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Post by Zany on Apr 28, 2024 9:24:35 GMT
The Tories have in creased spending on the NHS by 40% since they took power, so where the heck has all the money gone?
No one in there right mind thinks the NHS today is doing well, the news is filled with terrible stories, waiting lists for even critical things like cancer treatment.
So anyone know where the money has gone?
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Post by Orac on Apr 28, 2024 9:39:08 GMT
The Tories...sigh
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Post by cartertonian on Apr 28, 2024 10:21:37 GMT
In some respects, one can argue that the Tories are now reaping what they sowed four decades ago.
Very few people (in my experience and occasional straw-polling of students and fellow academics) have ever heard of the philosophy of 'New Public Management'. And of course, since it's now 40 years old it's hardly new anymore. However, most of the problems across the public sector and most strikingly in health, derive from this Thatcherite philosophy. You know the one... 'the most effective way to run an organisation is as a business'.
Hospitals, schools, Fire & Rescue Services, the Police...even Defence, have been subordinated to commercial and business style managerialism for four decades and the reality is that you can't run public services as if they were private businesses, yet we persist largely because this NPM philosophy was slowly and subtly introduced without great fanfare and has consolidated itself to the point that no-one notices (or as above, have ever hear of it as a distinct and coherent philosophy).
Thus in answer to your question, Zany, the money is diverted from coal-face patient care into self-serving managerial roles earning eye-watering salaries, swoopy, award-winning new hospital buildings that make delivering care more difficult, but which project an image of modernity and style - like the corporate HQ of a multinational business - and a 'spend to save' attitude in terms of adding layers of expensive bureaucracy in order to 'give the impression' of saving taxpayers money.
In particular, however, the effect of NPM is to breed short-termism, not only in strategic management, but also right at the coal-face. If you give a clinician a budget, and then make their annual appraisal focus on staying within that budget, they make short-term clinical decisions that kick the cost can down the road. Since I started nursing in 1989 I have seen this transition in action. These days - and the pernicious and subliminal nature of NPM has intentionally fed this - doctors, nurses and other clinicians will look to do as little as possible for a patient, because unconsciously they're more worried about the taxpayer than the patient in front of them (despite the two usually being one and the same). Instead of throwing everything, including the kitchen sink, at a patient to cure them, they fiddle about and fuck around, doing the least they can get away with, so that they can stay within budget for this financial year, forgetting that their penny-pinching in this FY is going to A: prolong the suffering of the patient and B: add costs to the next FY, and perhaps one or two more FY after that. In short, instead of nipping things in the bud, they prolong the agony - both physical/mental and financial.
Plenty of academics have argued that if we re-focused on preventative healthcare and health promotion/education, we could make a big dent in the health budget. But because the business mindset that comes with NPM is so short-sighted, Trusts and CCGs are forced to be solely reactive, rather than effectively proactive. It's a lot easier to sell a bean-counter the idea of spending on problems as they happen than on spending to prevent them happening in the first place.
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Steve
Hero Protagonist
Posts: 2,591
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Post by Steve on Apr 28, 2024 11:33:14 GMT
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Post by Zany on Apr 28, 2024 11:40:50 GMT
My wife experienced this first hand as a neuro radiographer for 30 years. Every couple of years they would be gathered together asked for opinions on how the department could improve performance and roundly ignored.
What made her leave was the focus on ticking the boxes to say the patient was seen within the stated penalty period, though often no progress was made. Its very disheartening to let people down like this on a daily basis. Though its wasn't as bad when she switched to Neurology as most of these patients were extremely critical, but another management change dissolved the specialist team back into the main department. Sigh.
Now she has just seen it from the opposite end (With the insider experience to know its happening. 4 years ago she tore the pectoralis tendon off her sternum. For 4 years she was given tiny clean out ops or steroid injections always just within the specified time limits for treatment. Last time she was offered another steroid injection she refused it. I asked does that mean they have to do the op properly she said no, the system will record they offered treatment and I refused it. Even though both she and the surgeon (Who she knows) agreed it would be pointless.
So yes I agree with your synopsis. Though I often wonder with the Tories whether its a deliberate attempt to make public health seem expensive and clumsy for the obvious reasons.
Q: We have heard hints of change from Kier Starmer do you think that's plausible.
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Post by Zany on Apr 28, 2024 11:42:57 GMT
Oh yes it was the other Tories, not us. We're the good Tories, They're the bad Tories. How can you tell the good ones? Easy, just pick your subject and go back in time to a period when it was in your opinion better.
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Steve
Hero Protagonist
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Post by Steve on Apr 28, 2024 11:50:00 GMT
The Tories brought in this idiocy of making individual departments focus on their efficiency and not have anyone focus on delivering a solution for the patient across multiple departments.
To get the urgent cancer treatment I needed a few years ago I had to become the solution manager connecting up and chivvying up separate departments and shaming those who failed. Even with that the NHS delivered late compared to its promises and I hate to think about how someone getting a similar diagnosis now would fare.
Does anyone think the majority of Tory MPS or indeed any of their ministers relies on the NHS? I don't.
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Post by cartertonian on Apr 28, 2024 11:53:45 GMT
Sorry to hear about your other half's experience, but that is entirely illustrative of the problem. Definitive surgery four years ago would have saved her suffering and saved the NHS money over the four years.
As to your question, I think we will see some improvements, but going back to my original 'thesis', Wes Streeting has grown up into a world where NPM is seen not only as 'the norm', but as some kind of unimpeachable truth, and so I suspect will continue (assuming he retains the health brief) to try and make improvements with one hand tied behind his back.
