Do you know of any areas of wasteful health spending?

The NHS is being changed, no matter what the public say...

The given main reason is to improve services but cost effectiveness is always included.

We are told that increased compatition will help this but can you think of other areas where there is waste which could be cut at a stroke without the loss of jobs?

Every Town Hall

Westminster


Whitehall

EVERY Quatermaster's Stores

The equipment the MOD insists on giving away for virtually nothing - They call it an auction!

Keeping 8 Chinook Helicopters in heated air conditioned luxury knowing they will never fly - near Bristol. (I may be wrong on that one, please let me know)

The American airforce easily beats a mere 8 chinooks in storage. Their $100million Raptor aircraft are never flown over anything but "home" territory for fear they might crash and fall into unfriendly hands.

If you just want to talk about waste in the NHS, a lot of money could be saved by refusing to treat self-inflicted injury, i.e. the drunken or drugged ones who turn up in A&E every Friday night, the motorcyclists who return repeatedly with various broken limbs and the bladders of lard who won't stop eating junk food. You could add those with emphysema, bronchitis or throat cancer due to heavy smoking.

Maybe for the sake of humanity, a policy of three strikes and you're out.

OW
so you see the treatment of certain sections of the population as wasteful?

I notice you didn't include the treatment of the elderly in your list of those who should have treatment withheld....

The thing I was looking at was more where costs could be cut whilest still maintaining services.......the wasteful spending.....

We have had the 'shock horror' stories of the cost of changing lightbulbs but there are more unrecognised waste which seem to be totally ignored and in my opinion are the result of rules and practices, which could easily be changed without a major overhaul of the NHS........

"I notice you didn't include the treatment of the elderly in your list of those who should have treatment withheld...."

Well how long have you got? The list is endless. On the topic of the elderly I consider it criminal that clinicians insist upon keeping people alive who have expressed a wish to die. Spare me the Hippocratic Oath garbage, their motive is a version of experimenting on white mice.

There's terrible waste of the 999 facility.

I work for the London Ambulance Service, and I see first hand just how little understanding there is of what an emergency is.

I have had call-outs to:

- numerous obvious viruses (patient has vomited twice)
- cut fingers
- tummy aches
- bad menstrual period
- need a repeat prescription
- "walkers" who have a car available
- headaches
- moderate limb pain

Each time we go, it costs the NHS over £200. We squeeze the patient into the accident & emergency department, where the nurses already have too many patients.

But how do we solve this problem? The call-takers aren't medically trained. They sit there with a computer that tells them what questions to ask. The worst case scenario is always picked for safety, and the call is categorised.

Perhaps we could start having medically-trained call-takers? It would cost a lot, but maybe it would end up saving money.

Many of my colleagues want to see people being charged for silly call-outs. It sounds harsh but, if you spent a day with us, you'd start feeling the same way. Problem with that is, would we rather people called us for the wrong reason, or people were scared to call us and then some would die?

What we tend to find is that it is foreign-born people who call us for silly reasons, and they expect us to be able to administer treatment and drugs on scene and then leave them at home. When we explain that we are an emergency service and that our job is to get them to hospital for emergency treatment, they get grumpy and baffled. So, the people we need to target are those who don't understand the British system.

I don't see any such advertising or targeting. In fact, what I see more is encouragement to dial 999! I think we've all seen adverts for the signs of heart attacks and strokes. As soon as one is shown repeatedly, calls rise and most are unnecessary.

Any ideas?

The call-takers aren't medically trained.

Good Morning BH

Iffin the guys and gals who are at this time retiring early on injury grounds, were retained on their pressent wage and pension, this may change. When ambulance driving in Scotland we often took the call ourselves - we HAD to go obviously but if we knew the caller, then we could set out a plan for how to deal - while the wagon was running to the incident. Primarily, this was standby duty out in the sticks.
The fire service do not retain firefighters who have broken legs, ankles or have ilnesses that preclude them going up ladders. These people could be retained and work on the control. Same with the Polis!
This keeps skills on hand, and I know that sometimes the controller gave me some help when at accidents, as he had been through "the mill" himself.

They're trying to cut retirement on the grounds of injury down.

