Ah'm no' a free marketeer, but...

[Brainwrong]

The NHS should be not be privatised but, I think there are parts of it that it's patently shit at that, putting out to tender could resolve.

It's not very on-message for a leftie but I think I'm right (no pun intended).

Thoughts?

 

[Jack]

And how much of the already tight NHS budget should be put aside to line the pockets of these companies. Companies I might add that haven't exactly covered themselves in glory down south or indeed, as far as I'm aware, anywhere they've operated.

 

[Smurf]

And how much of the already tight NHS budget should be put aside to line the pockets of these companies. Companies I might add that haven't exactly covered themselves in glory down south or indeed, as far as I'm aware, anywhere they've operated.

And there's no money wasted in the NHS?

 

[egb_hibs]

I think healthcare should be free at the point of use, but how it is delivered should be open to what works best around the world - which seems to me to rule out the basket case of American healthcare but provides models to learn from elsewhere. I am sceptical of referral services being private as this can be skewed by commercial interests (i.e. People referred to lucrative services they don't need). In terms of those providing required treatment, as long as that is of high quality and remains free to the patient I completely fail to see why we need to be wedded to a supply model.

 

[Brainwrong]

And how much of the already tight NHS budget should be put aside to line the pockets of these companies. Companies I might add that haven't exactly covered themselves in glory down south or indeed, as far as I'm aware, anywhere they've operated.

How much of the NHS budget is already spunked on shite infrastructure? There must already be a budget for the crappy companies and cowboys you're on about. And, how much money & time is lost due to historic mistakes and errors of judgement by management and by the companies you refer to?

I'm not talking about bleeding funds, I'm talking about doing things better, stuff that the NHS isn't and was never designed to do or absorb.

 

[Dub]

And there's no money wasted in the NHS?

I shudder to think how much is wasted. When I was in hospital a light bulb in the toilet went out and the staff had to wait until an external company sent a man in to change it at a cost [he told me] of £50.00. That's only a small instance but there will be many more. Surely an orderly could and would get on a step ladder to change a lightbulb at no obvious cost other than the bulb itself.

 

[Brainwrong]

Which parts specifically Brainwrong?? I see no merit whatsoever in privatising any part of the NHS only for whomsoever tenders coming back to ask for subsidies as happened with the railways. Do we all fuckin zip up the back here??? The NHS do a fantastic job on a severely restricted budget, a decent wedge of which already goes to agency nurses who are earning around twice the hourly rate of state registered NHS nurses.

What next?? Management consultants being called in with their "land and expand" and "risk and reward" schemes designed to bleed companies of fees based on savings....not efficiency or profit, but the simple act of making cuts.

Leave the NHS alone....no privatisation or tendering out of any part of it. Some service industries do not lend themselves to privatisation and the infestation of the fat cats.

Cheers
`

I think the left, and I include myself in that, need to get over ourselves and realise that parts and aspects of the NHS and it's patients would genuinely benefit from being opened up to the market.

Here's an example I don't think anyone could argue in favour of;

Every time I go into a GP, Hospital or NHS Health Centre or whatever, they're all using different feckin' IT systems. Some terrible, some decent. The decent ones tend to be because the GPs put a bit of effort into their practices and see the value in a stable, easy to use, trustworthy IT system, they're (GPs) often ahead of the curve in this respect. But, they can be as innovative as they want but they'll never be able to affect change in the fact that there are, as far as I can see, zero integration points between any of these systems.

So, a real world scenario is; GP wants/needs to pass patients notes to the hospital or elsewhere, or, the hospital requests the notes. These notes are then printed off at the GP practice, Faxed to the hospital, picked up, manually entered into the system by admin resource and hopefully associated with the correct patient records. There are a few more steps in there, including getting the fax to the right person/department etc. But, you can see how much of a ridiculous system, or lack thereof, it is from that example, shirley?

However, I would not expect the NHS to be brilliant at IT, that's not their skillset. But, I would expect our governement to make sure that the infrastructure is solid, stable, quick and efficient, allowing medical professionals to do their jobs without having to worry about all this pish.

This is where the market can help. If I had the time and resources I'd totally be doing this. Making things better. If I won the lottery, I'd set up an innovation foundation to look for the issues in the NHS that technology can solve and solve them. Our own altruistic Silicon Valley.

