The NHS prescription: £22 billion of efficiency savings

At what point can an organisation which has undergone many years of reorganisations and “efficiency savings” actually create any more efficiencies and still comply with the regulatory regime?

Leave aside the arguments about the £350 million lie of the Leave campaign, because it’s not actually relevant until Brexit is complete.  Even if every penny we actually pay into the EU were diverted to the NHS, apart from the inability to fund agricultural subsidies and infrastructure funding, that is a long way short of £22 billion, and money that the Leave campaign posited would be free in 2019 is no use when the NHS needs it in 2016.

One might say that NHS Trusts would just say that they need the extra money to fund patient care or they may have to close units, cut staff and ration treatment – one could suggest they are exaggerating just to get extra money out of the Government.

But are they exaggerating?

Go back to my first point.  As regulation has increased, additional bureaucracy has arisen to meet it to avoid affecting patient care.  Privatisation of services (contracting out, clinical commissioning, whatever it is called in whichever area this week) requires considerable overhead in specification, tendering, monitoring, and variations to cover months when too many patients walk into A&E and need operations and other treatments which are not covered in the contract, artificially increasing costs.  Existing cuts and growing waiting lists requiring contracting out of work by private firms staffed by NHS doctors and other clinicians in their spare time.

Throw in the effect of delayed action due to waiting lists, where more expensive treatment is required to lack of early intervention, and also the mental health impacts of delayed intervention – autism services always come to my mind, but waiting for an operation that would considerably improve quality of life is damaging, due to the extended restriction on enjoyment.

With this amount of overhead imposed by the Government, and with so many years of efficiency savings already carried out, the question is: are there any lawful true efficiencies that can be carried out while still delivering the same or better clinical care? Should we in fact be looking at undoing some of the efficiency savings due to what were already diminishing returns having long since turned negative?

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  • chrisjones2

    I think there are but whether they are enough is a moot point.

    Take one example ….. many people end up blocking beds in hospital because although they are medically fit to go home they do need support in the community and it either takes time to organise or just isn’t there, That means that beds arent available to take in emergency cases from A&E, blocking up scarce A&E space. This flows back to Ambulances who cannot offload as the A&E has to manage intake. It also leads to cancelled operations as there are no beds for the patients

    Redirecting some NHS money to support getting the ‘blockers’ out into care in the community – which is where many are desperate to go – could have huge savings down the line. But this all needs managed. In NI I think we are better of it as the link between Health and Social Services is much better but in E&W its an utter mess

    The NHS is also very bad at recovering costs from those who should pay – for example where people are injured in road accidents the NHS is supposed to claim treatment costs off the insurers for the party at fault., It generally doesn’t do it. Its the same with health tourists. Why not make it a condition of entry to the UK that you show proof of insurance? We often dont even bother to claim the costs of treating EU citizens from their home Governments. Collectively all this must run to tens of millions (if not more)

    As a society we also need to do something about the huge waste of resources by some individuals who wash up drunk in A&E every week blocking / delaying access for those that really need help

  • SeaanUiNeill

    Chris, while I’d agree with you on some of what you say here, this obsession with the “undeserving poor” rankles me. Have you ever thought what has occurred in the lives of those people who “wash up drunk in A&E every week” to ensure that getting blind drunk is their life choice? It’s like any other form of self harming, a fingerpost to events in a life which are evidently beyond coping with. You are correct in suggesting that a gestalt of the whole process of illness is needed rather than the current occasional and partial intervention, but blaming the vulnerable rather than the system which has crushed them in that it valorises and rewards the abusiveness of public winners and their narcissistic greed is simply not the way to even begin to answer this problem. Take it from an old leftie, having a genuinely caring society will always work better here than letting the market regulate things through its own brands of inefficiency.

  • Anglo-Irish

    ” There but for the grace of God ” isn’t a bad attitude to adopt when considering the plight of others.

    Even for those of us who are unsure as to whether or not there is a God.

