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Globalising the NHS


nomoss
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[quote user="NormanH"]My health problems are a direct result of poor practice in the NHS, which the French system has bravely but too late tried to address.

It was cheap (free in fact)but nasty

[/quote]

Bad things happen in all the systems including French and American, for example a friend had an operation on her neck in the US, not only were her insurance company arguing about what treatment they would pay for while she was on the table, but she has constantly had to use heat pads for the resulting pain on her neck ever since.(and we are taking several years) And this wasn't some hick in the sticks operation, but a good Washington hospital

Over the years some people haven't been that enamoured of the French system either.

In addition, no one actually stops you going Private in the Uk....
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Well it makes sense for a private clinic to offer its services abroad.

What I still don't see is how you can offer the NHS without exporting the concept of 'free at the point of delivery', since the NHS is not a question of particular medical expertise, but of a welfare system.

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[quote user="Rabbie"][quote user="Quillan"]

[quote user="Rabbie"]IMO the NHS needs to spend more of its budget on Doctors, nurses, auxiliary staff  and drugs etc and reduce the expenditure on management and administration.[/quote]

Why, is a UK doctors salary not enough. Drugs, why let the drug companies dictate the price, I mean £19 charge to the government for the prescription of dissolvable paracetamol! As the NHS is such a big purchaser of drugs it should be working on a cost + percentage and dictating to the drug companies what profit they should make. Last time I was in the UK I paid £13 for a Ventolin inhaler which cost €5.16 in France and Spain. Seems to me the drug companies are ripping off the NHS. Then we move on to agency nurses, another disgraceful waste of money.

[/quote]I take your point. I did not express myself clearly. At present about 50% of NHS wage bill is spent on administrators and managers. That is what IMO should be reduced. The standard of ordinary GPs in Britain is not a high as it used to be. Being a GP used to attract people who had a vocation and were excellent at their jobs. Nowadays it seems to be people who have been unable to get specialist posts in hospitals who become GPs almost as a last resort. It gets very frustrating always seeing a different doctor on each visit. Fortunately I enjoy good health but you hear regular horror stories about poor cleaning in many NHS hospitals so I say more cleaners and less people in suits with clipboards draining the NHS budget

[/quote]

I agree with most of that Rabbie. The problem with the cleaners is not so much the lack of them but what they can't do due to Health and Safety like wash walls below waist height (I have seen the results of this first hand), they often get contract 'wall cleaners' to come in once a week just to clean these areas but then the money comes out of a different budget. Mrs 'Q' works in the legal profession and one of the areas she specialises in is medical negligence and the case load is almost doubling year by year. Currently the equivalent of 30% of the NHS budget is set aside to pay claims and costs and at £200 per hour for a Barrister it is easy work although Mrs 'Q' admits that with some small changes the number of claims could be drastically reduced and the money saved could go to better health care. The problem is health care, like education, is a political 'hot potato' and it always causes problems when you try to change it even if it is for the better.

The NHS is the second biggest employer in the world only topped by the Chinese army. It also employs more accountants than any private or public institution. As you say too many chiefs and not enough Indians.

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[quote user="NormanH"]Well it makes sense for a private clinic to offer its services abroad.

What I still don't see is how you can offer the NHS without exporting the concept of 'free at the point of delivery', since the NHS is not a question of particular medical expertise, but of a welfare system.

[/quote]

I don't think the idea is that care abroad is supplied free, maybe the governments of the countries involved are paying, or other institutions.
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[quote user="Russethouse"] In addition, no one actually stops you going Private in the Uk....[/quote] Provided of course you have the financial resources to pay for it! Not everybody can afford that option. As  I know from personal experience private healthcare insurance in the UK is very quick to raise premiums once you have made a claim. Luckily ours is still  affordable because Mrs R is still working. When she retires it will be problematic whether we will be able to continue with it.
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Interesting thread, especially as I have just retired from the NHS after 41 years of service working on the estate side of things.