I'm left as fuck but I'm not going to just say no to help because it's traditionally Tory as fuck to utilise the corporate world.

Agree with EGB too; Free at point of service, of course.

 

[Jack]

And there's no money wasted in the NHS?

There is but privatisation wouldn't fix that.

 

[Jack]

I think the left, and I include myself in that, need to get over ourselves and realise that parts and aspects of the NHS and it's patients would genuinely benefit from being opened up to the market.

Here's an example I don't think anyone could argue in favour of;

Every time I go into a GP, Hospital or NHS Health Centre or whatever, they're all using different feckin' IT systems. Some terrible, some decent. The decent ones tend to be because the GPs put a bit of effort into their practices and see the value in a stable, easy to use, trustworthy IT system, they're (GPs) often ahead of the curve in this respect. But, they can be as innovative as they want but they'll never be able to affect change in the fact that there are, as far as I can see, zero integration points between any of these systems.

So, a real world scenario is; GP wants/needs to pass patients notes to the hospital or elsewhere, or, the hospital requests the notes. These notes are then printed off at the GP practice, Faxed to the hospital, picked up, manually entered into the system by admin resource and hopefully associated with the correct patient records. There are a few more steps in there, including getting the fax to the right person/department etc. But, you can see how much of a ridiculous system, or lack thereof, it is from that example, shirley?

However, I would not expect the NHS to be brilliant at IT, that's not their skillset. But, I would expect our governement to make sure that the infrastructure is solid, stable, quick and efficient, allowing medical professionals to do their jobs without having to worry about all this pish.

This is where the market can help. If I had the time and resources I'd totally be doing this. Making things better. If I won the lottery, I'd set up an innovation foundation to look for the issues in the NHS that technology can solve and solve them. Our own altruistic Silicon Valley.

I'm left as fuck but I'm not going to just say no to help because it's traditionally Tory as fuck to utilise the corporate world.

Agree with EGB too; Free at point of service, of course.

Phew! Don't know where to start.

GPs, as in surgeries in Primary Care, have a choice of 2 systems. Both are able to give and take information to the other i.e. when a patient transfers to another practice. GPs of the practice were considered to be the "owners" of these records.

Both systems can transfer information to Seconday Care, hospitals. It's not really transfer though as the information is always available, see below.

I'm not sure if dentists, opticians and the like have the same systems but they too are compatible with the system.

Secondary Care have their own system but like the others it's capable of transferring information. The NHS "own" this information.

I'm not sure what you mean by Health Centre as you mention this separately from the others. The official term means a location normally made up from a number of GP practices but often includes other services. There are also places like the Leith Community Treatment Centre. They provide Secondary Care facilities, like x-ray, in the community. See systems above.

Because of patient confidentiality not all the information is available to everyone on the system. I'm fact I can't think of any individual that would have access to the whole system.

So, for example, the paramedics that turn up only get very basic information.

The protocols around who sees what is well established through agreements with the various users although in the time I was there there was always some group wanted to see more so it was always under review.

Most of Secondary Care is paper light. More and more GP practices around Scotland are becoming paper light.

All this was in place before I retired almost 4 years ago and when I left they were still looking at ways this could be improved.

In England they tried for years and spunked 100s of millions of pounds on an all singing, all dancing single system before deciding it wasn't possible. I'm fairly certain they eventually went down the Scottish route of having a small number of approved systems that are compatible.

 

[FTJT]

there's plenty to get into but as others have touched on, there is absolutely no record of private involvement in the NHS being anything other than expensive, inept, or both. It's never worked here and it doesn't really work anywhere else - the NHS is phenomenally cheap for what it does, and honestly the main cash bleeds are those where the private sector has a foot in the door - PFI facilities contracts, agency nurses, private surgery, contractual obligations to purchase branded drugs (rather than operate through CMU, or whatever the Scottish equivalent is as I don't think Scotland uses DH procurement).

IT is actually a great example because money has been haemorrhaged due to low-bid procurement rules forcing NHS Trusts to buy shit services from multinational cowboys hawking an unsuitable system (NPfIT gave...Siemens? I think? an absolute shitload of cash for absolutely fuck all end product and years wasted), rather than creating something to spec. The IT systems that work really well in my experience have been either those created within the NHS, within academia, or - very occasionally - those with extraordinarily specific design docs.