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Post by Zany on Apr 28, 2024 12:07:17 GMT
Sorry to hear about your other half's experience, but that is entirely illustrative of the problem. Definitive surgery four years ago would have saved her suffering and saved the NHS money over the four years. As to your question, I think we will see some improvements, but going back to my original 'thesis', Wes Streeting has grown up into a world where NPM is seen not only as 'the norm', but as some kind of unimpeachable truth, and so I suspect will continue (assuming he retains the health brief) to try and make improvements with one hand tied behind his back. Yes, it was that Labour seemed to be talking to doctors again rather that just telling us what was needed. I live in false hope
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Post by Zany on Apr 28, 2024 12:08:39 GMT
The Tories brought in this idiocy of making individual departments focus on their efficiency and not have anyone focus on delivering a solution for the patient across multiple departments. To get the urgent cancer treatment I needed a few years ago I had to become the solution manager connecting up and chivvying up separate departments and shaming those who failed. Even with that the NHS delivered late compared to its promises and I hate to think about how someone getting a similar diagnosis now would fare. Does anyone think the majority of Tory MPS or indeed any of their ministers relies on the NHS? I don't. You'd be amazed how many departments are prepared to st1t on each other to get past the post. Such is the pressure of the budget fine.
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Post by Orac on Apr 28, 2024 12:42:58 GMT
Oh yes it was the other Tories, not us. We're the good Tories, They're the bad Tories. How can you tell the good ones? Easy, just pick your subject and go back in time to a period when it was in your opinion better. You seem to be talking in Riddles. I'm talking about the people who control the actions of the Tory party. i'm surprised you had less to say about their manifesto here. Constitutional reform Desecration of tradition Importing endless migrants Legalistic persecution of native BritonsThe Tories tick a lot of boxes for you. It might be worth thinking about.
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Post by Zany on Apr 28, 2024 13:46:32 GMT
Oh yes it was the other Tories, not us. We're the good Tories, They're the bad Tories. How can you tell the good ones? Easy, just pick your subject and go back in time to a period when it was in your opinion better. You seem to be talking in Riddles. I'm talking about the people who control the actions of the Tory party. i'm surprised you had less to say about their manifesto here. Constitutional reform Desecration of tradition Importing endless migrants Legalistic persecution of native BritonsThe Tories tick a lot of boxes for you. It might be worth thinking about. Meaningless phrases. Constitutional reform. In what form.. Desecration of tradition Which traditions, The tradition of helping the poor Importing endless migrants. Which no one supports. Legalistic persecution of native Britons. In your head.
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Deleted
Deleted Member
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Post by Deleted on Apr 29, 2024 13:57:46 GMT
In some respects, one can argue that the Tories are now reaping what they sowed four decades ago. Very few people (in my experience and occasional straw-polling of students and fellow academics) have ever heard of the philosophy of 'New Public Management'. And of course, since it's now 40 years old it's hardly new anymore. However, most of the problems across the public sector and most strikingly in health, derive from this Thatcherite philosophy. You know the one... 'the most effective way to run an organisation is as a business'. Hospitals, schools, Fire & Rescue Services, the Police...even Defence, have been subordinated to commercial and business style managerialism for four decades and the reality is that you can't run public services as if they were private businesses, yet we persist largely because this NPM philosophy was slowly and subtly introduced without great fanfare and has consolidated itself to the point that no-one notices (or as above, have ever hear of it as a distinct and coherent philosophy). Thus in answer to your question, Zany, the money is diverted from coal-face patient care into self-serving managerial roles earning eye-watering salaries, swoopy, award-winning new hospital buildings that make delivering care more difficult, but which project an image of modernity and style - like the corporate HQ of a multinational business - and a 'spend to save' attitude in terms of adding layers of expensive bureaucracy in order to 'give the impression' of saving taxpayers money. In particular, however, the effect of NPM is to breed short-termism, not only in strategic management, but also right at the coal-face. If you give a clinician a budget, and then make their annual appraisal focus on staying within that budget, they make short-term clinical decisions that kick the cost can down the road. Since I started nursing in 1989 I have seen this transition in action. These days - and the pernicious and subliminal nature of NPM has intentionally fed this - doctors, nurses and other clinicians will look to do as little as possible for a patient, because unconsciously they're more worried about the taxpayer than the patient in front of them (despite the two usually being one and the same). Instead of throwing everything, including the kitchen sink, at a patient to cure them, they fiddle about and fuck around, doing the least they can get away with, so that they can stay within budget for this financial year, forgetting that their penny-pinching in this FY is going to A: prolong the suffering of the patient and B: add costs to the next FY, and perhaps one or two more FY after that. In short, instead of nipping things in the bud, they prolong the agony - both physical/mental and financial. Plenty of academics have argued that if we re-focused on preventative healthcare and health promotion/education, we could make a big dent in the health budget. But because the business mindset that comes with NPM is so short-sighted, Trusts and CCGs are forced to be solely reactive, rather than effectively proactive. It's a lot easier to sell a bean-counter the idea of spending on problems as they happen than on spending to prevent them happening in the first place. You have described what has been going wrong very well and from an insider perspective. I have long believed that the problem is as you have described it, but you have summed it up far better than my own words ever could have. It ought to be a no brainer that spending whatever it takes to most effectively resolve a medical problem now will save money in the longer term, but focussing upon cheaper sticking plasters to save money in the short term and kicking the can down the road inevitably costs much more in the end. It almost certainly costs lives in some cases. And contributes to the growing number of people off work for medical reasons of one kind or another.
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Steve
Hero Protagonist
Posts: 2,591
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Post by Steve on Apr 29, 2024 16:31:50 GMT
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Post by cartertonian on Apr 29, 2024 16:51:17 GMT
It's not so much about the money spent on management, it's the type of people in those management roles. That is the legacy of the NPM philosophy; trying to run public services like pseudo-businesses, wherein the MBA-clutching management types have merely replaced making profit with saving taxpayers' money.
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