Agency staff:

It is often cheaper to employ agency staff or contract out services such as cleaning and catering as there are set pay levels within the NHS if people are directly employed.

Quality of buildings:

Introduced within the NHS some years back was Capital Charges. This took in to account the depreciation and rate of return of the capital that is lost through having it tied up in buildings and capital equipment. The depreciation is the amount of capital that trusts have to improve buildings and also renew equipment. This is never enough for what is required. My experience was that there would be bids each year of 50 to 60m and the capital available would be 10m. Often clinicians would say we need to replace this piece of equipment becasue we cannot detect this - certainly x-ray equipment which is very expensive needs very regular replacement to keep up with new developments. Often maintenance of the buildings would suffer - given the choice what would you decide, a replacement piece of x-ray kit that can detect certain conditions that the current kit cannot or maintenance of buildings.

Maintaining buildings:

So you have the budget to carry out a ward upgrade but, due to political pressure certain targets have to be met so the trust cannot allow a ward to be taken out of action with the consequent bed loss for the number of months required to carry out the upgrade.

Government initiatives:

January or February the DoH tells a trust 'you have £x to do a specific thing and the money must be spent by the end of March. Normally this will involve planning, getting planning consent and building control approval (It is many years since hospitals lost Crown Immunity) tendered and completed in a couple of months. There are sometimes fiddles that go on to make it appear the money has been spent.

Doctors:

Full of self interest and will block things at a whim. The number of times I have heard of surgeons threatening to cancel lists and actually doing it at times if they are not happy with something 'Mr Smith says that unless something happens immediately then he will cancel his list'.

PFI:

Wonderful system of getting private money to build facilities that then cost a fortune in 'rent' - very much draining some trusts budgets making them unviable - of course the politicians at the time took great credit 'look what I have done for my constituents'.

Managers:

You have businesses that turnover several hundred million pounds a year so do you really need managers and accountants. Back to the clinical directorates, they like overspending if they can and then the non clinical directorates have their budgets reduces, including the cleaning and maintenance ones.

Paul

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They operate a form of PFI in France, more to point near me anyway. Two years ago we had a new scanner added to one of the larger hospitals in Carcassonne and whilst waiting for my scan one of the chaps who ran it explained how it worked from a financing point of view.

Everything has a price in the French health system and in this case a scan has a fixed price depending on what is being scanned. The company that installed and runs the scanner was approached by the hospital and basically the hospital guaranteed x amount of different types of scans per year so the company knew what their income would be. The then make a deal with the hospital, the hospital supplied the land (part of a car park) the company built the building and installed the scanner at it's own cost which is offset by the guaranteed income from the hospital in the form of number of scans committed to. This seems to work well, the hospital has access to a top of the range scanner and the company makes money although not a massive amount like they do with PFI in the UK.

A friend of mine has a sister who is very high up in a regional health authority up the north of England. He told me that his sister was complaining because the PFI hospital they use costs so much to run. Apparently if they want a lamp bulb replaced the contractor has to be approved by the company that owns the building and that the hospital is charged some ridiculous amount of money. How true this is I have no idea as it is second hand information.

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[quote user="Quillan"]

"Figures from international economic organisation OECD show the average density of doctors across France is around 340 per 100,000 compared to the UK which has just 220 per 100,000. So, comparatively, France has no shortage of doctors." Fom the source you gave. Personally though I wouldn't believe a lot of what that paper prints, they have been proved to be wrong on more than one occasion.

So it would seem that there are a lot more doctors in France than there are in the UK. What is the point of setting up a doctor to service a dozen people per week when there is often more than one just down the road. Many of the Cantons round here, including my own, do not have doctors so you have to travel. Fortunatly in my case it's five minutes down the road but for others it is 15 or 20 minutes drive. Our nine doctors by the way are supported by one nurse and two receptionists where in the UK I had the same amount of doctors supported by about 15 staff. Perhaps having to pay for such luxuries  would be different if it came out their own pocket rather than the UK throw tax payers money at them.