It's also worth noting that the single biggest obstacle to good IT systems in healthcare is the absolutely massive barrier to interoperability provided by a) data protection requirements and b) fragmentation of NHS commissioning - nobody's empowered to buy one big system, and even if they were, nobody would be allowed to use it. Services that actually are structured and commissioned on a national level within the NHS - the full-on statist bits, eg speciality surgery, cancer hospitals - are the services where the NHS is world-leading.


(This may have been a bit rambling - sorry if so)

 

[egb_hibs]

I tend to agree on the IT side which I know a bit about though not in the healthcare sector. While I think data issues are probably not as much of a barrier as (understandably) cited - other sectors have equivalent challenges - IMHO a single unifying system on NHS scale is unlikely to be achievable.

That said, imaginative use of tech can help healthcare. I remember hearing somewhere about some attempt to create a unified diagnostic system which was the kind of farrago FT alludes to. However, the wiki model would allow such a thing to be self created by doctors around the world for buttons. You'd need some kind of governance over it, but I'm sure that's not beyond the wit of the WHO, national medical association or whatever body or bodies would be applicable.

[MENTION=9931]Jack[/MENTION] I congratulate you as representing NHS management in Scotland for what sounds like a sensible, bullshit avoiding, approach.

 

[Brainwrong]

Phew! Don't know where to start.

GPs, as in surgeries in Primary Care, have a choice of 2 systems. Both are able to give and take information to the other i.e. when a patient transfers to another practice. GPs of the practice were considered to be the "owners" of these records.

Both systems can transfer information to Seconday Care, hospitals. It's not really transfer though as the information is always available, see below.

I'm not sure if dentists, opticians and the like have the same systems but they too are compatible with the system.

Secondary Care have their own system but like the others it's capable of transferring information. The NHS "own" this information.

I'm not sure what you mean by Health Centre as you mention this separately from the others. The official term means a location normally made up from a number of GP practices but often includes other services. There are also places like the Leith Community Treatment Centre. They provide Secondary Care facilities, like x-ray, in the community. See systems above.

Because of patient confidentiality not all the information is available to everyone on the system. I'm fact I can't think of any individual that would have access to the whole system.

So, for example, the paramedics that turn up only get very basic information.

The protocols around who sees what is well established through agreements with the various users although in the time I was there there was always some group wanted to see more so it was always under review.

Most of Secondary Care is paper light. More and more GP practices around Scotland are becoming paper light.

All this was in place before I retired almost 4 years ago and when I left they were still looking at ways this could be improved.

In England they tried for years and spunked 100s of millions of pounds on an all singing, all dancing single system before deciding it wasn't possible. I'm fairly certain they eventually went down the Scottish route of having a small number of approved systems that are compatible.

I know you know your stuff. And i have no intention of being contrary to someone who has worked in this field for many years. Other than to say, are you saying that the transfer of information from GP to Hospital is a simple electronic transfer?

Yes, leith community treatment centre is an example of what I was attempting to allude to with health centres.

When we're talking IT systems, all I'm talking about is integration points which, have been shown to me to be, and of course I'm relying on friends in the bidniz, so, purely anecdotal, totally nonexistent. Certainly in non manual sense.

When I talk about innovation, I'm talking about bridging these gaps.

I have to admit id not put a massive thought into data protection as it's all the NHS and it's purely a thought not a design, spec & build.


Sent from my iPhone using Tapatalk

 

[Jack]

I know you know your stuff. And i have no intention of being contrary to someone who has worked in this field for many years. Other than to say, are you saying that the transfer of information from GP to Hospital is a simple electronic transfer?

Yes, leith community treatment centre is an example of what I was attempting to allude to with health centres.

When we're talking IT systems, all I'm talking about is integration points which, have been shown to me to be, and of course I'm relying on friends in the bidniz, so, purely anecdotal, totally nonexistent. Certainly in non manual sense.

When I talk about innovation, I'm talking about bridging these gaps.