  • chrisjones2

    Ok …go and stand in A&E and they are there…sometimes violent ….mostly just drunk. Last time I was in A&E there were three of them – a woman stone drunk in her PJs pacing endlessly up and down, full drunk and two others sitting in seats clearly just very very intoxicated and arguing incoherently at length.

    When we were called in for treatment another – a well known local tramp who i have some sympathy for as I know he has mental health issues but who i know can be very belligerent and violent – was parked fast asleep on a trolley at thye end corridor. It wasn’t a cold night, he didn t seem ill – from the smell he was just stone drunk and they were letting him sleep it off

    The NHS staff have to cope with them, their temper tantrums, demands etc. I agree that some need help but for some its all just self inflicted – ever wonder why there are so many posters in A&E about zero tolerance of violence and threats to staff?

    A genuine caring society must first care for the NHS staff who work so hard to look after the genuinely ill. It also needs to find a way to prioritise the demanding drunks. A good start might be a £100 fixed penalty if there proves to be nothing wrong with them but drinking too much

  • Anglo-Irish

    Well yeah, if you insist on being pedantically correct about it.

    : )

  • chrisjones2

    …but its not infinite …so far as we can tell

    Not that I am pedantic

  • Kevin Breslin

    “We often dont even bother to claim the costs of treating EU citizens from their home Governments.”

    Any evidence of this … I mean isn’t that the reason pretty much the case that the European Health Card exists?

    I’m being to think this stinks of Daily Express/Daily Mail mopery … Telling the British people every day that they are the Most Oppressed People Ever … It’s surprising they aren’t all running away to take refuge in Syria.

  • Anglo-Irish

    Following 15 years research on observations from the Hubble Space Telescope astrophysicists published the information last Thursday that the observable universe contains 10 times more galaxies as originally estimated.

    They now estimate that there are two Trillion galactic systems in the bit we can see.

    However, as Einstein said ” Only two things are infinite, the universe and human stupidity, and I’m not sure about the universe “.

  • Gopher

    First and foremost financial legal liability has to be removed from the NHS for any failures towards anyone who puts themselves in their care. That will get rid of the vast proportion of wastage. Secondly if you are prepared to pay a fixed percentage for appointments, operations etc you go to the top of the list. Thirdly people need to be responsible for their own health so lifestyle should determine treatment priority.

  • Am Ghobsmacht

    Two TRILLION systems?! Man, some of the space-trash I read may be true! (As long as it isn’t the Warhammer 40k universe, I don’t fancy that for a lifestyle for our descendents…)

  • Old Mortality

    I couldn’t agree more. Financial compensation from the NHS should only be available in cases where gross negligence or wilful malpractice can be proved. That would dramatically reduce doctors’ insurance premiums which they frequently cite as a major burden.

  • Am Ghobsmacht

    There’s some good points below.

    Following on Gopher’s point;
    “Thirdly people need to be responsible for their own health so lifestyle should determine treatment priority”

    I think some day there’s going to be a crossroads, we’ll either have to take the red pill and ditch the NHS as we know it and go private to some degree (or completely) which means people can continue their modern lifestyle choices without modification e.g. take-outs, biscuits, soda drinks, fried food etc or take the blue pill and say “enough is enough, if you want the state to look after you then you must come up with the goods; national insurance goes up 5-10 fold, soda, ready meals an McDonalds et al get taxed to the hilt, biscuits and crisps get taxed but this way we can look after you when your system implodes”

    It may sound severe but people don’t seem to understand the link between eating rubbish and ill health but in the UK and Ireland the path of least resistance is junk, it’s so bad that many people don’t even think biscuits, crisps and coke are junk.

    I’m no temple of health but my general rule is ‘if it’s made in a factory then avoid’ (there are exceptions like some pastas and cheeses an a few things besides) and since I’ve stuck by that my health has improved a great deal even though my consumption of things like pork and some other fatty foods has went up at least 5 fold in the past 5-8 years.

    Anyhoo, the point is modern life is geared to corral us down a particular unhealthy path and the NHS sees the end result and this can’t go on forever.

    We have a great thing but we’re responsible for its maintenance.

