National Health service in your country

That’s a crying shame about your son. I hope pulls through.

You’ve pinpointed some of the reasons why a lot of people in the UK are against health insurance. There are just some things were it is better for the state to provide, for the common good. Defence, law enforcement and to many minds healthcare.

At the same time, I and many others do not trust the government – because of the manifest incompetence with which it usually conducts itself. The health service especially!

Some countries have opted for a middle ground, a state health system like the UK but with significant insurance elements. But none of them are great. We’re still looking for the “third way”.

One of the blunt comparisons is the conception that if you fall ill in the UK, you will be treated no question. If it happens in the US, the ambulance crew won’t even try to resuscitate you until they’ve swiped your credit card. That isn’t entirely accurate, but is the popular image over here of a healh system based in the private sector.

Here in the US, healthcare is on a “Every man (woman and child) for himself.” The only industrialized country in the world without some form of National Healthcare. There is some service for the truely needy, but it is not really adequate for the demand. Some states like California provide better public health, but that system is challenged. Healthcare insurance is available (but not mandatory) and generally expensive.

The good news is that if you have insurance, the care in the US is the best in the world.

Currently, I am much too familiar with the US healthcare system as my 13 year old son is being treated for Lymphoma, a type of blood cancer. Long story short, he will be fine once he gets past his next major treatment (radiation and stem cell transplant). His treatment is fully covered under my insurance policy at the finest Cancer Hospital (City of Hope Hospital in Duarte California).

The other downside to US healthcare: Because my son has a pre-existing condition (Lymphoma) I can never leave my current insurance company for another. The new company will not pay for treatment for a sickness that you already have. As my insurance is through my employer, I will have to work at my current job indefinately to make sure my son’s treatment is covered.

Scott

Most banks consider a mortgage from the point of view of affordability and not earnings these days. Ie. They will basically look at your bank statements and jusdge if you can afford the monthly payments or not.

it does give rise to teh question is the idea of a ntaionl pay award valid

on say £25k i can live nicely up north but never get a mortage (ie 4x 25K) for london and in south east at best i would get a naff terrecr / ex council house

rabie 😉

Isn’t that a frightening thought!

The implication is that the qualification process for becoming a doctor is shoddy. Would you agree?

Part of being a professional is knowing your abilities and of course lack thereof. As an accountant, there are certain areas I’m good at but some where I have no practical experience, or where I learned stuff for an exam but can’t really remember it. I have to restrict myself appropriately – if I don’t I would be struck off if anyone complained about duff advice I gave, and of course I’d face a huge and unwinnable lawsuit.

The sheer workload should NOT change this principle. If you are overworked, tough. It’s managements duty to hire some more people or else sack you and get someone more efficient.

The urgent nature of the work is not really a justificstion.

Mongu,

perhaps you are right, I could have phrased my point about junior doctors a little more delicately. Medicine is an area in which you can do as much book learning as you like but the junior doctors are unleashed on the public with the knowledge but not the experience to put it all into practice. I agree the hours are too long, but the juniors do have a safety net. Above them they have Senior House Officers, Registrars and then the Consultant in charge of their team. Junior doctors do literally have to be wet nursed through their first few weeks. They have the knowledge but not the interpersonal skills, the practical skills, the dexterity and in many cases the emotional maturity to cope with their every day work load. I think this is true of medicine more than any other profession.

Your analogy of a First officer doesn’t really work when applied to medicine. It appears that being a junior doctor in the NHS would be akin to someone who’s just passed their PPL being made captain of a 747.

Regards,

kev35

Yes, clinical managers should have a clinical background.

But there is an inherent contradiction in that…too much background and the are institutionalised, too little and they are not suitable. It’s a fine line and the NHS is clearly erring on the side of experienced people. A little movement in the other direction is necessary I think.

Your arguments against unaccountable, petty and overpaid managers is accurate and I couldn’t agree more. But for progress to be made, they must be replaced by better candidates. If the going rate for an acountant with 3 years experience is £40k in the North, then that is what they will have to pay. If the going rate for a nurse is £25k, again, that is what they will have to pay. You cannot seriously argue against paying market based wages?