It's already not possible to retire early due to a bad back, which was apparently the most common problem (we do a lot of heavy lifting, pushing, pulling, and bending over). Now, they say that we have sufficient training and information to avoid back injury, so it is not the service's fault.

I like the idea of frontline staff moving onto call-taking once they have had enough of being on the road though. Perhaps it should be offered now that retirement age has gone up! I will suggest it I think.

Just to add, we already have systems in place to reduce the number of ambulance dispatches, but the problem is being sure that we have the right diagnosis. Also, we can never refuse an ambulance, and most people who call in the first place are quite sure that they need one. Many don't speak English that well and it is safer to just provide one.

Ambulances are much too comfy. People would be slower to shout for one if what then came was an Army Surplus WW2 lorry from the Western Desert.

The nice ones could be kept for inter-Hospital emergencies !

Comfy?! It's horrible lying on the hard bed, going backwards with no windows (patients who didn't feel sick to begin with have ended up puking up en route!), and then being shoved about on a rickety trolley bed.

Blamhappy wrote:Comfy?! It's horrible lying on the hard bed, going backwards with no windows (patients who didn't feel sick to begin with have ended up puking up en route!), and then being shoved about on a rickety trolley bed.

Then what can be the reason for the continuing public clamour for Ambulances?

Is it that dread word "entitlement" again? I want it 'cos I've paid for it. (Well, someone has, haven't they?)

It's a free taxi ride to hospital and lack of understanding of what an emergency is.

That's such an attractive word, "FREE".

Friend of the Advertiser and Freeloader alike.

Charging $50 for an ice pack, another $30 for a bandage, and $150 for the doctor to simply tell you, "We don't treat that kind of condition here. Goodbye."

My father was charged $450 for the doctor to come in, ask him how he was feeling, and then leave.

All of these instances of price-gauging are endemic in the US health business.

Part of the explanation is the extraordinary cost of Professional Indemnity Insurance for a Doctor practising in the USA.

Part of the explanation is the extraordinary cost of Professional Indemnity Insurance for a Doctor practising in the USA.

Or the rising costs of doctor salaries.

In 2011, MSNBC ran a story outlining the 20 fastest rising salaries in America. Of those 20 salaries, 13 of them were doctors. In addition, the top 6 fastest rising salaries in the US are doctors. All of them were making well over $300k to $400k per year.

In an era when everyone is having to make sacrifices and tighten that proverbial belt, these doctors can do the same. When you're already making $400k per year, you don't need a 13% raise. In fact, their RAISES were larger than the average salary in this country.

In this respect, a number of people adopt a Rule "You get what you pay for." There is no price that isn't worth paying for Good Health, assuming you can afford it.

There is implicit reassurance that your Doctor is "worth" what he's charged you when it's eye-watering.

Could this whistle-blowing continue under the Lansley Rules? ....

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Tory MP Dr Phillip Lee clearly thinks that giving diabetics free treatment is wasteful; in fact, he calls it "indefensible". After all, it's more money that could be better spent on providing tax cuts for millionaires....

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More info on what the good doctor said.


Free medicines will have to be cut back because Britons cannot put up with aches and pains like their wartime forebears, says Tory MP
People’s access to free medicine on the NHS will need to be limited because 21st century Britons are unwilling to put up with aches and pains in the way that wartime survivors did, according to a senior Tory backbencher.
Christopher Hope

Phillip Lee, a practising GP, said patients must live healthier lives or help meet the cost of their care from their own pockets. “If you want to have doughnuts for breakfast, fine, but there is a cost implication down the line,” he said.

Dr Lee predicted hospitals will be unable to cope in a decade’s time because modern day Britons are unwilling to put up with minor ailments in the same way that their parents and grandparents did.

Lets be honest he holds a very valid point.

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Logic might seem to suggest that a lot of the money involved in dispensing medicine is "wasted" on healthy people. Millions of pounds are spent on dosing patients with preventive measures, for example on Statins which control blood pressure and reduce the likelihood of a heart attack.

Presumably those with similar views to MP Christopher Hope and Doctor Lee would wait until an actual illness presented.