  • Anglo-Irish

    Back in 2013 astronomers estimated that there could be 40 Billion Earth sized planets orbiting in the habitable zone of sun like stars.

    That was based on research from the Keplar space mission data.

    The Hubble research released last week has increased the possibilities tenfold ( based on the totally unscientific assumption that such planets may exist in a similar percentage) which means that the likelihood of life on other planets is almost certain.

    As to whether we’ll manage to make contact before this planet reaches the end of its existence is another thing.

  • notimetoshine

    We just have to realise we need o pay more for our health treatment. Surprisingly, the uK does have one of the financially efficient health services in the developed world. But it means there is room for investment. It may not be popular, but maybe it’s time to look seriously at significant increases in national insurance.

    However, Northern Ireland does not have an efficient health system. In fact our health system is an absolute disaster. A testament to the incompetence of the storming executive. 18 to 24 month waits as standard for urgent appointments for specialist scans and consultations, appalling mental health services and an A and E service that aspires to be appalling. I wish our nhs was in the condition the english service is.

    As for social care, properly funded social care would take an awful lot of pressure off health services. What the government was thinking of in England cutting care fusing I don’t know. But Northern Ireland again is horrific.

    I am the primary carer for my grandmother, and when we health first took a downturn she was hospitalised for just under four weeks. She was ready for home after five days but was forced to spend 3 weeks in hospital waiting on care arrangments. It took the family threatening legal action to get some movement! On her ward the woman next to her was there for a month! Waiting on a care package. Two of the oter patients also there for more than a week waiting for care, all ready to be discharged. The cost to the nhs must be astronomical.

  • Am Ghobsmacht

    Off the top of my head would it be tempting fate to force some people e.g.long-term unemployed, or time wasters or re-offending drunks to help out at local NHS facilities (at a menial level)?
    E.g. let’s say someone has made a few appearances at A&E drunk, well, they could be forced to grab a mop and bucket and help out on a Friday and Saturday night.
    Once they’re at the coal-face they might have some empathy for the staff and become less likely to act the lig in future.

  • chrisjones2

    Yeah its all made up to justify Brexit

    ….but wait ………… the EU card provdies for treatment free at point of delivery but requires that the treating state recover costs from state of residence. If people are resident here then of course they should be treated here but if they are on holiday or a visitor then their home state is supposed to pay ……..if the NHS collects the data and the Government bill them.

    So Polish plumber working in Derry – entitled to free treatment here. If his Granny visits and suddenly needs heart surgery she gets it free but the NHS should claim the costs off Poland.

    Anjd if you dont believe Sky (Murdoch Rag that isnt anti Brexit enough!!!) the This is from earlier this year. It is the Blog of the man who was trying to manage the programme to get the NHS to change their behaviours and collect the cash

    Reading between the lines ‘herding cats’ might be a fair comparison

  • Gopher

    They require supervision, supervision costs money.

  • chrisjones2

    Who says they are poor. Many are. Many are not. Go down and stand outside the Waterfront after say 12mn on a Friday night and you will see young, often apparently affluent, middle class young people stone drunk and having to be treated in the SOS Bus or carted off to hospital

  • chrisjones2

    If they do arrive lets hope they dont access the viability of human kind based on an examination of Stormont

  • chrisjones2

    Perhaps but there are two excellent fly on the wall programmes on TV at the moment.

    One is 999 Whats your Emergency and the second focuses on the Ambulance Service and the calls they receive. Both are illuminating. I seem to recall that they said at one point that 70% of Ambulance calls are drink related and yous ee them trying to balance the demand as drunks phone up demanding Ambulances on tap delaying the treatment of the very seriously ill

    This can be misleading of course but just watch a couple and see where the drivers in the service really are

  • Anglo-Irish

    Presumably any aliens capable of surmounting the difficulty of traveling millions of light years to arrive here would have the capability of monitoring and evaluating our communications.

    In which case they will have witnessed the current Presidential election campaign taking place in the most powerful and advanced nation the world has yet produced.

