The future of the NHS

[DownOnTheUpside]

So, do your friends think it's more expensive because of the standards set for the product or, is it target price for sales or, have I misread that?
Also, shouldn't the gov't be able to put pressure on pharmaceuticals re pricing structures?

Edit: Yes, I know gov't wants profits and employment but, surely this is an area, like education, where other priorities take precedence?

As regards the govt and companies that's totally beyond me tbh

Total speculation: since these products tend to be specialist, if the company started being threatened with legislation or w/e they could turn off the taps and cause utter chaos

 

[tadao]

Yerh it's mostly because theyre confined to an approved list of products essentially and people like infection control are an utter nightmare to convince them to add something to that approved list
Thats not the exact situation but it's the best I can do without going into crazy detail

A big form of waste is again a communications issue: departments like to air on the safe side by ordering more stuff than they need and sending stuff back once it gets anywhere near expiry dates (im talking 2 months before on a lot of things) it's in the clinic's interest to air on the safe side while purchasing has to try and save money

The final layer of issues is around budgets - if you have budget left at the rollover date then the excess is taken out of your next budget
So say if your department budget is £200, and you only spend £180; then your next budget allowance is dropped to 180
So departments around april start buying a load of stuff they don't need - i've seen computers still in boxes being used as doorstops
But if you don't play this inane game then you can have your budget cut and you dont know how much next year will cost

That's how school budgets are run apparently!

 

[tadao]

As regards the govt and companies that's totally beyond me tbh

Total speculation: since these products tend to be specialist, if the company started being threatened with legislation or w/e they could turn off the taps and cause utter chaos

Not that I'm advocating nationalisation of companies but, if there was a properly funded national company to provide the product, the competitive tap might be cheaper to turn on?

 

[DownOnTheUpside]

That's how school budgets are run apparently!

Not sure who came up with that idea exactly

One of the main budget drains comes from the fact that a trust is a huge unwieldy thing with the turning circle of an oil tanker attempting to respond to needs that are really variable and move fast
For example adrenaline syringes are kept by all wards in case they need to bring someone out of a severe allergy or w/e
The problem is you could need 10 of them january and 40 february so its a nightmare to predict how much each area will need
And they're hugely expensive (talking hundreds of pounds each) and have expiration dates
No company is gonna go much lower on price (because they're really expensive to produce) and theres a ton of different strengths

One time a supplier couldnt produce them for a few weeks and they were the only company that made these particular ones
It was utter utter chaos for a week since every clinic was needing them
Also all clinic orders are paid in advance, before the stuff's delivered
So we were having to refund these syringes, move them from ward to ward and keep tabs on the supplier
And this was just some everyday hiccough with production

If the gov comes along and says you have to sell them for xyz well maybe that supplier pays more to make them than that and so stop trading in them
Maybe they dont but just say fine then we arent making them
It's not like anyone can just overnight pick up and start making highly specialised items like these

 

[DownOnTheUpside]

Not that I'm advocating nationalisation of companies but, if there was a properly funded national company to provide the product, the competitive tap might be cheaper to turn on?

Which product though? You'd be making the thing even bigger and more unwieldy cause you'd have to cater for thousands of different products and respond to changing market demands
Plus even nationalised companies have suppliers who can play hardball
And ontop of that theres patents on a lot of these products

Honestly manufacture is best left to the private sector as theyre better placed to handle these sorts of situations
The nhs is a huge contract and so they tend to get good deals on stuff

But healthcare is fundamentally expensive and tell people they're paying more taxes amd they bring back the guilletine

 

[tadao]

Not sure who came up with that idea exactly

One of the main budget drains comes from the fact that a trust is a huge unwieldy thing with the turning circle of an oil tanker attempting to respond to needs that are really variable and move fast
For example adrenaline syringes are kept by all wards in case they need to bring someone out of a severe allergy or w/e
The problem is you could need 10 of them january and 40 february so its a nightmare to predict how much each area will need
And they're hugely expensive (talking hundreds of pounds each) and have expiration dates
No company is gonna go much lower on price (because they're really expensive to produce) and theres a ton of different strengths

One time a supplier couldnt produce them for a few weeks and they were the only company that made these particular ones
It was utter utter chaos for a week since every clinic was needing them
Also all clinic orders are paid in advance, before the stuff's delivered
So we were having to refund these syringes, move them from ward to ward and keep tabs on the supplier
And this was just some everyday hiccough with production

If the gov comes along and says you have to sell them for xyz well maybe that supplier pays more to make them than that and so stop trading in them
Maybe they dont but just say fine then we arent making them
It's not like anyone can just overnight pick up and start making highly specialised items like these

Which product though? You'd be making the thing even bigger and more unwieldy cause you'd have to cater for thousands of different products and respond to changing market demands
Plus even nationalised companies have suppliers who can play hardball
And ontop of that theres patents on a lot of these products

Honestly manufacture is best left to the private sector as theyre better placed to handle these sorts of situations
The nhs is a huge contract and so they tend to get good deals on stuff

But healthcare is fundamentally expensive and tell people they're paying more taxes amd they bring back the guilletine

Cheers for the replies.
It's always to easy to play PM and think you know the solution but, the NHS and Education are complex areas, with national ramifications.
Best left to the experts.
Although, playing PM, you do wonder if all the changes in direction/strategy can ever be made with a common ground, between the main political parties? At least then, a course of action has a proper chance at success or failure?