Also, I disagree about any “merit” in overworking junior doctors. Back to my aviation analogy: would you fly on an airline which preferred to overwork First Officers, so that the airline could tell if they had the “right stuff”? I mean hey, we’re not talking jumbos, just a Dash 8…No, the First Officers ARE the right stuff. Some obviously are better than others, but all are of the required standard. How do they figure this out? A little thing called “training” and “licensing” preceded my rigorous selection. Come to mention it, the same as trainee lawyers being called to the bar, or accountants and bankers receiving their charter…

Hi, Mongu.

“The trouble is, if a manager really knows how the NHS works, he/she is likely to be institutionalised and therefore not the best person to move the organisation forward.”

To effectively manage a unit, a speciality in the NHS, that manager cannot do the job well without a sound knowledge of the particular requirements of that speciality, hence the incident I described. The catering manager has a catering background, the financial manager has a financial background, the human resources manager has a background in human resources. But the medical services manager, the most important in the terms of how care is given, can tell you everything you need to know about steel stockholding. Really useful to the people at the forefront of the job who have to cope with unrealistic demands. See the obvious discrepancy? In this case the knowledge which Mongu’s ‘institutionalisation’ brings to the situation is invaluable.

“Certainly, part of it is that doctors have to sort their profession out.
Junior doctors are treated unprofessionally – low pay and unrealistic hours. But for some reason, doctors, as a profession, do not want this to change because it would erode the position of the minority of really senior doctors who get money shoved at them and work shorter hours.”

Junior doctors are rarely professional when they hit the wards. The analogy here is that when you’ve passed your driving test, that is when you really start to learn. The same thing applies to doctors. The hours are unrealistic but observing junior doctors as they face the challenge of adapting to these hours provides a clear insight as to who is going to make the grade. It is in that first six to twelve months decisions are made which will guide the junior doctor through the rest of their career. Their aim is to be a Consultant by the time they are 40. Those that make it are almost guaranteed to make £150 – 200,000 per year for the next twenty years. As for eroding the position of senior doctors if the juniors worked shorter hours, I don’t think that would happen, at least not to consultants and probably not to registrars.

“Why not a lawyer, accountant or banker? Their medical knowledge is not the same obviously, but maybe their ability to effectively run an organisation is better. If they really ARE high calibre professionals, they will not micro manage or endanger clinical needs by meddling.”

It seems the policy of the NHS is to micro manage. Remember the manager of linen supplies? The one who had two assistant managers, one for sheets, one for pillow cases and over blankets. The real joke there being that the two assistants were paid more than a senior staff nurse.

“Despite whining about “overpaid” NHS managers, how would you compare their pay to that of your average solicitor, chartered accountant or bank manager? Not too well, is the answer. “

That is not the comparison which people in the NHS would make. They would look at the salary of managers and compare that to the ludicrous (in comparative terms) pay which a ward sister is paid who is held accountable for her actions. This is not the case with NHS managers. A transgression by a senior manager usually means they are offered a considerable financial inducement to leave. A ward sister would be dismissed, likely lose her PIN number and as a result of that be unable to work in the profession again. There is no eaquality in treatment there.

Mongu, it’s over to you….

Regards,

kev35

Kev

The trouble is, if a manager really knows how the NHS works, he/she is likely to be institutionalised and therefore not the best person to move the organisation forward.

Certainly, part of it is that doctors have to sort their profession out.

Junior doctors are treated unprofessionally – low pay and unrealistic hours. But for some reason, doctors, as a profession, do not want this to change because it would erode the position of the minority of really senior doctors who get money shoved at them and work shorter hours. Basically, as this is an aviation forum, the comparison is that junior First Officers have to fly for 14 hours a day but senior Captains only for half an hour. Clearly that position is not only unprofessional, but is unsafe and endangers public safety.

