What can you tell us Yanks about Healthcare in the UK

As I tried to convey... the reason it has to be so complex is because of the sheer size of the workforce, and the number of people it is serving. Physical centralisation is impossible, because you cannot fit 700,000 people in one place. No business in Europe employs as many people, or serves as many people as the NHS does. There is no comparison.

And some things are normal office expenses, sure. And I'm pretty sure most international companies have localised budgeting departments and office managers who deal with the day-to-day expenses of running a branch/subsidiary/local office and have a fair degree of license with these local budgets.

But things like the disposal of clinical waste are not normal expenses. It has to be done in a particular way, at a particular time, taken to a particular place. Checks need to be in place to make sure we are disposing of clinical waste properly at our end, and that whatever company takes it away is dealing with it correctly at theirs.

It makes more sense to have a localised department - a Primary Care Trust - that coordinates this operation for a local area... say, Tower Hamlets.... with a local company or company subsidiary running the disposal programme. If there is an issue with Tower Hamlets clinical waste disposal, you then have a local framework that can deal with the problem far more quickly and effectively than a team of 10 that actually works in Hull and deals with both Tower Hamlets, Bath and part of Southampton.

Why does everything have to be processed and audited?*** Accountability.

You cannot simply prescribe drugs willy-nilly, indefinitely or bill expenses to a central pot without reciepts.

I have no idea how much is spent on ball point pens by the NHS each year, but a pack of 50 costs about £5. So if everyone in the NHS uses 1 ball point pen each year, you are looking at just shy of £150,000 pounds. But they don't. They use at least... five... (10? I, for one, have used at least 20 this year.) not to mention all the patients who walk off with them with alarming regularity... so you're looking at closer to a £700,000. At a very conservative estimate.

If there is no local accountability... no financial administrator working opposite me at my practice to audit local claims... how easy would it be to just bill for a few packs of phantom biros to the central pot? Quick 20 quid there. Or, more pertinently, bill every piece of personal stationary you've ever wanted to the central account? Hell... I could even produce a reciept for the 5 reams of paper I ordered... but no one at central accounting will know that I just took them home.

Similarly, if no one is checking at a local level how often Bethnal Green GP is prescribing powerful painkillers to 25 year old men without serious chronic pain issues, no one can say - "wait a minute... Bethnal Green GP might be defrauding the state here".

Granted, that doesn't happen often.

What does happen with far more regularity is 25 year old man shopping about from GP to GP, attempting to get scripts for Co-Codamol as regular patient in Bethnal Green, and scripts for Co-Codamol as a temp patient in Fulham, and scripts for Co-Codamol as a temp patient in Haringey, scripts for Co-Codamol as a temp patient in... and so on.

We regularly run practice wide audits of patients on repeat prescribed medicines, particularly various high-risk groups of medicines, because you just gots to. You need to know exactly when patients are supposed to be coming off them. When they were put on them. You need to be able to look at why they are on them if certain issues are flagged up, which is a lot easier the lower down the ladder you perform the audit.

And ultimately, someone needs to pay... so everything has to be audited at some point for that to happen. You need to be able to check how much has been spent on Co-Codamol from year to year... otherwise you'll never be able to make informed decisions regarding which drugs to use more of, which to phase out, which are 'in-demand', which need to be monitored more closely etc.
**
Which brings us back to 9,500 requests for the contraceptive pill, alone, per day. **
Could you imagine if 3 staff members from the contraceptive pill department were suddenly knocked out with swine flu for a week and a half? A backlog would develop that would take months to overcome again... drugs would go unpaid for, corners would be cut etc etc.

And as for salaries... again, just not so simple.

I am not contracted to my practice. I forgo holiday pay and so forth for flexibility in my hours. Some weeks I work 37.5 hours, some weeks 23. Sometimes, over 40. I can take three days off when I want, provided I give a week or so's notice. I submit a weekly timesheet of hours and my manager knows exactly what I do with those hours because I work next door to her. She knows I'm putting the effort in and can easily approach me if she needs me to cut or increase my hours from one week to the next. It works for them, because I am a computer literate graduate working for half the pay I could be getting in a private sector job, and it works for me, because the thought of being tied down to a single desk for 8 hours a day, week in week out is still a terrifying prospect. And I believe in the NHS, which helps!