I understand that a doctors job is not easy but how comes they can earn an average of £103,000 dropping to £81,158 if working for a primary trust (Telegraph 30th May 2012). On top of this they will receive money towards running their surgery. There are loads of people out there who's job is just as demanding and technically challenging who can only dream of such a salary.

[/quote]

Only partners earn the top rate according to the article and by no means all GPs are partners. There may be plenty of people with technically challenging jobs, but how many of them had to do a minimum of 5 years at university, plus 2 years of hospital "house" jobs, plus a GP traineeship in order to be qualified even to begin to do that job? For goodness sake, there are lots of peple working in the City who get more than £100K as an annual bonus and how many lives do they save?

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Well it cost the UK tax payer around £2.8M to train me and I had the potential to save thousands if not hundreds of thousands of lives at the end and all I got then was around £29k per year. In 1982 I probably saved about five or six hundred in a few days but that's by the by. The very maximum I could earn today doing the same job would be £45k. What I am trying to say is that there are many people out there doing jobs that save lives and probably a lot more frequently as well yet they get nowhere near the salaries that GP's get let alone the expenses and in their own way just as highly trained. Likewise there are lot of people out there who don't work in the City or even a financial institution yet they earn of £100k per year it's just you never really notice them and yes your right they don't save lives although actually sometimes they do (contractors working on hospital IT systems is an example). As Rabbie said (and I agree with him) there was a time when in was seen as a vocation to be a doctor or a nurse now it's a job like any other. I don't have a problem with this providing I get quality service I need and when I need it which in my and my families experience, even today, is not the case.
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I think we will just have to agree to differ on this, Quillan. Wherever and whenever I have interacted with the NHS my experience seems to have been immeasurably better than other people's for some reason and I feel I have been well-served throughout my life.

I don't know what you think justifies your blanket assertion that doctors and nurses no longer feel called to do what they do and see it as just another job. However I can tell you, from many years of personal knowledge, that my doctor niece (now a paediatrician in her 30s) knew this was what she had to do from childhood onwards (and worked incredibly hard to achieve it) and if that isn't vocation, I don't know what is.

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Just to say how pleased you must be with your daughter and well done her. Like Rabbie my comments about vocation are in general and like your daughter there will always be those few that feel it is their vocation. It is always very pleasing to hear about somebodies childhood dream turning in to reality.
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It's my niece, not my daughter, but I'm still very pleased for her. I just query your assertion that she is an exception in feeling called to be a doctor. Her GP husband is another who always knew he wanted to be a doctor and I bet they would both say that most, if not all, their colleagues felt the same. It's too long and hard a training to do successfully unless you're convinced that it really what you should be doing.

I have a theory that sometimes the word vocation is used as an excuse for poor pay, as though feeling called to do something and actually been properly paid for doing it are seen as mutually exclusive.

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The fact remains that London is one of the worlds leading medical centres for teaching hospitals and pioneering medical treatment and clinical research in fields like cancer, childrens medicine, eyes and transplant surgery. Hospitals like the Royal Marsden, Great Ormond Street, Moorfield Eye Hospital, UCLH to name a few, are global centres of excellence that attract patients and research scientists from around the world. The idea behind the proposals put forward originally by the previous Labour UK government, are to emulate the Moorfield Eye Hospital who have opened in Dubai and use the profits to develop their London hospital.

By comparison France despite its good overall health service no longer has the equivalent world renown medical centres of excellence, probably in part due to the general decline in the world standing of French Universities and the absence of the equivalent to the sizable UK medical research charitable sector. Also maybe because culturally the French are not educated to think out of the box but follow the rules, which does not make for the best clinical research doctors. 

A lot of people read health service horror stories from the UK and presume that the lack of equivalent reporting in France means the situation there must be better. Not so, French privacy laws prevent any equivalent reporting so any problems that arise are hidden from public view. The UK generally has a free press and media, France does not! 