Is everyone aware that when a patient dies in a private nursing home all the drugs that are left from their prescription even if it is a full months supply have to be destroyed, they are not allowed to be returned to the pharmacy for re allocation to other patients even though they have been paid for by the local PCT/NHS........

Some of these drugs can cost over £30 per 100 mil bottle..........so imagine a patient on 10mils three times a day could have over £250 worth of meds wasted..........!!!!!!!!

astradt1 wrote:The NHS is being changed, no matter what the public say...

The given main reason is to improve services but cost effectiveness is always included.

We are told that increased compatition will help this but can you think of other areas where there is waste which could be cut at a stroke without the loss of jobs?

North Tees and Hartlepool NHS Trust is threatening to dismiss and re-engage its staff in order to force through a change to their contracts that will prevent them being paid their enhanced rate for unsocial hours if they're off sick - a move that will cost nightshift workers about 15% of their income, even if that sickness or injury is work-related. The Trust says it needs to do this in order to meet its '£40m challenge'.

The total saving that it will achieve? £500,000 a year. Yet NTH NHS spent over £1m this year on consultants.

astradt1 wrote:Is everyone aware that when a patient dies in a private nursing home all the drugs that are left from their prescription even if it is a full months supply have to be destroyed, they are not allowed to be returned to the pharmacy for re allocation to other patients even though they have been paid for by the local PCT/NHS........

Some of these drugs can cost over £30 per 100 mil bottle..........so imagine a patient on 10mils three times a day could have over £250 worth of meds wasted..........!!!!!!!!

Excellent point, astradt, I was astonished when the hospital dispensary declined the return of unopened pain-killers that my wife hadn't actually needed. However, on mature consideration, we could guess the newspaper headlines arising from someone later being offered "second-hand drugs".

tlttf wrote:-
Phillip Lee, a practising GP, said patients must live healthier lives or help meet the cost of their care from their own pockets. “If you want to have doughnuts for breakfast, fine, but there is a cost implication down the line,” he said.

Lets be honest he holds a very valid point.

Let’s be honest – Lee stinks, and so does anybody who agrees with him.

With the country almost bankrupt from the Second World War, a decent, caring Labour government set about implementing the Beveridge Report with its ethos of ‘cradle to grave’ care. Naturally the Tories opposed it then and have done everything possible to undermine both the welfare state and the NHS ever since. Now, aided and abetted by the quisling Lib Dems, they are hell-bent on destroying both before they get slung out in 2015.

For more than sixty years after 1945, the economy of this country grew at an average of 2% a year, yet we’re now supposed to believe that we can’t afford to treat all sick people. Absolute rubbish! This evil, quasi-fascist government found £1.1 billion to bomb Libya, £1.6 billion to effectively privatise the NHS, whatever it cost for Mrs Windsor’s jamboree and even £10,000 to re-stuff a snake in Hague’s office. It’s prepared to waste billions of pounds on a replacement for Trident. Yet a mealy-mouthed bastard like Phillip Lee – a so-called member of a caring profession – doesn’t want to pay for medicine for type 2 diabetes sufferers because he claims that their lifestyle has caused their illness. I don’t know when Lee last practised medicine, but he’s clearly incompetent. Type 2 diabetes is caused by a number of factors, not just lifestyle; genes and age can also play a part.

Lee claims that stopping free medicine for those suffering certain illness will “save the NHS from collapse”. What dishonest drivel. The NHS would be “safe” if Tory governments didn’t starve it of funds and asset-strip it for the benefit of their party donors. In fact, the NHS would be a lot safer if the Tories were never allowed near it.

I think making First Aid training compulsory in schools would really help cut down problems with unnecessary 999 calls and it would also save lives. It would be reasonably cheap to administer and the benefits endless - it teaches contribution to society, responsibility and the feeling of being able to help someone or save a life is a powerful incentive to get involved and care for society. It's also a bonus in the future workplace.

I would also use more motorcycle paramedics who can get on a scene quicker and professionally assess a situation before the use of an ambulance depending on the call type and save ambulances for 'they're not breathing/unconsious/lost a limb/blood spurting/fitting' situaiton.