 

[DownOnTheUpside]

I'll answer as best I can anthing else you wanna ask in this area tomorrow once i've had a kip haha
I never dealt directly with suppliers or reps or that but I was sitting next to people who did, and suppliers are generally onboard and willing to court trusts and offer deals because the contracts are normally huge from trusts
So it's not like they're always out to get you

 

[DownOnTheUpside]

Cheers for the replies.
It's always to easy to play PM and think you know the solution but, the NHS and Education are complex areas, with national ramifications.
Best left to the experts.
Although, playing PM, you do wonder if all the changes in direction/strategy can ever be made with a common ground, between the main political parties? At least then, a course of action has a proper chance at success or failure?

Haha i can talk a bit on group relations too since my degree is in psych but im not long for this world tonight haha, done in

 

[tadao]

Haha i can talk a bit on group relations too since my degree is in psych but im not long for this world tonight haha, done in

Cheers mate and goodnight.

 

[Bruce Wayne]

So, do your friends think it's more expensive because of the standards set for the product or, is it target price for sales or, have I misread that?
Also, shouldn't the gov't be able to put pressure on pharmaceuticals re pricing structures?

Edit: Yes, I know gov't wants profits and employment but, surely this is an area, like education, where other priorities take precedence?

Drugs would be easier (and thus cheaper) to develop if they (the pharma companies) had access to patient records. Stimulus was mentioned earlier. Perhaps we could pay for everyone to have their genome mapped under the condition that this data is made available for medical research purposes.

From the pharma perspective, it takes 12-14 years to develop a drug, with that costing in the region of $2.5 billion, but only something like 10-20% of drugs ever make it through the entire trial process, so there's awful a whole lot of money spent on drugs that fail. So given the expense it's perhaps not surprising that they want to cash in on the drugs that do make it through.

 

[Bruce Wayne]

I'll answer as best I can anthing else you wanna ask in this area tomorrow once i've had a kip haha
I never dealt directly with suppliers or reps or that but I was sitting next to people who did, and suppliers are generally onboard and willing to court trusts and offer deals because the contracts are normally huge from trusts
So it's not like they're always out to get you

I tend to work at the other end of the spectrum, ie not with huge pharma companies with established links with a trust, but with startups and research labs that have no links but incredibly neat products, and it's a Kafka like process trying to get anything done at all. Talking to a trust themselves is generally impossible. NHS England launched their test bed scheme, but that has largely been a failure. The AHSNs are awful at their job, so seldom are innovative solutions sought out, and even more seldom are any of those that are found to work in one trust then spread to all of the others.

Hence you get things like the recent announcement of a new AI based triage system that billions is being spent on, when a company just down the road from me has developed (and is using this with customers) a service that already does this (and does so for a fraction of the cost of the proposed NHS system). I spoke to them at the time of the announcement and no one from NHS England had even been in touch.

As I said previously, there is sooo much incredible stuff going on in the healthcare industry at the moment, and the pace and spread of innovation is the like of which I've never seen before. But I'm not confident whatsoever that the NHS is equipped to ingest all of these things.

 

[Jags..class]

I know people hate tax but we must protect the NHS. I don't want to see anyone in our country refuse statement like America. Another idea is to invest in companies who make our machines and buy them at a low cost, invest in companies who are at the cutting edge of treatments and bring then in at a low cost and charge high to private companies.

 

[anjelikaferrett]

So simplifying the tax system to free up resources to enforce a compliance based system is a non-starter?
Fair enough.
Attacking the large companies for avoidance is easy to do on a forum, but due to the complexity of tax law it is difficult to do in practice and HMRC will always go after the micro business first. Most companies incorporated in the UK (certainly in the last 13 years since I've been here) were done specifically to reduce the tax and NI burden for sole traders and small partnerships. For years it didn't make sense to be a sole trader,
Just saying.

Not at all. I'm all for simplification. My point is that huge global companies are getting away with paying miniscule amounts of tax compared to what they should pay at the correct rate- not asking them to pay more, just what they should. Why let them do it? It might not be illegal but it is certainly immoral. You or I couldn't do it and Joe the plumber or Fred the decorator who take a few cash in hand jobs will be the ones who get caught and punished severely.

And while I'm on a rant, look at the resource dedicated to catching benefit fraudsters (which is also illegal and I'm not advocating it) It is huge compared to the resource dedicated to tax avoidance, which costs the economy far more. I'm waiting for the equivalent programme to Benefit Street too- Tax Avoidance Towers maybe?

 

[anjelikaferrett]

Nobody talks to anyone in the nhs in my experience working in it
You have to spend half your time chasing people to find out where anything is or whats going on and its pretty ridiculous

The admin is actually underfunded and very very nescessary otherwise people dont get paid or stuff isnt ordered or people don't get correct treatments or whatever

For every treatment you need someone booking in patients, someone ordering stock to make sure its available, someone making sure the trust gets paid the right amount for that patients treatment, someone updating details of any test results etc etc

And theyre all nescessary functions but theres no real public will to fund these departments compared to primary care staff

I'm a Civil Servant, I love admin and I appreciate it is a vital function of any organisation. However in my limited recent experiences of the NHS the whole system seems to be cumbersome and could be quite easily made more efficient if people talked to each other and accepted some responsibility. It really does seem to me that the right hand doesn't know what the left hand is doing leading to colossal amounts of waste.

 

[Groucho]

It's "chronically underfunded."

The government should be running a fiscal stimulus program. And since healthcare spending is particularly stimulative, much of the stimulus program money should be pumped into the NHS.

Agree. How can you expect something to work when you fund it less and raise it's workload?

Classic privatisation tactic, and I for one, oppose it.

If I remember correctly, we actually spend less than most nations on healthcare, so in answer to the OP, basically, fund it properly.