 

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[quote user="KathyF"]

It's my niece, not my daughter, but I'm still very pleased for her. I just query your assertion that she is an exception in feeling called to be a doctor. Her GP husband is another who always knew he wanted to be a doctor and I bet they would both say that most, if not all, their colleagues felt the same. It's too long and hard a training to do successfully unless you're convinced that it really what you should be doing.

I have a theory that sometimes the word vocation is used as an excuse for poor pay, as though feeling called to do something and actually been properly paid for doing it are seen as mutually exclusive.

[/quote]Having read your CV on your blog site I accept that you are clearly an expert on poorly (in monetary terms) paid vocations[:)].

 I would not deny that there are still doctors who have a sense of vocation. My point was that there seem to be fewer nowadays who have a specific desire to become GPs but would rather be specialists, consultants, surgeons etc. The impression seems to be that being a GP no longer has the status that it used to.

When I was at school it was generally accepted that you needed a sense of vocation to get through the years of training to become a doctor. I am sure that is still the case today. Several of my schoolfriends always wanted to become GPs. I just don't see the same enthusiasm for the GPs job in many that I see nowadays.

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Quillan, you are correct in that France has more doctors per head of population, but the the majority are hospital doctors and specialists, as few new doctors in France are attracted to the paltry pay and conditions of French general practice. So the growing problem in France is not the overall number of doctors, but the fast declining numbers of those who want to practice general medicine.

The UK was facing a similar situation and managed it by increasing pay and conditions, which some may argue is now too generous!

By the way £29k thirty years ago was a  v good salary and adjusted for wage inflation would not be that far off a doctors salary today.

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"France despite its good overall health service no longer has the equivalent world renown medical centres of excellence'

I think that is a bit overstated. Perhaps you know the London centres better, but there is good research going on in France

http://www.inserm.fr/index.php

http://curie.fr/

http://www.pasteur.fr/ip/easysite/pasteur/fr

http://www.unicancer.fr/le-groupe-unicancer/la-federation

Two of the Doctors who treat me  have spoken at International conventions.I never had people of that quality here:

http://www.somerset.nhs.uk/community/our-services2/community-hospitals/our-services-community-hospitals-bridgwater-community-hospital/

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[quote user="Sprogster"]

Quillan, you are correct in that France has more doctors per head of population, but the the majority are hospital doctors and specialists, as few new doctors in France are attracted to the paltry pay and conditions of French general practice. So the growing problem in France is not the overall number of doctors, but the fast declining numbers of those who want to practice general medicine.

The UK was facing a similar situation and managed it by increasing pay and conditions, which some may argue is now too generous!

By the way £29k thirty years ago was a  v good salary and adjusted for wage inflation would not be that far off a doctors salary today.

[/quote]

I was quoting from the article that Kathy gave a link to, I have no idea how accurate these figures are given that particular newspapers past reputation.

Actually the wage has gone down in today's terms as I stated, the max is just over £45k and that's with long service but with current cuts it is highly unlikely that many ever get close to the figure, most will be around the £38k to £39k mark which is less than a GP.

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[quote user="NormanH"]"France despite its good overall health service no longer has the equivalent world renown medical centres of excellence'

I think that is a bit overstated. Perhaps you know the London centres better, but there is good research going on in France

http://www.inserm.fr/index.php

http://curie.fr/

http://www.pasteur.fr/ip/easysite/pasteur/fr

http://www.unicancer.fr/le-groupe-unicancer/la-federation

Two of the Doctors who treat me  have spoken at International conventions.I never had people of that quality here:

http://www.somerset.nhs.uk/community/our-services2/community-hospitals/our-services-community-hospitals-bridgwater-community-hospital/

[/quote]

Bridgewater looks to be a small cottage hospital,my feeling is people of the calibre to speak at international conferences are more likely to be working at larger hospitals, perhaps teaching hospitals and 'centres of excellence'
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Bridgwater deals mostly with the results of inbreeding, ininbreeding, violence and drunkenness, with a special service for Weston Zoyland and other places on the Moors. It also deals with animals as some are so suspiciously human that it is felt that there should be no discrimination. Hmmm, where was it you were Norman?
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But Bridgwater is a typical NHS hospital.