Another aviation comparative would be in the choice of managers. Now I know a lot of pilots sometimes dislike and even disrespect their line managers, maybe even because they are not all pilots! But you cannot doubt that the average airline is better run than the NHS! So the argument is: why should managers be doctors and nurses (If I’m an American – “health care professional”) ? Why not a lawyer, accountant or banker? Their medical knowledge is not the same obviously, but maybe their ability to effectively run an organisation is better. If they really ARE high calibre professionals, they will not micro manage or endanger clinical needs by meddling. How to attract such people….decent salary is part of it. Despite whining about “overpaid” NHS managers, how would you compare their pay to that of your average solicitor, chartered accountant or bank manager? Not too well, is the answer. Small wonder then, that Mr. solictor or accountant is not employed by the NHS.

In my experience the NHS is really really good if you’re going to die in the next 24 hours… they generally stop that and patch you up pretty well for free!

However, I’ve had to receive treatment for a couple of other things that weren’t urgent – in that case I’d have to say the NHS is a massive waste of time and it’d be quicker to save up and have the treatment done privately. The fact is, in Yugoslavia I was able to receive better, more specialised care much quicker than in the UK (and it was free out there too). Yugoslavia has had many more economic and political problems than the UK – the fact that its health system is better is a scandal.

Slight amendment to my earlier post before I continue:
Insert “massively over-paid” between many and managers.

A few years ago I accompanied the female half of this partnership to our local Casualty Dept. Chesterfield Royal Hospital, apart from waiting, which is the same everywhere, no complaints aimed specifically at them.
While waiting, and pacing around, a couple of people came to empty the vending machines in casualty of cash.
They were pushing a trolley, which to my fairly well-trained eye, was made of stainless steel and solid timber. This must have cost several hundred pounds.
The person that ordered it should be made to pay for it themselves, sacked and barred from working in any public service for life as he/she is obviously not to be trusted with public money.

According to my other half, I’m getting grumpier as I get older.
Perhaps it’s just me.

Mongu.

“Actually, not that I want to kick off a debate with Kev, but the problem isn’t too many managers, but too many useless ones, especially petty little beurocrats and “suddenly, just because I’m a doctor, I must also be a manager” types.”

Only just spotted this. The problem is that the NHS suffers both of the problems mentioned above. There are too many mangers and too many who are useless. That is how it appeared to the people working on the ‘front line’ (nurses, carers, doctors, ancilliary staff) in the mid 90’s. Having not worked since 1998 I can’t vouch for the situation now. From comments made by former colleagues, the situation is much the same today.

I think your comment about doctor’s feeling they are also managers is a little harsh. Junior doctors, who arrive at a hospital twice a year, shiny new stethoscope and a pocket full of pens, don’t have time to feel they are managers. A week sees a very different character. Bleary eyed with fatigue they struggle to manage their own caseloads. The good ones? They have learned to query everything with either the nursing staff or their Senior House Officers. The SHO’s ‘manage’ the juniors while they themselves chase their tails to ensure they don’t incur the wrath of the Registrar. The Registrar tries to keep everything up to date by pressurising the SHO’s, after all he is just one step away from the exalted position of Consultant. The Consultant has a secretary who manges the consultant’s time for him, always ensuring there is significant time for him to pursue his career in private practice. That is where the money lies and very few Consultants do not take the opportunity to benefit from this license to print money.

“They need to attract a higher calibre of person to manage the NHS.”

There I agree. But they should also have knowledge of the way in which the NHS works. I believe I mentioned an incident in which the medical services manager tried to transfer a vebtilated patient to a medical ward during the night. Three staff on the ward to look after 27 patients. If the ventilated patient was admitted to the ward the trained nurse, or the senior student (in that case, myself) would have had to spend the whole time with the ventilated patient. How could anyone then be expected to receive an appropriate level of care? And the manager? Their previous managerial experience had been as a senior stock controller in a steel stockholders.

No debate, Mongu. Just a couple of points to consider.

