NHS, Where has all the money gone?

Of course we can't, there is no upper limit. But we can afford considerably more than we do now. Most of the people I associate with have 50 to 100k cars and 3 or 4 holidays a year, they spend 200 quid on wind chimes. And these aren't people who consider themselves rich.

This argument for the laughter curve has been made and adjusted many times.

But they wont leave family friends hobbies homes and one of the nicest countries in the world for another 5k a year in tax.

Denmark. I would prefer something that is progressive. 

No, let's remember that until two years ago I was the manager of the UK's largest military mental health team, working daily alongside colleagues in primary care from both the military and the NHS, and I now teach healthcare in a university. The GP IS the 'case manager'. That is how the system is designed. They are supposed to know everything about their patients and act as the central hub for a patient's care, with all of the secondary and tertiary care provision reporting back in to them, like a spider in the centre of a medical information web. Where the system falls down is in what you said in your earlier post about, "...the idiocy of fragmented groups all with individual targets that disincentivise effective solutions". The structural and organisational changes made in healthcare over the last three decades have wrought a situation wherein, as you intimate, each part of the supposedly seamless care process has become stove-piped and self-absorbed, so they can stay within their budget. 

This is compounded by the lack of a joined-up information management system. Some may remember that in the early 2000s the government were trying to introduce a unifying, fully-integrated computer system to the NHS, so that any information held anywhere about a patient was accessible to GPs and also to anyone else who had legitimate need to access that information. The project failed rather spectacularly for the NHS, but we in DMS were working alongside NHS at the time, to have a similar system for defence that would integrate with the NHS system, so I have had many years' experience of working with the sort of system the NHS should have had. I could go to anywhere in the world where we had a UK facility and access all the information about my patient, from primary care, to pharmacy details, even dental details (not that I needed those), so that I could make absolutely sure that what I was doing with my patients was consistent with their overall healthcare pathway.

Ergo, most of the service delivery problems the NHS has today derive from the aforementioned fragmentation and the corresponding lack of effective communication. 

When I was trying to get my cancer tests and eventual surgery in the promised times my GP (and they are excellent) was very clear that they had no more information than me and that once the local trust had been given the case they had no ability to direct them. So I had to but I did get good advice from the GP about which buttons to push.

Monday's farce: they phone one of my friends who's now in a care home and tell him he needs a follow up appointment but he has to get himself to the hospital for a blood test first.
He points out he can no longer drive etc so they tell him he has to drive himself to the doctors instead. Actually being a care home the doctors do visits but seems the 'read a script' erk at the hospital couldn't think of that. We think we've got it sorted.


Today's farce. yesterday they phone me to say I need a CT scan (standard post cancer follow up). No apology that they're a month late and they read the script and say I have to got to the hospital for a pre blood test. I say why not the doctors instead and they say OK but then I ask for the blood test form. 'Oh the doctors will already have that online' they say. So today I go to the doctors and of course no such form has been seen and isn't in my records there.

As I said: if you have a serious condition it is YOU that has to be the case manager because no one in the NHS will because that's how the Tories disorganised it.

Now I've been a project manager in my time, I know how to make such things work but what about those that haven't or can't? Hard to escape the conclusion the Tories plain don't care.