I have to admit id not put a massive thought into data protection as it's all the NHS and it's purely a thought not a design, spec & build.


Sent from my iPhone using Tapatalk

When you're in hospital your discharge summary is sent via snail mail back to the GP practice. I don't know why this is still the case. There's no technical reason.

There is an issue here though where in some areas the number of secretaries typing these discharge summaries has been slashed while the number of consultants has grown, quite a lot.

In the area I'm thinking that's a good thing, more medical type people. Yes? Well not really. Competition for theatre time and all the other back up stuff is intense and because of the increase in production the secretaries for example fall way behind in getting the summaries and other reports out to GPs, sometimes up to a month.

It's not perfect but there's no shortage of quite innovative people looking for solutions. While at the same time other, dull people, are too intent on looking at cost savings and obviously staffing is a target.

Sometimes I'm fecking glad to be out of it.

- - - Updated - - -

I think the most innovative thing bubbling under in Scotland is Telehealth and Telecare. The advantages in my opinion could be massive, on a massive scale!

I'd need more time than I have just now to explain but if anyone is interested.

 

[Brainwrong]

When you're in hospital your discharge summary is sent via snail mail back to the GP practice. I don't know why this is still the case. There's no technical reason.

There is an issue here though where in some areas the number of secretaries typing these discharge summaries has been slashed while the number of consultants has grown, quite a lot.

In the area I'm thinking that's a good thing, more medical type people. Yes? Well not really. Competition for theatre time and all the other back up stuff is intense and because of the increase in production the secretaries for example fall way behind in getting the summaries and other reports out to GPs, sometimes up to a month.

It's not perfect but there's no shortage of quite innovative people looking for solutions. While at the same time other, dull people, are too intent on looking at cost savings and obviously staffing is a target.

Sometimes I'm fecking glad to be out of it.

- - - Updated - - -

I think the most innovative thing bubbling under in Scotland is Telehealth and Telecare. The advantages in my opinion could be massive, on a massive scale!

I'd need more time than I have just now to explain but if anyone is interested.

So, notes to hospital are transferred electronically?

Very interested to hear about Telehealth/care.


Sent from my iPhone using Tapatalk

 

[southfieldhibby]

I think the most innovative thing bubbling under in Scotland is Telehealth and Telecare. The advantages in my opinion could be massive, on a massive scale!

I'd need more time than I have just now to explain but if anyone is interested.

I'm interested to hear about it Jacko.

 

[Jack]

Telehealth and Telecare are very exciting! Well if you're into that sort of thing and I used to be!

Telecare is basically having monitoring devices that the patient uses themselves. I'll give examples of 3 of these.

In the GP practice. Some people may have already seen this in their own surgery. The kit is normally in a booth or small room. The kit could comprise of an easy to use blood pressure cuff you just slip your arm in, this also does heart rate; a wee hole you stick your finger in that measures blood oxygen levels; there's other devices that are a piece of piss to use that measure all sorts of other things. You've already told the machines who you are so all the measurements are recorded in your record. Anything outwith an individual's preset parameters you get an immediate appointment with the nurse or doctor depending on what's up. It's under 5 minutes normally.

A record can be built up over time do that when the nurse or doctor reviews your health they have a more complete record.

Hopefully most of us don't need such regular monitoring that some conditions require but even annual check ups for cholesterol and blood pressure can be managed by these systems.

For the patient it's more convenient, they can just pop in anytime that suits them. I'm unaware of anywhere where an appointment system has been necessary. The booth you use could be located anywhere, another surgery or even the likes of Boots.

It all means people's health can be better monitored while at the same time freeing up nurse and doctor time for those patients who actually need a face to face chat.

Simpler versions of these devices are installed into (older) people's homes. To this are added pressure pads by the auld buddies bed, to make sure they get up when they normally do; alarms and stuff like that. This is, or was, a bit of a fecking nightmare because now you're mixing up health care, the GP type monitoring, and the pads and alarms which is a social care thing. I've heard on the news recently about great strides in merging these two cultures NHS and Social Care and I wish them good luck!

The good thing about having this stuff in GP practices is that by the time the kit gets fitted in their own home the old folk are used to it and how it works.

