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<blockquote data-quote="Yorksman" data-source="post: 373504" data-attributes="member: 55568"><p>Well that method fails spectacularly:</p><p>2008 £102.1 bn</p><p>2009 £109.7 bn</p><p>.....</p><p>2014 £129.9 bn</p><p>2015 £133.2 bn</p><p></p><p>It's just a line which doesn't stand up to any scrutiny at all.</p><p></p><p>Cost control is of course a serious issue and it is a problem for any system of health delivery, not just the NHS. Even insurance funded schemes entirely in the private sector suffer from it. The question is, how does one control costs? The evolutionary approach, whereby finances are squeezed in order to ensure a survival of the fitest doesn't work. The <em>'dead wood'</em> doing <em>'non jobs'</em> to use the 1980s terminology proved remarkably resilient and even thrived. They were simply better able to adapt to changing circumstances than their medically trained colleagues who tended to not pay too much attention to the way things were run and who wanted to concentrate on their vocation.</p><p></p><p>Freeing up the financial constraints and pouring in cash, up from £36 bn to £102 bn between 1997 and 2008, into a new target driven model didn't work either. It simply resulted in empire building, an endorsement of Parkinson's Law which states that work expands to fill the time, [and money], available. Hence out of 1,700,000 staff, only about 535,000 are anything to do with medicine, and that includes the ambulance drivers. What are the other 1,165,000 people doing? Switching the nature of the targets to targets based on delivery of service simply results in more manipulation. For example 3 hospitals with maternity services in Huddersfield and 3 hospitals with maternity services in Halifax results in a rationalisation whereby only one hospital in Huddersfield and only one hospital in Halifax end up with maternity services. But, why stop there? Merge Huddersfield and Halifax and why have two when one will do? Lets not bother having maternity services in Huddersfield and have them all in Halifax. When they tell you about 'patient choice' and improvement in service, you can be sure it is all about cutting back on the spend. But, as we see, the staff numbers and costs keep rising. Result is an increase in the number of births in ambulances during the rush hour traffic jams on the Elland by pass. The decision to attempt to stop heart surgery in another hosital has nothing to do with quality of service, it is just a high cost which takes up a disproportionate amount of budget. What excuse can we possibly come up with to free ourselves from this inconvenient burden and shift the problem onto someone else?</p><p></p><p>Seriously, I have been told that no one wants to go into heart surgery as it is too difficult. Yeah right, all those students who do 7 years at uni before they even start to train in surgery turn their backs on brain surgery, heart surgery and neurosurgery because they all have burning ambitions to do piles and peptic ulcers.</p><p></p><p><em>"like giving surgeries incentives to have healthier patients who will cost less in the long run"</em> is a polictical line. It's just spin and has nothing to do with the reality. It is the sort of thing a health minister says because he doesn't know how to save costs but has to be seen to be doing something. It's up there with those other sad excuses of having to fight this war to save civilisation or having to impose austerity to ensure prosperity. I would like to know why the NHS is the 4th largest emplyer in the world with a non medical to medical staff ratio of 2:1. It is in the proliferation of the non medical staff and in the poor quality of the decisions of the management where the money is wasted.</p></blockquote><p></p>
[QUOTE="Yorksman, post: 373504, member: 55568"] Well that method fails spectacularly: 2008 £102.1 bn 2009 £109.7 bn ..... 2014 £129.9 bn 2015 £133.2 bn It's just a line which doesn't stand up to any scrutiny at all. Cost control is of course a serious issue and it is a problem for any system of health delivery, not just the NHS. Even insurance funded schemes entirely in the private sector suffer from it. The question is, how does one control costs? The evolutionary approach, whereby finances are squeezed in order to ensure a survival of the fitest doesn't work. The [i]'dead wood'[/i] doing [i]'non jobs'[/i] to use the 1980s terminology proved remarkably resilient and even thrived. They were simply better able to adapt to changing circumstances than their medically trained colleagues who tended to not pay too much attention to the way things were run and who wanted to concentrate on their vocation. Freeing up the financial constraints and pouring in cash, up from £36 bn to £102 bn between 1997 and 2008, into a new target driven model didn't work either. It simply resulted in empire building, an endorsement of Parkinson's Law which states that work expands to fill the time, [and money], available. Hence out of 1,700,000 staff, only about 535,000 are anything to do with medicine, and that includes the ambulance drivers. What are the other 1,165,000 people doing? Switching the nature of the targets to targets based on delivery of service simply results in more manipulation. For example 3 hospitals with maternity services in Huddersfield and 3 hospitals with maternity services in Halifax results in a rationalisation whereby only one hospital in Huddersfield and only one hospital in Halifax end up with maternity services. But, why stop there? Merge Huddersfield and Halifax and why have two when one will do? Lets not bother having maternity services in Huddersfield and have them all in Halifax. When they tell you about 'patient choice' and improvement in service, you can be sure it is all about cutting back on the spend. But, as we see, the staff numbers and costs keep rising. Result is an increase in the number of births in ambulances during the rush hour traffic jams on the Elland by pass. The decision to attempt to stop heart surgery in another hosital has nothing to do with quality of service, it is just a high cost which takes up a disproportionate amount of budget. What excuse can we possibly come up with to free ourselves from this inconvenient burden and shift the problem onto someone else? Seriously, I have been told that no one wants to go into heart surgery as it is too difficult. Yeah right, all those students who do 7 years at uni before they even start to train in surgery turn their backs on brain surgery, heart surgery and neurosurgery because they all have burning ambitions to do piles and peptic ulcers. [i]"like giving surgeries incentives to have healthier patients who will cost less in the long run"[/i] is a polictical line. It's just spin and has nothing to do with the reality. It is the sort of thing a health minister says because he doesn't know how to save costs but has to be seen to be doing something. It's up there with those other sad excuses of having to fight this war to save civilisation or having to impose austerity to ensure prosperity. I would like to know why the NHS is the 4th largest emplyer in the world with a non medical to medical staff ratio of 2:1. It is in the proliferation of the non medical staff and in the poor quality of the decisions of the management where the money is wasted. [/QUOTE]
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