I would also encourage the use of NHS Direct 0845 4647 as is a great service that operates 24/7, I wish more people would utilise the knowledge there. It's particularly good for peace of mind and going though basics of 'do I need to see a doctor' 'do I need to go to hospital' 'do I need an ambulance' I wish they had a more simple number like 991 etc I've saved a lot of time using this service as they go though symptoms of concussion and when you should dial 999. They also have specialists as well as it's core of nurses if it sounds more serious than dehli belly.

I would also cut down on unnecessary managers, administrators and admin and put the money in front line - doctors, nurses and overseen by Doctor's and Matrons who get an admin assistant.

Completely get rid of PPI Most hospitals have gone broke because of it.

I would also make sure cleaners are hired direct, not outsourced and give them more of a feeling that they are saving lives too. Way too many people are killed by unhygenic surroundings MRSA c-dif, etc. Being a part of the hospital team, rather than a hired-in random 'cleaner' that doesn't give a s**t would make a difference and generally be more cost effective.

I would also have better outpatient groups for those with chronic pain and chronic illness, mental health issues and use a few more group support teaching medication monitoring and management, pain management, and meditation, lifestyle changes, pacing, exercise, nutrition, rehabilitation, physio, social support, balancing finances, etc People could pay extra for certain complimentary treatments such as acupuncture, osteopathic, NLP and sports massage, depending on their situation and requirements, which would also boost local industry and keep an eye on complementary practitioners. It would be cheaper than people keep seeing their GP's for aches and pains, help people manage their conditions with less medication and get people in a state of getting them back to work. Most people with chronic illness are just left too it on their own and basically go down hill, costing both the NHS and DWP more in the long run. I think anything that engages the population and helps them take control of their situation is a good thing and cheaper in a prevention is better than cure kind of way. This would also cater for the above mention of alcoholics/drug addicts mentioned above. Most people get in those situations are isolated as they have no social support or help with mental health issues and tend to self medicate.

Give a man a fish and he'll eat for a day, teach him how to fish....

PhoenixLeo wrote:I think making First Aid training compulsory in schools would really help cut down problems with unnecessary 999 calls and it would also save lives. ....

I would also encourage the use of NHS Direct 0845 4647 as is a great service that operates 24/7 ....

Give a man a fish and he'll eat for a day, teach him how to fish....

Has NHS Direct 0845 4647 been replaced by 111?

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I do so sympathise, Bobby. In our family we have the same problem, but have taught ourselves the simple aide memoire using the bingo allegory of two ducks in a row (22) but then adding one to make (33) which is a lucky number in some Cultures. Multiply that by 30.3 (recurring) to get 999 which is the number to call in any emergency, and ask the Operator for the new Medical Emergency number. They're sure to know, but won't know why a service which worked well has been scrapped.

But what a relief it is to know that our NHS is in safe hands with the Tory-led Coalition.

oftenwrong wrote:Has NHS Direct 0845 4647 been replaced by 111?

 http://www.dh.gov.uk/health/2012/11/impact-nhs-111/

I'm not sure... weirdly they forgot to mention it on the NHS direct website if it has changed... [You must be registered and logged in to see this link.]  A report on the impact of an invisible transition of number seems a bit of a waste of money! lol

One idea that might help reduce strain on the Ambulance Service is to force doctors (GP's) into earning their six figure salaries and being forced into making house calls to their patients.

They (the GP's) should also be made responsible for delays in treatment to their patients caused by their receptionists blocking patients getting appointments and for the bad advice that the receptionists give out. I suspect a redesign of the reception systems would help immeasurably if it is done properly, especially if it made automatic calls to a locum service is overwhelmed.

Patients who abuse the system (not those that the GP's don't like or those that are a strain on his budget) might be better served if they all had to share the services of a specialist GP service.

Just suggestions.

Heretic

I think this may be another example of the "Postcode Lottery", Heretic.  When I stupidly damaged myself at home last month and telephoned the Practise for advice, a Doctor drove out to my house as soon as they had dealt with the people attending Surgery in person.

You can't get any better than that even by going Private.

