Cuts in the NHS

[rory_20_uk]

As those in the UK are probably aware, and others might be to, the NHS due to Market Reforms is having to save a lot of money.

The Managers are often deciding that the way forward is to sack / remove positions of staff. Today one trust is reducing the workforce by 500 (10%).

Generally we are told that this is fine, as there will be an increase in efficiency to offset this - and clinical care will not be affected.

So, IMO there are two cases:

1) They are right! Closing wards and removing positions (and saving millions) will not cause a decrease in care: why the hell has it taken this long to cut out this MASSIVE amount of dead wood??
2) They're basically lying.

Am I missing something, or are they either wrecking the NHS, or belatedly pointing out that it's taken senior managers years to realise that they are wasting hundreds of millions of pounds?

[InsaneApache]

It was in 1997 that Tony Blair warned the electorate that they had just"24 hours to save the NHS".

Yeah right......

[econ21]

I remember when Mrs Thatcher started introducing the internal market into the NHS about 20 years ago, it was said that up until then NHS management did not have data on costs. Hence, it was inconceivable that they were being cost effective. It is rather analogous to us only finding out that nuclear power had enormous decommissioning costs when they tried to privatise it.

I suspect in public sector organisations, it is easy for inefficiencies to endure. People have their jobs to do, which are probably largely determined by traditional working practices and few have a concern with a financial bottomline. Even if the management do have that concern, it is probably very hard for them to bang heads and get their way. This is probably particularly true in the NHS, when the senior clinical staff still have enormous prestige and specialist knowledge which could be used to browbeat the bean-counters.

The other aspect is the soft budget - I suspect some trusts may over-spend, either unwittingly or thinking that they will be bailed out. Adjusting to a real budget constraint is probably inevitably going to lead to some train wreck situations until people learn to play by the new rules (or smash right through them). In some ways, it reminds me of debtor nations - creditors sometimes can't afford to let them default, so they are repeatedly bailed out.

Frankly, I don't buy all the talk of NHS cuts - I didn't under the Tories and I certainly don't under Labour. Any decent statistics will show massive real increases in NHS resources. Failing to manage such real increases and getting into financial scrapes just seems like indiscipline.

[rory_20_uk]

From what I've seen, senior clinical staff get told what to do by said bean counters. It's almost that the managers are more important than the cliical staff these days - they even come to demand to be told what doctors are doing in some cases - erm, treating patients? Yes, but not quickly enough! But... they're very ill... And???

[English assassin]

The other aspect is the soft budget - I suspect some trusts may over-spend, either unwittingly or thinking that they will be bailed out. Adjusting to a real budget constraint is probably inevitably going to lead to some train wreck situations until people learn to play by the new rules (or smash right through them).

yes, and moving to real budgeting on a trust by trust basis is going to cause massive problems until they get used to it. Hitherto, thrusts that had overspent in a year sort of "borrowed" money from other trusts that had underspent, and so long as the overall figure came out where the DoH wanted it that was an end of the matter. This was not a completely stupid approach, since in a sense "its all the NHS" but it didn't put much premium on adhering to budgets. Its all changing now, and its catching some people out.

Also I never cease to be amazed at the lack of basic financial information held by Trusts. For an organisation supposedly run by bean counters they have very little data on whatb they spend their money on or what they get in return.