Anyway once again all these devices are monitored normally via some sort of broadband link (provided) but it could be automatically sent down a phone line. Big numbers of people can be monitored by very few. It could be nothing needs done, good news, or be a phone call to make sure someone is ok through to a GP or an ambulance being called out. It could also be used to set a health visitors or social care visitors priorities once again meaning those who need the care most get it while those that don't are still being cared for.

The third is really a combination of the two above in a homecare setting where an individual's room had pads and stuff but there's a wee room with the medical stuff.

Oh aye! A favourite device of mine is the GPS tracker. It came about in Chicago I think. Prostitutes were being murdered. The police and the prozzies agreed that the prozzies would only work a certain area and they would have GPS trackers in their shoes. As soon as a prozzie left the area the police were alerted knew where she was and the murderer was caught. Well the same system can be used to track all these old timers who go walkabout and don't know who they are or where they live. Brilliant I think.

Telehealth is where the likes of videoconferencing (fancy encrypted high resolution kit capable of mucking about with x-rays and stuff) is used for appointments. This is mainly used in remote and rural areas. It could be a GP appointment or a hospital appointment pre or post op. There's no reason it couldn't be used for most standard GP appointments* or home visits* saving time and travel.

A by product of this is staff training, particularly in remote and rural areas where 'continuing professional development' is a real problem.

Another thing it can be used for, and this tickles me, is remote hospital visits for family and friends. It's proven that visits help the recovery of the patient and help moral. So wheel in a big telly next to the hospital patient in Inverness/Glasgow/Edinburgh and if necessary get the folk down to the GP surgery* in Stornoway and hey presto happiness all round.

Of course the quick of mind among you will have also spotted the opportunity for easy 24 hour a day care here in that the medical professional in the other end of the telecare lens needn't be in Scotland or even the UK. I understand trials have taken p!ace using healthcare professionals in Australia and New Zealand!

And there's the opportunity to use this technology to provide or assist in providing health care in the really remote areas of the world or where health care is currently almost impossible to provide.

* Something like Skype or Facebook messenger could be used. When all this was originally being discussed these apps weren't as popular and of course you'd still have to make provision for those that don't use them for whatever reason.

 

[jock3]

Too much detail Bouncers....

What we have to realise is that the creeping privatisation of the NHS by the Tories is for IDEOLOGICAL reasons. They don't give a SH*T about the costs, lost jobs and service; what matters to them is as much money as possible goes to the private sector. It's no surprise the Tories are backed by; and have their fingers in various private providers.

This f&ckwit government in an unprecedented act of stupidity even took on the BMA during the Junior Doctors' strike.

On a daily basis the Tories lie and lie about the NHS, backed up by the majority of the Murdoch press.

And instead of exposing the shocking demise of the NHS, the Blairites start a coup against Jeremy Corbyn

The first thing a new Labour government should do is end all the PFI's, for a kick-off.

I remember my mum(bless her) telling me what it was like before the NHS; how you had to go literally cap in hand for treatment.

 

[1875]

I shudder to think how much is wasted. When I was in hospital a light bulb in the toilet went out and the staff had to wait until an external company sent a man in to change it at a cost [he told me] of £50.00. That's only a small instance but there will be many more. Surely an orderly could and would get on a step ladder to change a lightbulb at no obvious cost other than the bulb itself.

How much does it cost to employ the member of staff? How was the fault reported, to whom, how was it recorded, folowe dup and closed out, did it establish a trend, hing oan I changed the is 'bulb' every week for the last six months, maybe their is another fault at the root of this, lets check the records. We cannae, an orderly changed it. I am not sure how anyone might have known the £50 cost stated, sounds made up to me.

 

[Jack]

Too much detail Bouncers....

What we have to realise is that the creeping privatisation of the NHS by the Tories is for IDEOLOGICAL reasons. They don't give a SH*T about the costs, lost jobs and service; what matters to them is as much money as possible goes to the private sector. It's no surprise the Tories are backed by; and have their fingers in various private providers.

This f&ckwit government in an unprecedented act of stupidity even took on the BMA during the Junior Doctors' strike.

On a daily basis the Tories lie and lie about the NHS, backed up by the majority of the Murdoch press.