  • Anglo-Irish

    The last time that I had reason to visit an A&E department was approximately 5 years ago when one of my daughters suffered a trapped nerve in her neck causing severe pain and preventing her taking care of our grandson who was three at the time.

    My wife looked after him whilst I ran her to hospital.

    There were four people waiting treatment ahead of us. One was a drunk who was accompanied by his equally drunk ‘mate’.

    They got into an argument and the injured one beat up his ‘ mate’.

    There were now five people waiting treatment ahead of us.

    It was just turned 1 o clock in the afternoon.

    You are correct in that it’s a major problem and the hospital staff shouldn’t have to put up that type of behaviour.

    They have notices everywhere requesting that NHS staff mustn’t be attacked and there are CCTV cameras with accompanying signs warning people that they are being recorded.

    Whilst holding his ‘mate’ in a headlock and punching him in the face with his spare hand the clown I mentioned above was shouting ” You wanna be on TV, you wanna be on TV? “.
    Hopefully they followed through on the incident and the idiot was prosecuted, but I get the impression it’s that commonplace little happens because of all the form filling that needs to take place.

  • hgreen

    Agree 100%. Here in the UK we expect world class healthcare but don’t expect to pay for it. We are all living longer therefore we need to pay more.

    Problem is we keep electing Tories who hate the NHS and can’t get it into their simple minds that a publically funded service can outperform a private one.

  • notimetoshine

    While I agree the Tories aren’t doing the bus any favours, labour wouldn’t be much better. They all promise the earth but aren’t willing to make the unpopular decisions necessary to provide te care.

    Doesn’t make a difference labour or the Tories, they shy away from the fundamental reforms needed. It’s the same with pensions and an ageing population they tweak the system but never actually drill down to te core of the problem, more spending is needed. Root and branch reform of nhs funding.

    Social care is even worse, it like the orphan child of social welfare. Yet solving care would relieve so much pressure on the bus in terms of both preventing hospital admissions and also shortening stays.

    We have to see an increase in national insurance, or a new social care levy, because the boomers are going to bleed health and social care services dry.

    As usual though NI is even worse. Our service is a shambles, not just under strain like the english system.

  • hgreen

    Labour were much better. Yes they made errors (pfi) however A&E and operation waiting times dropped significantly under the last labour govt, staff recruitment and investment in facilities went up. It really does make a difference when the NHS is managed by a labour govt.

  • notimetoshine

    Oh of course they did some good work rectifying Tory mistakes, but it was just like their Tory brethren do, poltical short termism. That short termism is clear when one looks at the Pfi scandal or those ridiculous gp contracts. Short term gain for long term cost. Labour are just as bad as the Tories at taking the long view, about fundamental structural reforms. Oh no doubt labours ideology makes it more amenable to the nhs, but they still don’t have the balls to make the hard decisions and policies necessary to prepare for the future.

    It’s a symptom of party politicking and ideologically driven policy.

  • SeaanUiNeill

    Suffering and abuse does not steer clear of those with the readies chris. there are victims of for example, sexual abuse in elite circles just as there are amongst the poor.

  • SeaanUiNeill

    Look chris, this is not a see saw of either/or, addressing the causes of people seeking for regular bouts of oblivion helps everyone. And remember the Auden lines,

    “Those to who evil is down,
    Do evil in return…”

  • AndyB

    Chris, I agree with quite a bit of what you say. We should be investing in community care and hospital wards to make room for more people to be admitted from A&E, reducing the strain on the whole system.

    The problem is that such eminently sensible measures that are good for the patients in the beds and even better for the patients and staff in A&E require cash that isn’t being made available. From conversations I have had, the problem is wider than people occupying beds unnecessarily, it also requires an absolute increase in bed capacity. Not a popular point of view with the bean counters, but there is such a thing as a false economy (unfortunately!)

    Reclaiming costs from insurers and recording EHIC card numbers to reclaim from EU countries should be a given, especially if the other countries are assiduous about doing their part.

    Dealing with those who require treatment due to alcohol abuse (whether just an occasional bender or alcoholism) is an incredibly difficult thing. There is a massive societal issue that needs to be addressed – and yes, I agree with the guys below about part of the response being “there but for the grace of God go I.”