If the NHS is going to be exported it is that that they they have to sell.

Sprogster quoted an equally unbalanced list of Hospitals.

There is no way on earth I would have ever been admitted to any of her list when I was in the UK, whereas I have been in some in mine in France.

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The hospital in the link maybe typical for Somerset, but it certainly isn't for here...and a friend of mine who lives in Somerset has ben referred to both Southampton and Taunton...

In addition I think you are mistaken, my late S- I-l was admitted to the Royal Marsden, why don't you think you'd be admitted to any of the hospitals on that list if there was a clinical need ?

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My issue is that we British tend to think we are world leaders in lots of things but who says we are, an independent body? For instance when talking about hospitals I see the term 'centres of excellence' used, excellent compared to what, the hospital in Somerset? I should hasten to add by the way that I would put Newham in with that one and St Barts not far behind (where my MIL died).

In a recent independent report (commercial, not available to the geneal public but acceptable under English law) out of 16,026 hospitals world wide the first French hospital (Hôpitaux de Rouen ) ranked at 37th (ranked 1st in Europe) and the first British hospital (Guy's and St Thomas' Hospital NHS ) was ranked 67th (13th in Europe). Great Ormands Street hospital was ranked 611th in the world the best childrens hospital being St. Jude Children's Research Hospital ranked 10th. In just the European hospital ranking the first of the 'centres of excellence', Radcliffe comes in 60th, Nuffield comes in at 70th, Central Manchester and Manchester Children's University Hospitals NHS comes in 67th, Great Ormand Street is not on the European list as it is only the top 100 listed. There were other UK hospitals in the list like Oxford, Cambridge, several Scottish hospitals (no Welsh or Irish, neither north or south) .

I wish I could make this information available to you all but it belongs to Mrs 'Q' and you pay a lot of money for it so as you can imagine it is copyrighted. This report was updated in July 2012. What I can link you to is the NHS website where they gave a report on UK hospitals in 2011 covering such things a mortality rates etc issued in 2011.

http://www.nhs.uk/news/2011/11November/Pages/2011-hospital-performance-data-analysed.aspx

RH - Royal Marsden is ranked 703rd in the world and 175th in Europe.

So it seems to me it is the UK that is rating it's hospitals and to be honest I think it is more political than realistic.

One thing that came to mind, I understand that the NHS was mentioned as part of the Olympic opening and many people were asking why, well now we know, free advertising to the world.

 

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I wonder whether a bit of lateral thinking mighht not be applied here: if, instead of chucking money down a drain in aid to dubious recipients, certain hospitals could be paid by government to set up and run reasonably priced services in countries which need them, with a reasonable prifit margin covered by the UK state. Thus the NHS gets extra money and the aid money is better spent.
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[quote user="Quillan"]

 ................ Currently the equivalent of 30% of the NHS budget is set aside to pay claims and costs ................ [/quote]

 

Are you quite sure about that? (Presumably by "costs" you mean those arising from claims)

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[quote user="nomoss"][quote user="Quillan"]

 ................ Currently the equivalent of 30% of the NHS budget is set aside to pay claims and costs ................ [/quote]

 

Are you quite sure about that? (Presumably by "costs" you mean those arising from claims)

[/quote]

They have not been very good at winning in the past unfortunately so it's their legal costs, the legal costs of those making a claim and the claim. Many things come in to the equation and the values of the claim rises quite dramatically the younger a person is. The biggest cost out of the costs, if you get my drift, if when they argue about how a person would have progressed through life, the position and salary they may finally achieve etc all has to be accounted for when the claim is agreed. This can take months, sometimes years before an agreement is reached and of course the cumulative charges of the barrister and solicitors on both sides becomes quite high. Even if an offer is made at the beginning it is often rejected because all you have to get is a penny more than the offer and the defendant pays all the fees. The money set aside used to be more but the NHS is making more realistic offers these days which is helping to reduce costs.

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