US Health Reform (at last)

1. A large proportion of the support is unskilled and clerical. And interestingly in amongst all the ONS material the growth in frontline medical staff is far less than that of management and admin over the last 5 years. And there are fewer beds available for in-patients. So something is going in the wrong direction.

2. I cannot see that I have made any assumption resembling that which you ascribe to me in your last paragraph.

Support staff are not medical staff, as are doctors, nurses etc, so we are playing with numbers, again.

Mmm but as I pointed out the NHS needs more than just doctors and nurses – in fact every health system in the world employs more than doctors and nurses.

a) Doctors and nurses can’t do the tasks that physios, OTs, paramedics etc do
b) The NHS figures include all these in support for clinical staff as so superbly illustrated in your pie chart. Very clear – thanks!

Your posts appear to suggest that only doctors and nurses should be employed in the NHS – I’m not sure how you think that would work..?? I would respectfully suggest that were this to happen the state of the NHS would be in a much worse state than it is now!

You also make the erroneous assumption (admittedly a common assumption) that health care is a useful way of measuring the health of the population – it isn’t. Poor health is cause by a range of socioeconomic and environmental factors. The UK has some of the worst health inequality in the world that need to be addressed by a lot more fundamental actions than improving health care alone. Only then will we see improvements in the nations health.

Support staff are not medical staff, as are doctors, nurses etc, so we are playing with numbers, again.

You can argue it whichever way you like but the facts are clear, as I have set them out. Now if the NHS did not exist and our health service was provided by smaller autonomous groups then you would have a valid point. But it isn’t. If only it were – then we might not be having a debate about its effectiveness.

I’ll go right back to my original post, which was to state that the NHS is the 4th largest single employer in the world, after the Chinese army, Indian railways and Walmart. QED – it is the largest health employer, by employee numbers, in the world. The employee numbers came from the Office of National Statistics and were published in a broadsheet daily some weeks ago.

An additional pie chart from the ONS.

http://www.statistics.gov.uk/resources/graph1alternative_tcm119-24946.jpg

Interesting pie chart there – seems I was wrong to suggest that admin and management was at 8% It’s now down to 7.1%

What Swerve has outlined is correct. You are stating that the NHS is the largest SINGLE health employer. What you are missing is that in the other countries you state their health services are organised differently and so their employment figures are calculated differently. France has a network of private and public systems and so these people are employed by different organisations. Therefore no one SINGLE employer employs everyone. You are also comparing apples with pears as you would need to measure whether the same services were provided as well as the amount of funding. A more accurate (but equally as meaningless) comparison would be to measure the number of employees as a ratio using the total population as a denominator. Would get you a meaningless figure but at least it would be a more accurate meaningless figure!

Back to the subject of the thread. This Bill isn’t coming into law without a fight!

http://news.bbc.co.uk/1/hi/world/americas/8586492.stm

Please re-read my posts and you will see that I have dealt with each of your points in different posts and in response to various contributors, but, for the last time to summarize: NHS largest health employer bar none. UK ranked 18th in WHO table, with several countries with similar populations above it – two of them at 1st and 2nd in the table.

Secondly the pie-chart breaks down the clinical and support percentages very clearly.

But that says absolutely nothing about how employment in health care in the UK compares with other countries, or how the share of administrative & other support staff compares.

You claimed that other countries provide better care with fewer people. You have provided no evidence to support that claim. All the evidence you have provided relates to the NHS.

The NHS employs 2.3% of the total population of the UK, & consumes over 80% of British health spending. I have supplied evidence that one country (the USA) employs 4.7% of its population in health care – from this source. That’s far more.

I’ll go right back to my original post, which was to state that the NHS is the 4th largest single employer in the world, after the Chinese army, Indian railways and Walmart. QED – it is the largest health employer, by employee numbers, in the world. The employee numbers came from the Office of National Statistics and were published in a broadsheet daily some weeks ago.

An additional pie chart from the ONS.

http://www.statistics.gov.uk/resources/graph1alternative_tcm119-24946.jpg

You clearly know how the other nations’ health services are constituted but not how many are employed. Please clarify.

Weeellll . . . you’re the one who made the original claim that we employ far more here than in other countries, so I think the onus is on you to find the figures to support what you say. So far, you’ve provided no evidence for your assertion. It ain’t easy to dig ’em all out, except for the US total (14.3 million in 2008). In France, for example, health employment is usually lumped in with social services, & medical personnel are separately listed – e.g. here.

Also note that the NHS does not employ all health care workers in the UK. There are private hospitals, for example, non-NHS dentists, etc.

You clearly know how the other nations’ health services are constituted but not how many are employed. Please clarify. And obviously anyone working for the NHS is counted as working for the NHS, because that is who employs them.

At the end of the day, as we probably might agree, statistics can be made to mean whatever we want them to mean. In the WHO rankings we fall well short of those countries I have mentioned.

So, it comes down to one’s personal experience and perception. Having had reasonable experience of the health systems of Denmark, Germany, France and the UK, I certainly would place the UK at the bottom of my list. And no one has yet convinced me that considerable savings cannot be made in manpower.

I must, however, make it quite clear that I am not denigrating the job that the majority do extremely well, and often against insuperable odds. That was shown so clearly in Gerry Robionson’e excellent programme a year or so ago.

Yes I have. I’ve explained that it’s an illusion, a product of the way statistics are presented. Also, you have not presented any data to support your claim. Do you know how many people are employed in health care in Italy, Spain or France?