My Doctor only visits the terminally ill and I'm not in that category yet. I remember when I was a child that our doctor made house call for measles or chickenpox just in case it was masking something else. That attitude of 'service' needs to return to our GP's, maybe if we halved their salaries then we could afford twice as many of them (I know it wouldn't quite work out like that). It might also help in the need to catch injuries and illnesses sooner and it would probably save money. Bring their salaries down to five figures instead of six. There is no reason a doctor should be on a salry greater than an MP (that is a reason to reduce doctors pay not increase MP's pay).

Heretic

Has the penny, excuse the pun, finally dropped with those who now control the purse strings of everyday care spending in some areas....

Wasted medicines cost £1.2m a year

Health commissioners are urging people to stop wasting medicine to help save vital funds for the NHS.
People living in areas covered by clinical commissioning groups in Newark and Sherwood and Mansfield and Ashfield are wasting around £1.2m-worth of medicine every year.

The CCGs are working with GP surgeries, community pharmacists and care homes to drive home the importance of ending the culture of waste, which costs the NHS nationally an estimated £300m a year.

That represents approximately £1 in every £25 spent on general practice and community care in England.

Healthcare leaders are urging people to order only what they need and are raising awareness that unused medication cannot be re-used.

The CCGs are working with care home and community staff to help avoid the stockpiling of medication in residential and nursing homes , which is thought to be one of the sources of unused medication.

Health leaders have published a leaflet appealing to patients to think twice before ordering repeat prescriptions they may not need and to avoid stockpiling medication in an attempt to reduce the £90m-worth of unused prescription medicines that are kept in people’s own homes at any one time.

The campaign will include a series of roadshows at Newark Hospital to highlight the cost of wasted medication by displaying the empty packaging from returned medicines to the public.

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The size and scope of the NHS means that even that old standby of commercial firms "savings on paper-clips" can represent real money, but the business of dispensing pharmaceutical treatment is unfortunately not quite that simple.

The traditional gatekeeper GP is not seeking arguments with his/her patients, and usually accedes to routine requests for a particular medicine, even though the GP is not necessarily convinced they are absolutely necessary.  Moreover the placebo effect is not imaginary. A further complication arises with unused prescription medicines. They are destroyed if returned, because re-cycling would not sit well with subsequent patients apparently receiving "second-hand goods".

Newspaper headlines appear with monotonous regularity when some super-miracle drug is launched that costs £20,000 a year to treat each one of a tiny number of sufferers. Big Pharma is somewhat influenced by the profit motive, and it's the reason why so many Tory supporters are very interested in obtaining a slice of the action.

One of our members posted on another board that the USA is the largest economy in the world, but that “it cannot even afford to treat its poor”. He correctly indicated that the USA spends 17% of its GDP on healthcare, “well ahead of the world average and twice that of the UK”. This chart shows how spending on health, country by country, is broken down between private and public provision:-

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For decades, the Tories have peddled the lie (to justify their selling off of state assets to their donors and cronies) that private provision is always more efficient than public. You don’t have to look far to know that isn’t true. Look at the security shambles over the 2012 Olympics; state provision (namely the armed forces) had to save the day after G4S couldn’t cope. Then look at the railways, with the mess that Southern Rail is in, and how some commuters are losing their jobs because they can’t get to work. The East Coast line was taken back into public ownership after twice being abandoned by the private sector. In public hands it returned a billion pounds to the taxpayer, but that wasn’t convenient for the Tory ideologues and so it’s been privatised again. The joke is that some of our railways are owned by foreign states, but the Tories don’t seem to mind that. It would cost nothing to renationalise all the railways. All that has to be done is that they are taken back into public ownership as each franchise expires.

There is no better example of the inefficiency of the private sector than in healthcare. A glance at the above chart will show how the USA spends more than twice as much on private healthcare than any other country listed. Private medicine is primarily about making vast profits rather than satisfying patient need. And with it goes an army of bureaucrats, itemising every last item used in treatments, then billing the patients and/or their insurance companies. There’s your area of wasteful spending! Of course the USA could treat its poor if it adopted an efficient, free-at-the-point of use system similar to our much-maligned NHS, but the political will has to be there.