Regards,

kev35

In the UK you have to pay for dental treatment unless you are in dire financial straits (you will then have all on finding a dentist to treat you on the NHS) or are an asylum seeker (in which case you will have priority treatment, no expense spared sort of thing).
The local hospital in my town is quite good, with relatively short waiting times for treatments, good staff and even nice hospital food, so I cannot complain there. The NHS overall is in a shambles – not enough medical professionals, too many managers, people leaving to work abroad or in the private sector, patients left on trolleys in corridors for hours because of lack of beds (notice there was an intensive care bed available in Liverpool for an Iraqi imported for burns surgery, some poor British kid will have had an operation cancelled to make way for the Iraqi, that is something else which happens alot in Britain – asylum seekers and imports don’t have to wait as long as native Brits for treatment. That in the long run breeds bad feeling among the British population, it’s no wonder that the far right is making gains in some areas, though not in my town I hasten to add.

Golden rule i suppose…as long as the money comes in, they aren’t bothered what happens to it. When it stops coming in, they’ll go overboard with cutbacks.

VAT

Quite right they won’t/can’t intoduce VAT just for one specific public sector, so it will emcompass much more.

We are told that the States have to cut back on their spending, then in the next issue of our evening post we are told that despite public opinion they are going to build a bridge on the water-front at an estimated cost of £2m, they are also doing feasability studies on a link to France £3 billion+

We have an airport terminal that went 10m over budget, a drain water recover chamber that went £8m over budget, a steam clock (the only one in the world) that doesn;t actually run oin steam, this cost £500,000 at a time when the hospital required a MRI scanner that the states refused to fund, it was finally bought by public subscription.

Something is wrong somewhere, if you were to run your own personal finances like this islands does you’d be declared bankrupt by now.

Interesting about the VAT…the consensur seems to be that the lack of a VAT regime is the one thing holding Jersey back from the next big growth era.

Maybe the “limited” VAT for healthcare funding will actually be full VAT by the back door?

VAT

The States of Jersey are threatening to introduce a form of VAT to finance amongst other things the health service.

You’re probably right about poring money into the Islands health services, we also have the added problem of housing restriction here in Jersey, health workers come in on a 5 year contract and then leave, so to encourage them we have to pay a premium rate.

The housing and immigration problem is being looked into but just like every where else it takes time to form a committee of enquiry, then divide this into sub committees to report to the main committee, this is then divided into more sub committees etc……..

The end result is a camel, “A horse designed by committee”.

To be fair Ian, the IOM and CI just tend to chuck money at their health systems and it sorta trundles along better than in the UK as a result.

In the IOM’s case I don’t really think it is possible to say how much we each contribute, beause a huge proportion of government revenue is based on VAT receipts, unlike the CI.

UK and CI health service.

Kev I tend to agree with you that the UK health service is way too top heavy with managerial staff. It is now facing a shortage of Doctors and Nurses.

Many of the Doctors were brought in from Asia during the 1960’s as dare I say a cheap and affordable way of filling the need for more Doctors, now these guys are coming up for retirement and their places aren’t being filled.

Nurses receive their training in the NHS but then a lot of them move away to the private sector, where pay and conditions are much better.

I can’t speak for Guernsey or the Isle of Man, but here in Jersey we pay 6% of our salaries in Social Security contributions to finance the Health Service and hopefully a state pension when we retire.

On the whole the healthcare is good, and from experience compared to the UK the time from being emitted as an emergency case to getting a bed on a ward is less then 3 hrs depending on the treatment.

My father is permanently cared for by the health services after suffering a stroke nearly 2 years ago, I can’t fault the care and treatment that he gets, the staff are brilliant and really take pride in their vocations.

Working in the finance industry I’m lucky enough to have Health Care Insurance as part of my employment package, it’s amazing how quickly you can get treatment in comparison to the public sector. I know of one chap who’s waiting time was cut from 3 months to 24hrs when he mentioned Private Health Care.

In theory, I am proud of the British system. In practice, it is badly run and to a certain extend underfunded.

Actually, not that I want to kick off a debate with Kev, but the problem isn’t too many managers, but too many useless ones, especially petty little beurocrats and “suddenly, just because I’m a doctor, I must also be a manager” types.

They need to attract a higher calibre of person to manage the NHS.