And instead of exposing the shocking demise of the NHS, the Blairites start a coup against Jeremy Corbyn

The first thing a new Labour government should do is end all the PFI's, for a kick-off.

I remember my mum(bless her) telling me what it was like before the NHS; how you had to go literally cap in hand for treatment.

Yeah I have to sgree. There's the goodies and the baddies.

I'd like to think I was a goodie despite being an ingrained civil servant. I was in a development team and to be honest money or cost wasn't uppermost in my mind it was how the patient came out at the end that was important. Of course money is a factor but I never thought it should be the most important. There was always enough money sloshing about in the system to cover the cost of innovation. What's described in my previous post is peanuts in the great scheme of things. I'm pure fuckin ragin min the grey clouds never got off their arses to make it happen. My early retirement was probably in some way brought about by frustration.

With regard to PFI and it's sons and daughters. They could well be the death of the NHS as they know it in England. I have high hopes the UKs third largest party who unlike the two above them had nothing to do with it* find a way to overcome the inevitable spin into oblivion.

When Labour and Torys whinge about the SNP doing stuff like free prescriptions and stuff on the railways perhaps they should reflect on the collective billions spunked on these contracts in the NHS and widespread throughout local authorities at al and the pockets they're lining.

* The SNP did have their own version, which was considerably softer but still not great, but in deciding if they were baddies or not, the system for it still had to be passed by Westminster.

To put it in a nutshell there's a huge number of people passionate, really excited and working their tits off to make the NHS even better.

And then there's the politicians who can't wait to get their hands in the NHS pocket and the money men whose self ambition is more important than the NHS itself. ****s.

 

[Dub]

How much does it cost to employ the member of staff? How was the fault reported, to whom, how was it recorded, folowe dup and closed out, did it establish a trend, hing oan I changed the is 'bulb' every week for the last six months, maybe their is another fault at the root of this, lets check the records. We cannae, an orderly changed it. I am not sure how anyone might have known the £50 cost stated, sounds made up to me.

The £50 was the minimum call out charge as I understand it M and no, I'm not making it up. I've no idea how much investigation went in to Bulbgate, just that I spoke to the guy who told me that was the cost for him to come in and change the bulb. If it's any help though, it didn't go out again in the time I was there so it lasted at least a week.

 

[Doc Shrink]

The £50 was the minimum call out charge as I understand it M and no, I'm not making it up. I've no idea how much investigation went in to Bulbgate, just that I spoke to the guy who told me that was the cost for him to come in and change the bulb. If it's any help though, it didn't go out again in the time I was there so it lasted at least a week.

Must have been some dose of the shits for you to be in the toilet for a week.
They would have had to pay someone a lot more than fifty quid to go in there after you came out.

 

[Dub]

Must have been some dose of the shits for you to be in the toilet for a week.
They would have had to pay someone a lot more than fifty quid to go in there after you came out.

I wasn't having to use the toilet to go for a shit at that time of my life boss.

 

[Davy]

The £50 was the minimum call out charge as I understand it M and no, I'm not making it up. I've no idea how much investigation went in to Bulbgate, just that I spoke to the guy who told me that was the cost for him to come in and change the bulb. If it's any help though, it didn't go out again in the time I was there so it lasted at least a week.

I believe this happens as unions fought years ago that any electrical work be done only by qualified electricians, Seems crazy to me, although they will say that if something went wrong the claims would be greater. Had a problem at work few weeks ago where there is a wall around the external roof and a passageway under the outside of windows. Boss tried to get a cleaning and or roofers to come clear some dirty needles which had been thrown out window...was getting replies such as we cant be insured for that...it would require specialists and require x amount off money....he told me the issue and next day...the needles had magically been lifted at no cost to the company. :

 

[beefy]

I believe this happens as unions fought years ago that any electrical work be done only by qualified electricians, Seems crazy to me, although they will say that if something went wrong the claims would be greater. Had a problem at work few weeks ago where there is a wall around the external roof and a passageway under the outside of windows. Boss tried to get a cleaning and or roofers to come clear some dirty needles which had been thrown out window...was getting replies such as we cant be insured for that...it would require specialists and require x amount off money....he told me the issue and next day...the needles had magically been lifted at no cost to the company. :

Davy...He's like a cat on a hot pin roof.





Boo!