Bye Bye NHS

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icowden

Legendary Member
For example, Steve Black argues that there are just one or two hospitals in the country that have a computer system that can monitor the progress of each patient from admission to discharge in real time. This means that they can't identify where the bottle necks are in real time, and can't direct resources to clearing the holdups in real time. Therefore a large amount of labour goes to waste nursemaiding patients whilst they're stuck in traffic jams.
I agree, although I think that is slowly increasing.
Just recently, Paul Johnson of the IFS commented on the parlous state of NHS IT, and also pointed out that the NHS is the most undermanaged health service in the world.
Part of the issue is that every Trust has to manage it's own IT procurement, contracts and importantly legal redress. IT companies often get away with stuff because contracts haven't been tightly drafted or the legal costs of suing a tech company would be prohibitive.

Scotland and Wales both went for countrywide solutions which work much better and allow much easier records transfer and access. But - as I pointed out there is a lot of money wastage as well.
 

albion

Guru
Public sector does not have the talent because it is bound by legislation to pay uncompetitive salaries. This results in IT outsourcing and that frankly is a sh*t show.

Contrast that to the insurance funded US system where they end up paying 1000% of our drug prices and companies like Acadia apparently kidnap anyone mildly mentally challenged for ransom/ bleed the insurance cover dry.
 

Regular.Cyclist

New Member
That's true but it doesn't work out. There are around 252 working days in a year. Lets take off 30 days for holiday. That leaves 222 days.
A Band 8a tops out at about £61k with full London weighting.

A contractor working on an IT project in a senior role at 8a sort of level is currently being offered around £500 a day. That's £116k but of course that doesn't include the agencies 20%, so we need to add on £23,200. The contractor because of IR35 isn't going to go direct, they will be employed by a project which will probably include at least a 20% profit margin on the staff. So without doing all the complex maths lets call it another 20%.

That IT Contractor is now costing (per annum) £162,400 of which almost £50k is going to the companies rather than the contractor. It's also three times that £61k salary and any learning or knowledge leaves at the end of the project.

To me, that doesn't feel like value for money. Of course if you offered an 8d the contractor might go employed (or even an 8b), but that's one or two bands below the COO and CEO type roles. Not a standard senior rank and file role.

And bear in mind that that £500 a day rate is what I'm currently hearing offered for NHS work, not private sector - expect at least £750 private sector, double if it's banking. I've settled for the reliability of employment elsewhere and once you take off taxes and overheads you don't earn the full £116k - a lot of that goes back to HM Gov, so an 8b to 8d would be enough to recruit similar talent.

But the fact remains, it is not cheaper to pay for IT through a Project.
NHS national job profiles can be found at https://www.nhsemployers.org/articles/national-job-profiles where you can see what is expected for each band in the various roles. It’s difficult to get high bandings for IT staff without a strong element of staff and budgetary responsibilities.

In my team (a support service) Band 8a manage a sector, Band 8c manages a service and Band 8d manages a department. These are some way from COO / CEO who are on AfC payscales.
 

Regular.Cyclist

New Member
Scotland and Wales both went for countrywide solutions which work much better and allow much easier records transfer and access. But - as I pointed out there is a lot of money wastage as well.

Not entirely true as I have witnessed in meetings with IT last week.
 

icowden

Legendary Member

Regular.Cyclist

New Member
Come on! - You can't just leave that hanging...
Health boards not being able to share data with each other from dermatology patients was the latest topic of discussion.

Patients visiting ED at a health board to the north of us having to be given written copies of their notes to hand to their own board.

GPs unable to access ECGs taken in a hospital and vice versa.

The list goes on.
 
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slowmotion

Active Member
Maybe I'm lucky living in west London, but the NHS IT systems don't seem too bad around here once you learn your way around. I went for some blood tests at my GP surgery at 9:40 am on 3rd September. They took less than five minutes. By 2:30 pm the same day, I could view 27 different blood parameters online, including graphs of how each was changing over time. Lord knows what it all means but I was reassured that somebody seems interested in my ancient carcase.
 

