Would you step in ?

[Burly Hurley]

It's about money mate.

I think you'll find that there is very little procurement within the NHS nowadays that isn't interrogated to a high degree to determine whether it offers value for money.

I had to jump through endless hoops to spend NHS money, and rightly so, it's public money at the end of the day. I don't doubt there was inefficient and wasteful spending in the past, but not now.

Hiya mate. I get this is a touchy subject and one I don't want to get into an argument about, but there's still a hell of a lot of inefficiencies in the NHS. Some of it is structural and would take years to fix.

But some of it is just bad work practice that needs someone to say enough is enough.

I've been the recipient of some extraordinary specialist care since May. And as someone who's worked nearly 32 years in the NHS, 27 of them on the Commissioning side since 1992 when the so-called market was introduced, I've also seen some work practices I thought had been condemned to the dark ages.

 

[Burly Hurley]

As for sickness in the NHS, it is a problem. I would argue that is down to overworked and under supported staff. The irony in the NHS is that there is actually very little care for the workforce.

Agreed!!

 

[PINKIE]

Hiya mate. I get this is a touchy subject and one I don't want to get into an argument about, but there's still a hell of a lot of inefficiencies in the NHS. Some of it is structural and would take years to fix.

But some of it is just bad work practice that needs someone to say enough is enough.

I've been the recipient of some extraordinary specialist care since May. And as someone who's worked nearly 32 years in the NHS, 27 of them on the Commissioning side since 1992 when the so-called market was introduced, I've also seen some work practices I thought had been condemned to the dark ages.

What did you do in commissioning mate ? I was part of KernowCCG in mental health services, but my main role was running therapeutic centres across Cornwall. As I said, there used to be a lot of inefficiencies, but during my time I saw (and was responsible for) a lot of that being mopped up. I can't speak for the whole service, but in my area every penny was accounted for. Probably because we were never given much in the first place

 

[thefanwithnoname]

It used to be the case that if I hadn't spent my budget by the time April came around, then any underspend was taken into account and taken off my next year budget, i.e. you only spent £1.2m out of your £1.8m budget so we only need to allocate £1.2 for the next year. I must admit that encouraged me to spend money that I didn't really need to, for fear of losing it for the next year.

I think the NHS wised up to that though and realised that rather than it saving money, it encouraged loads of managers to spend more than they needed to. As for equipment procurement though, when I was last in the NHS, it was like trying to get blood out of a stone trying to get new equipment. You literally had to write a funding application (and I've done a few of those 40+ page applications for charitable funding schemes) and explain every aspect of why you needed something, how much it cost, whether it could be sourced cheaper elsewhere, how much use it would get, what were the implications of not having it, could an alternative be used, etc

Yeah it's the same for local authorities. A reason why roadworks happen at the same time every year. If all else fails use the money to fix up the roads.


And I agree that what the people on the ground need is like jumping through hoops, be ause someone above has decided to get new phones or fancy blood monitors etc. But that is still wastage (of a worse kind)

Just to be clear in these things there is the nursing staff who do a brilliant job under stress and pleasure and the managers who think they know best

Give you an example outside the nhs. The police. Those on the ground do the hard lines but the inspectors motives for projects are to help in getting to the next level of rank. So they come UK with wild and wonderful schemes that achieve that objective but ling term are a waste of money

An example of that was property marking pens, bought at great cost and distributed free to residents. Here's the thing it doesn't really work as they don't have the scanners. Or maybe one in in the Midlands etc which doesn't get used

Fyi I have family in various roles in the NHS. My BIL is in the mental health field (quite senior) . Works for the NHS but isn't employed direct. Is employed as a "company"

 

[thefanwithnoname]

Hiya mate. I get this is a touchy subject and one I don't want to get into an argument about, but there's still a hell of a lot of inefficiencies in the NHS. Some of it is structural and would take years to fix.

But some of it is just bad work practice that needs someone to say enough is enough.

I've been the recipient of some extraordinary specialist care since May. And as someone who's worked nearly 32 years in the NHS, 27 of them on the Commissioning side since 1992 when the so-called market was introduced, I've also seen some work practices I thought had been condemned to the dark ages.

Spot on mate.