This kind of arrangement would be nigh-on impossible if I directly billed the DoH. Either I'd have to clock in and out constantly, requiring additional infrastructure to be paid for and installed at my practice specifically for me, or I would be able to add an hour here or there without anyone knowing... adding up to to a couple of hundred extra quid a year... if I was so inclined.

As I have said... better IT infrastructure is the single biggest change we can make. That requires investment and a rejection of the mass, conflicting interference from private companies. If we go open-source, IT professionals in departments across the country can tweak the software, improving it constantly for everyone... it will allow the sort of adaptibility and longevity that is utterly impossible with the current IT set-up.

A problem that sums up the absurdity of the current system:

All our computers run Windows, Office and Internet Explorer (except I insist on using Firefox...). We found that after installing Internet Explorer 7, our Patient Administration System could no longer communicate with Microsoft Word. Couldn't do it. It would just freeze when you attempted to perform certain tasks. Internet Explorer 8 fared no better.

In the time between Internet Explorer 7 and 8 were released, the makers of our PAS were able to do nothing to sort this bug out. Mainly because there is no way they can access the source code of Microsoft Word to actually figure out what the hell the problem is. And there is no way Microsoft can be bothered to do a thing about that... time and money wasted in their view. So we can't set our computers to automatically update, because if they download and install the latest Internet Explorer, I have to spend the day going round the practice uninstalling it again, and putting the far more flawed Internet Explorer 6 back on. So I have to spend hours going round each computer manually picking and choosing which updates to install, when. Which takes longer than you'd hope, especially when you scale it up over the course of the year.

This could, quite literally, go on indefinitely... because Microsoft are not going to do anything without significant financial incentive (i.e, the world's third largest employer threatening to go Open-Source), and the PAS company have still, after over a year, made no headway in sorting it themselves.

Okay. I'm done now. I think I just defrauded the NHS out of a good fiver writing all that...

Thread slowing down a bit, what do we think about medical professionals offering to pray for their patients?

I don't think that discussing religion with colleagues should be grounds for dismissal, and of course I don't mind if doctors and nurses pray for their patient in their own time, but keep quiet about it - it doesn't do any harm (or anything else, for that matter).

But I do think it's inappropriate for carers to bring the subject up with their patients ("do you mind if I pray for you?"). The patient is in a vulnerable position and it's despicable to use that as an opportunity for evangelism. Furthermore, any atheists or people with a different set of beliefs will be made to feel uncomfortable about refusal (at the least), for fear that it might prejudice their care. Finally, it's completely unnecessary - does the patient need to know about the prayer for it to work? Isn't that a tacit admission that God isn't really involved at all?

Wouldn't happen under BUPA, I tell you.

yeah sorry. touch of overkill on my part... I apologise. I'll try and return to brief and biting sarcasm... :P

Combining religion and anything in the same thread though? Luckily we are not in America. The thread might survive...

Brief opinion: No place for it unless specifically requested by the patient. Simple.

As I tried to convey... the reason it has to be so complex is because of the sheer size of the workforce, and the number of people it is serving. Physical centralisation is impossible, because you cannot fit 700,000 people in one place. No business in Europe employs as many people, or serves as many people as the NHS does. There is no comparison.

I'm with you on the IT thing, but the above raises the following question.
Why does the NHS employ more people than any other business in europe, when quite clearly europe contains several state healthcare providers each serving populations of a similar or greater size than our own. What are the French or Germans doing that we cannot?

Do we really need 700,000 admin staff, or do we actually need 5000 if everything was run efficiently but just happen to currently employ 700,000 because the process is so inefficient?

Here's the name and number of a doctor who will look at it for you. You will receive no bill. He's a good man, and thorough.

That's really thoughtful but I--

Please see him, Jeffrey. He's a good man, and thorough.

Yanks from MSN - ignore this, your healthcare system has a long way to go before it is beset by these kind of problems

This is required reading:

State Capitalism in Britain

Some key extracts:

The clear political advantage was that the public spending commitments created under these agreements, unlike the government borrowing that would have traditionally have been required for such investment, would not count as public debt.

The original claim for PFI was that it would raise finance that government could not - except that government discovered that contractors could not be found to accept the deals unless the risk was borne by the state and not them. Committed to making PFI work, Gordon Brown had no alternative but to agree terms that saw ‘capitalists' lay claim to future revenues without risking any investment.