  • AndyB

    While it’s an attractive idea, I suspect it may fall foul of requirements to keep the place super clean

  • AndyB

    I’m a member of Benenden, in order that if I need care in the future I can have intervention before worse intervention is needed. However, in principle, with an NHS working effectively, I wouldn’t want to see advantage for those who can afford to pay over those who can’t. What’s the difference between someone working part time for the minimum wage and getting tax credits and someone who could pay for their care in full or even at US healthcare rates out of their daily pocket money?

    I would far rather see systems changed so that the negligence that results in claims doesn’t happen in the first place – which of course means better staffing ratios and more money in general. I don’t want to see people denied justice because the United Kingdom has failed to treat their medical condition correctly, and changing the systems and supporting those system changes would be more effective in avoiding the costs of putting things right when they go wrong – including the intervention required to treat the problems created.

  • Am Ghobsmacht

    Well, i thought that might be the case as some shorter just has to make a hash of it to be relieved of their duties, hence i’d advocate making it a ‘going through the motions’ position with a proper cleaner accompanying them and making a proper job of it.

    Sometimes (when I worked on the rail road ) a gaffer would have us needlessly shovel stones just to give us something to do rather than stand idle.

  • chrisjones2

    I agree. This is not about that – its about a culture that its ok to abuse NHS resources because of ‘my rights’

  • chrisjones2

    I agree….we need to squeeze this out of the system. a right to refuse treatment would be small start

  • chrisjones2

  • Anglo-Irish

    Something needs to be done but it’s a difficult issue.

    Most of the people who decide upon a career in the medical/care profession do so because they wish to provide help to their fellow human beings.

    It tends to be a vocation ( which governments tend to take advantage of ) and asking people with that attitude to turn away people who need attention, whatever the cause, is asking them to go against their raison d’etre.

    Several members of my family in both Ireland and England are members of the nursing profession.

    I have a great deal of respect for them because I know for a fact that I am not cut out for that kind of work.

    Being able to treat people over a period of time, getting to know them, and then having to watch them die, then repeating the process again and again is something that I couldn’t do.

    Another thing that I couldn’t do is show patience understanding and consideration for idiots such as the ones I mentioned in my last post.

    Thankfully, there are people that can, but we need to find a way of lessening the burden.

  • John Collins

    In theory absolutely fine. But as one who worked at the front line for many years what happens if the said drunk is refused admission, or at least a thorough examination, and he collapses, or worse, as soon as he goes outside the door. I would not like to be in the position of the person who made the decision not to see said ‘drunk’.

  • chrisjones2

    In many areas it can. Examples include:

    Hearing Aids
    False Teeth
    Hip operations
    Knee operations

    etc etc

    All our GP services, Dentistry and most drugs dispensing are delivered by Private Contractors. The key is to get the best mix not a completely foolish rejection of the private sector

  • chrisjones2

    Then they created a massive population influx and didnt plan for it. Guess what happened despite billions extra pumped into the NHS

  • chrisjones2

    Thats why it needs to be statutory

  • grumpy oul man

    Just think. Out there we could be someones science fiction novel.
    When they make the movie i want Johnny Depp to play me.

  • chrisjones2

    They also made a spectacular mess of negotiating Doctors contracts, Beckett managed to ‘negotiate’ a 40% increase in costs for 0% increase in productivity

    Now a payrise was overdue but this was lunacy

  • Zig70

    I would lazily suggest than any sector managed by the insurance industry like courtesy cars, insurance repairs etc is hugely poor value for money. Health care seems to be little better. I enjoyed every test going and wages seem to be poorly controlled under private health care. As for the NHS itself, anyone coming from a modern manufacturing sector would laugh at the idea of health service efficiency. 2 changes I would make immediately, ban the word ‘Outcomes’, force clinicians to explain themselves and not control via jargon and replace GP’s with nurses. They can or do defer to consultants anyway, cost a fortune and moan endlessly about working too hard.