I have a disabled kid as you know and the staff have been absolutely brilliant. I have witnessed patients taking the piss to consultants being ****s and overall I would always thank God for the NHS

But I do think management needs sorting before more money is given and at a larger level it's a disgrace that I can buy a bottle of paracetamol from a supermarket for the price of one that the hospital pays

 

[DUNCAN DONUTS]

only you could think of this.

Shall i say black?

Think most of the racist abuse ive copped is from whites though (was in black area, racist abuse when living/travelling in white areas). Either way it told me not to be a **** and stare at my phone whilst walking without paying attention.

Just a brief description.

 

[Burly Hurley]

What did you do in commissioning mate ? I was part of KernowCCG in mental health services, but my main role was running therapeutic centres across Cornwall. As I said, there used to be a lot of inefficiencies, but during my time I saw (and was responsible for) a lot of that being mopped up. I can't speak for the whole service, but in my area every penny was accounted for. Probably because we were never given much in the first place

I've worked in North London the whole time mate. The NHS has been ****ed about with so much in that time I've probably worked for 8 or 9 different organisations without leaving my desk! From HA's, PCGs, PCTs, through to CCGs today.

I've done the whole range but the last 16 years or so has just been Non Acute Services, MH, CHC, Children's Special Needs, LD, blah blah blah...

You've said that money is the key factor but that's a very broad subject. Throwing more money at it isn't going to fix the massive problems it will face for many years to come.

 

[PINKIE]

I've worked in North London the whole time mate. The NHS has been ****ed about with so much in that time I've probably worked for 8 or 9 different organisations without leaving my desk! From HA's, PCGs, PCTs, through to CCGs today.

I've done the whole range but the last 16 years or so has just been Non Acute Services, MH, CHC, Children's Special Needs, LD, blah blah blah...

You've said that money is the key factor but that's a very broad subject. Throwing more money at it isn't going to fix the massive problems it will face for many years to come.

Obviously money has to be spent properly. But yes, I do maintain at the root of the problem within the NHS is a lack of funding.

 

[Burly Hurley]

Obviously money has to be spent properly. But yes, I do maintain at the root of the problem within the NHS is a lack of funding.

Its not just a lack of funding. It needs a massive redistribution of allocations to CCGs, which to be fair to this bunch of idiots, they've laid out a 5 year plan to achieve (we're in year 2 now).

 

[PINKIE]

Its not just a lack of funding. It needs a massive redistribution of allocations to CCGs, which to be fair to this bunch of idiots, they've laid out a 5 year plan to achieve (we're in year 2 now).

I thought all allocations from Dept of Health came through the commissioning groups now ?

 

[Burly Hurley]

I thought all allocations from Dept of Health came through the commissioning groups now ?

They do. But some CCG's are way under-funded and some way over-funded in relation to their weighted population figures. So the one's that get more than they need just ****ing waste it!!

 

[thefanwithnoname]

Its not just a lack of funding. It needs a massive redistribution of allocations to CCGs, which to be fair to this bunch of idiots, they've laid out a 5 year plan to achieve (we're in year 2 now).

Part of my role was to literally unpick everything when it cane to services, because the new thing when I started was about sustainability as money was becoming scarce

I found a lot of money wasted on meetings and lunches , amazing how the increase in funds meant better venues and food for the decision makers

I alos found practices that in the long run made future issues in terms of money but life easier for some in the moment

Give you a brief example. The rise in caesarians. The main purpose of this was to save time and bedspace. So an appointment could be made and you're in and out. Everyone loved it including mums who simply didn't have to go through 37 hours or what not of labour. Nursing staff didn't have to spend that time with would be mum and those doing the procedure found a demand for themselves

Long term it's had huge knock on effects as it surgery and all the costs associated with that (can outweigh the cost of normal labour) And other effects such as not being able to drive for 6 weeks which doesn't effect the NHS at first glance but it does if you consider after care and pain relief etc

But hey it cut down waiting time and cleared a bed.