The ‘third sector' is a grey area that has grown up where the division between public and private has broken down and many of the laws of classical market competition are inverted. Connecting for Health is an ‘arms length body' created to computerise the NHS. Its funds come in part from government directly, but mostly from the NHS Trusts that ‘contract' CfH to provide IT services. Except that the Trusts have no choice over whether to contract the service and the terms of the contract are secret even from those sitting on Trust boards. The ‘prices' follow no market laws, because CfH has to work, for political reasons.

Much of CfH's work is outsourced to consultancies. Not surprisingly, costs spiraled, while computerisation was painfully slow and inefficient. The ‘Choose and Book' system is estimated to cost £12 billion over the next ten years. Although it was formally launched last year, 90 percent of GPs' surgeries are not yet connected, and CfH admitted that hundreds of patients had to be turned back from appointments that were not properly recorded.

I said this in post No.105.

And this is in the news today.

NHS = Bloody marvellous.

Fantastic posts.

Well it seems the referenced MSNBC political boards have been closed down. All have migrated to MSN's UK political boards. God help England.

Gord help England.

Fixed.

best of craigslist > columbus > We crashed bikes. - m4w Originally Posted: Thu, 18 Jun 17:11 EDT
We crashed bikes. - m4w

Date: 2009-06-18, 5:11PM EDT

I was the dude who swallowed gravel during a cycling disaster at the construction zone near the Blue Danube. You were the "ohhhh shit" out of my right ear moments before impact. Damn, that hurt. Thanks for insisting that I go to the hospital. They charged me $5900 for a cat scan and an 11 hour wait in the ER. You were sure that it would be pretty cheap even though I don't have insurance. You owe me $5900 or a bunch of BJ's; your call.

• Location: Clintonville
  
• it's NOT ok to contact this poster with services or other commercial interests
  

^^That's hilarious. And a bit tragic.

My best friend broke his arm one night ('wrestling' with a guy he fancied at a club) and decided not to go to the ER immediately. When he did finally go (the next day), he learned he would need surgery. He now has a $38000.00 medical bill hanging over his head. He's never going to pay it, of course.

http://www.guardian.co.uk/world/2009/aug/09/obama-healthcare-reform-defeat

A lovely little gem of a quote from the US media via the Register;

http://www.theregister.co.uk/2009/08/12/hawking_british_and_alive/

A lovely little gem of a quote from the US media via the Register;

http://www.theregister.co.uk/2009/08/12/hawking_british_and_alive/

Good find. Shows you how prejudiced and bigoted the US private health'care' lobby can be. Good on Hawking for providing such a good counter-quote.

I don't know - It sounded a bit flat to me.

You have to get it on vinyl, like I did.

Taxes do not pay for the NHS. Your taxes pay the interest on the money your government has borrowed. In the case of the Uk which owes almost 100% of the countries GDP, it borrows from the Bank of England, a private company that produces money.

we have doctor Heather Clark
http://www.prideofbritain.com/contentpages/winners/2000/clark-Mulcahy.aspx

Dr Heather Clark and Dr Alastair Mulcahy performed open-heart surgery on a pub floor, with just a scalpel and a pair of scissors, to save the life of man who had been stabbed.
Heather, 35 had never carried out surgery before, but she had watched a similar operation just two days earlier as part of her training.

Go NHS!

She watched someone perform open-heart surgery on a pub floor as part of her training?
The NHS really needs to sort its budget out!

She watched someone perform open-heart surgery on a pub floor as part of her training?
The NHS really needs to sort its budget out!

I actually lol'd.

I used to live just opposite the A&E for the royal london (where the helicopter is based)

The charming Dr Heather Clark was often to be seen dashing around in her orange jumpsuit like Anneka Rice.

Oh my did my friends and I have a crush on her.

There's something not right about grown women who wear their hair in pigtails.

There's something not right about grown women who wear their hair in pigtails.

keeps it from falling in the pint glasses and ashtrays whilst she's performing surgery innit

free healthcare for all does sound fucking evil when you think about it.

but seriously, i love the NHS, haven't found long waits, good treatment when I need it, even just for minor things, all options explained, not really anything bad to say.