BoldonLad

Old man on a bike. Not a member of a clique.
Location
South Tyneside
Yet another reform/reorganisation, of NHS, what could possibly go wrong? https://www.bbc.co.uk/news/live/c0qejx03zjnt
 

Rusty Nails

Country Member
Yet another reform/reorganisation, of NHS, what could possibly go wrong? https://www.bbc.co.uk/news/live/c0qejx03zjnt
The NHS is not working so what alternative is there?
—Carry on, hoping that things will improve organically?
—Reorganise it, hoping that it will be more successful than previous reorgs?
—Just chuck more money at it?
—Scrap it and start again. How long will that take and will it be based on free at point of delivery, totally private (insurance), or a mix of private and state delivered?

The future of the NHS is too complex and large a problem to be left to any one transient government that has been voted in by a minority of the population/electorate and whose main concern is getting voted in again.
 

bobzmyunkle

Senior Member
The future of the NHS is too complex and large a problem to be left to any one transient government that has been voted in by a minority of the population/electorate and whose main concern is getting voted in again
Didn't that happen sometime in the past? 1948, I believe. Maybe if we had someone with a bit of vision? Someone prepared to be honest about what's possible?
(And tell the old folk they aren't going to live forever).
This one. It has been defunded over the last 15 years and has less money than ever before. It also needs investment in training so we get more doctors and nurses.
Maybe more money, more training (with a tie in - no getting trained and pissing off to Australia/New Zealand without financial penalties), and reform.
Let's be honest about the reform instead of suggesting we can get something for nothing by sneaking in more private sector involvement.
Starmer/Streeting - it's not going to happen is it?
 

BoldonLad

Old man on a bike. Not a member of a clique.
Location
South Tyneside
The NHS is not working so what alternative is there?
—Carry on, hoping that things will improve organically?
—Reorganise it, hoping that it will be more successful than previous reorgs?
—Just chuck more money at it?
—Scrap it and start again. How long will that take and will it be based on free at point of delivery, totally private (insurance), or a mix of private and state delivered?

The future of the NHS is too complex and large a problem to be left to any one transient government that has been voted in by a minority of the population/electorate and whose main concern is getting voted in again.

Agree.

Your last paragraph is my point exactly, the Politicians / transient ministers / transient governments need to stop meddling.

Quite how we get to grips with the complexity, I don’t know, but, if we don’t, the black hole labelled NHS will swallow us all.
 

Rusty Nails

Country Member
Didn't that happen sometime in the past? 1948, I believe. Maybe if we had someone with a bit of vision? Someone prepared to be honest about what's possible?
(And tell the old folk they aren't going to live forever).

Maybe more money, more training (with a tie in - no getting trained and pissing off to Australia/New Zealand without financial penalties), and reform.
Let's be honest about the reform instead of suggesting we can get something for nothing by sneaking in more private sector involvement.
Starmer/Streeting - it's not going to happen is it?

As someone who is just one year older than the NHS I think the old folk know they aren't going to live for ever more and accept it as the natural order. If only younger fat, unfit, smoking folk knew the same.

1948 was a far different time to today, with the second World War following on from a time of severe social deprivation and the NHS was set up following a review by a coalition government and was supported by all parties. (Around the same time as major changes in nationalisation and education). We are currently not experiencing anything like the level of poverty and social deprivation that existed then and I cannot see any politicians having the foresight or bravery to do anything other than tinker with the NHS, and certainly not work with "the enemy" towards radical improvement.

The NHS has been a wonderful, necessary thing but, like the old folk, needs to accept that it has no right to live forever in its current form. Its current form may meet the needs of the future with more reform and money but it is short-sighted (to use that word used as a pejorative to brexiteers) exceptionalism to not look at countries who seem to rank higher than us at healthcare performance such as Norway or France (who both shock! horror! have mixed systems including fee payment) to see what we can learn.
 
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