Obviously more to it but kept it simple

 

[Burly Hurley]

Part of my role was to literally unpick everything when it cane to services, because the new thing when I started was about sustainability as money was becoming scarce

I found a lot of money wasted on meetings and lunches , amazing how the increase in funds meant better venues and food for the decision makers

I alos found practices that in the long run made future issues in terms of money but life easier for some in the moment

Give you a brief example. The rise in caesarians. The main purpose of this was to save time and bedspace. So an appointment could be made and you're in and out. Everyone loved it including mums who simply didn't have to go through 37 hours or what not of labour. Nursing staff didn't have to spend that time with would be mum and those doing the procedure found a demand for themselves

Long term it's had huge knock on effects as it surgery and all the costs associated with that (can outweigh the cost of normal labour) And other effects such as not being able to drive for 6 weeks which doesn't effect the NHS at first glance but it does if you consider after care and pain relief etc

But hey it cut down waiting time and cleared a bed.


Obviously more to it but kept it simple

Thats a cracking example of a badly thought out idea having massive reverberations. That's the NHS at its best!

 

[Libby]

What wastage though ? The NHS is at breaking point and just about manages to operate, both being underfunded and understaffed. The cost efficiency savings I had to make when I was working in the NHS were crippling.

What are these wastages you're talking about ?

There's a lot of funds wasted in 'middle management' roles imo where it's not really necessary. Also the shortage of trained nurses means agency workers are relied on much more than they should be which costs a huge amount comparatively.

 

[Tel (they/them)]

The procurement in the NHS must be outsourced by now? I can’t imagine a single good reason why a) they’d source their own indirects and b) why anybody would want to work for them in a procurement role.

 

[PINKIE]

There's a lot of funds wasted in 'middle management' roles imo where it's not really necessary. Also the shortage of trained nurses means agency workers are relied on much more than they should be which costs a huge amount comparatively.

Agreed, there used to be a big problem of too many chiefs and not enough indians, when I was working in the NHS.

I was charged with trimming loads of band 6 middle management roles. It was tough for me to do because a lot of those jobs were still occupied by people who used to be my colleagues, but I had to agree with the rationale for doing it. I can't remember the exact pay banding now but I think a band 6 was on something like £28k-£36k scale. From my dept I shaved 8 out of 12 of those jobs and freed up around £350k, some of which just went into efficiency savings, but we also used it to recruit around 12 HCA's which I think was a band 3, so something like £15k-£18k and still managed to save the NHS something like £100k

 

[Libby]

Agreed, there used to be a big problem of too many chiefs and not enough indians, when I was working in the NHS.

I was charged with trimming loads of band 6 middle management roles. It was tough for me to do because a lot of those jobs were still occupied by people who used to be my colleagues, but I had to agree with the rationale for doing it. I can't remember the exact pay banding now but I think a band 6 was on something like £28k-£36k scale. From my dept I shaved 8 out of 12 of those jobs and freed up around £350k, some of which just went into efficiency savings, but we also used it to recruit around 12 HCA's which I think was a band 3, so something like £15k-£18k and still managed to save the NHS something like £100k

Good example there mate

 

[PINKIE]

The procurement in the NHS must be outsourced by now? I can’t imagine a single good reason why a) they’d source their own indirects and b) why anybody would want to work for them in a procurement role.

They were still doing a large proportion of it when I was working in there. Some of it made sense in terms of being able to have oversight of your own budgets and departmental needs. But it was a convoluted system that was tied into specific contracts and was very rigid in terms of competition. Even basic things like buying office chairs had to be done through the NHS procurement system, so you'd end up paying £200 for a chair that you could just nip down the road and get for £59 at office supplies.

 

[PINKIE]

Good example there mate

And you're right about agency workers. Even though the worker themselves might get paid less than their NHS equivalent, the cost of employing them through an agency was astronomical. A lot of that happened due to long term staff sickness and the inability to get people out of the door via HR. So you couldn't recruit for their job and had to rely on an agency worker instead, whilst also paying the sick pay of the person who's job was being filled. Hugely expensive.

 

[NSIS]

They were still doing a large proportion of it when I was working in there. Some of it made sense in terms of being able to have oversight of your own budgets and departmental needs. But it was a convoluted system that was tied into specific contracts and was very rigid in terms of competition. Even basic things like buying office chairs had to be done through the NHS procurement system, so you'd end up paying £200 for a chair that you could just nip down the road and get for £59 at office supplies.

Sounds like there may have been some brown envelopes involved here!...