In the UK, most health care workers are counted as NHS employees, even subcontractors & staff employed by subcontractors. In other countries, there is no comparable count. Individual hospitals, regional hospital boards, etc. are counted as separate employers. Comparing them with the NHS is like comparing, e.g., a country with a national police force to one with regional police forces, & asking why the country with a national force has more police. The answer is – it doesn’t.

The real count is that of the total number of people employed in health care. There is no evidence that the UK is exceptional in that.

No one has yet explained why the UK employs more staff than any other national health service yet languishes way below France, Italy and Spain, which have comparable populations, on the WHO rankings. Clearly the money spent is ill-spent and the statistics suggest that it is wasted on people rather than capital resources.

Most Americans I meet seem to be opposed to this.

Of course Misha, you worked at the estblishment at which I was employed and witnessed first hand just how ‘little’ management there was? And how effective that management was?

Regards,

kev35

My apologies – I was responding to the quote about top heavy management – it is a regularly trotted out line and simply is not true and never has been. I would be surprised if management outnumbered professions such as nurses etc.

I fear, Misha, that your view of the NHS is through rose-tinted spectacles. And to use the statistics you, yourself, have used, slightly under 700,000 of the 1.3+ million are NOT front line medically trained staff. They are support and administration

JoeyR –
Not at all – I have worked in the NHS on and off for many years and so have first hand experience of the good and not so good. Can I just ask what your experience is as you seem to have in depth knowledge about what support is required for health care to operate.

I’m just curious as you seem to think that front line clinical staff are the only staff required to operate a health service yet have taken out a whole swathe of important clinical staff to justify your argument. Admin and management accounts for around 240,000 posts in the NHS (I refer you to the statistics I referenced in a previous post). The support for clinical staff category relates to professions such as

Radiographers
Physiotherapists
Speech and Language Therapists
Occupational Therapists
Clinical Psychologists
Audiology etc etc etc.

Most of which are jobs that your regular doctor or nurse are not trained to do. Remove these and you will see a serious degrading of the service provided.

I would argue that the NHS is still under-managed. Compare the management costs with large organisations and you will find that they run at around 15% + management costs. You will be hard pushed to find much more than 8% management costs.

But that is the problem and why the NHS is in a state. It is a populist move to say lets cut the management . I have 12 years experience in the NHS and have gone through 8 reorganisations- each one designed to make huge savings and getting rid of those pesky managers. And yet still the problems remain. The reason for this is that the costs and jobs are a very small proportion of the total and therefore you are tinkering around the edges.

As for “dead wood” – where is that? A basic understanding of the roles of the system would show that there is little “dead wood” around. Don’t believe everything you read in the papers! It is a simplistic (and naive) view that healthcare is only doctors and nurses.

You mention targets as a problem – a major success has been the 2 week target for cancer treatment – no one now waits longer than 2 weeks if cancer is even suspected by the GP. How do you think that came about? Good management – that’s how.

Actually I had better state now that I am not a Manager in the NHS at the moment – have a more interesting role(!) but have worked as a manager in the past.

There are two issues here:
1) the size of the NHS as an organisation.
2) employment in health care.

The former I see as unimportant. It is a result of how state health care is financed & structured: a result, not a cause.

The latter is what matters. The UK is pretty normal in this, unlike the USA, where health care is a vast, bloated, industry. One reason why US health care is so bloated is that it employs far more support & administrative staff than other countries. I don’t know how the UK compares with other European states in this respect, but I can state with absolute confidence that the NHS is in a different league from the USA, with a far higher proportion of workers actually delivering care.

The NHS used to be conspicuous for its extremely low administrative overheads. Indeed, it was probably under-managed. Unfortunately, it’s now over-managed, & IMO has far too many non-medical staff. But it’s still well behind the US level.

With respect you cannot separate the Trusts. They are part of the NHS structure and have to be seen as such. In the US, of course, the structures are completely different.

I cannot comment on your last paragraph, but perhaps you can answer GA’s earlier question. What proportion of the total employment in US healthcare is non-medical? This relates tio an earlier series of exchanges you might have missed.

Swerve – in my earlier post and your reply we are talking about two different things. I am talking about numbers and you are talking about expenditure.

Employment in these cases is rather well correlated with expenditure. The higher US spending per employee is not enough to counterbalance the much greater spending. Medicare employs, although indirectly, far more people than the NHS.

The difference between the NHS & other systems is that you are counting the many staff of separate NHS trusts as employees of a single organisation. In practice, they operate largely independently, although being funded by, & having to conform to rules laid down by, central government.

BTW, in proportion to population, far fewer people work in health care in the UK than in the USA.

GA – I notice that you had second thoughts about your unequivocal, initial response to my post. I wish I could agree that I had exagerrated the “dead-wood” effect. But I don’t think I have. I fear that it is fundemental to solving the massive NHS problem and the fact that all the main political parties have declared it “off-limits”, out of fear of the electorate, fills me with despair.

I reckon that if you polled people the question ” Would you accept a large reduction in the money spent on the NHS, if there was no reduction in the quality of the service and a likely improvement in that service over 5 years?” – you wouild get a significantly strong “yes” response. he naysayers woild be those who couldn’t accept the premise that you can often get more by spending less.

Which it probably wasn’t really 20 years ago and certainly isn’t now.

Of course Misha, you worked at the estblishment at which I was employed and witnessed first hand just how ‘little’ management there was? And how effective that management was?

Regards,

kev35

Swerve – in my earlier post and your reply we are talking about two different things. I am talking about numbers and you are talking about expenditure.