multiplying fees, many of which don’t even exist in other countries: fees for blood draws, fees for checking the blood oxygen level with a skin probe, fees for putting on a cast, minute-by-minute fees for lying in the recovery room.

<...>

After Alexa Sulvetta, a 30-year-old nurse, broke her ankle rock climbing at a San Francisco gym this past January, she faced an out-of-pocket cost of $31,250. <...> 

The hospital charged Sulvetta a $15,666 trauma response fee, a hefty chunk of her $113,336 bill. Her insurance decided that the hospital fees for the one-day stay were too high, and — after negotiations — agreed to pay only a charge it deemed reasonable. The hospital then went after Sulvetta for $31,250.

“My husband and I were starting to think about buying a house, but we keep putting that off because we might need to use our life savings to pay this bill,” she said.

<...>

An ibuprofen, two medical staples — and a $26,998 bill <...> Sam Hausen, 28, was charged a $22,550 trauma response fee for his visit to Queen of the Valley Medical Center in Napa, California, last January. <...> He was at the hospital for only about half an hour for a minor cut on his head, and he didn’t even need X-rays, CAT scans, or a blood test. “The only things I got were ibuprofen, two staples, and a saline injection. Those were the only services rendered. I was conscious and lucid for the whole thing,” said Hausen.

 

[DrP]

21 hours ago, StringJunky said:

This was the 80's or 90's.

I'm talking about the 0ties I think...  the Blair/Brown government  -  they pledged so many billion to the NHS... but spent it like twats (or con men - depending upon what actually happened).