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NHS underperformance


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#1 ckn

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Posted 16 December 2013 - 01:41 AM

I don't get the government's plans... they promise to fine hospitals up to £12m if they under-perform at weekends.  Also, who'll pay the fines?  Surely it'll be the patients in terms of hospitals having to cut services to budget for that £12m they've been fined.

 

I'd appreciate it if someone could correct me on that as obviously I must be mistaken...


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#2 Tiny Tim

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Posted 16 December 2013 - 10:07 AM

Surely they should just bill tax payers directly.


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#3 JohnM

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Posted 16 December 2013 - 10:48 AM

If they didn't "under-perform" they wouldn't have to pay the "fine".  A bit like incentives in other fields. 



#4 ckn

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Posted 16 December 2013 - 11:01 AM

If they didn't "under-perform" they wouldn't have to pay the "fine".  A bit like incentives in other fields. 

But surely, using a rugby analogy, that's like fining the punters coming in through the gates for their team under-performing while leaving the team management unhindered.  It hits the wrong people.  Surely the correct method is to make everyone above a certain grade liable to performance related pay, e.g. meet targets = 100% pay, exceed targets = 110% pay, fail to meet targets = 90% pay, fail to meet a critical target = 70% pay, proof of negligent management = 50% pay or dismissal for repeat offences.


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#5 Northern Sol

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Posted 16 December 2013 - 12:55 PM

I don't get the government's plans... they promise to fine hospitals up to £12m if they under-perform at weekends.  Also, who'll pay the fines?  Surely it'll be the patients in terms of hospitals having to cut services to budget for that £12m they've been fined.

 

I'd appreciate it if someone could correct me on that as obviously I must be mistaken...

You are correct. It is utterly insane.



#6 Wolford6

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Posted 16 December 2013 - 01:04 PM

The NHS is a punchbag.

 

My Nan lived to 102. Just before she died, and the trigger for her death, she contracted a kidney infection and was suffering from kidney-stones. She was taken to hospital where doctors tried to remove the stones via an operation, or else she would have died . Unfortunately, a piece of the operating equipment broke during the operation and a second-phase operation had to be conducted to retrieve it.

 

It was obvious that, when telling us what had happened, the hospital was dreading that our family would be suing it for negligence. What good would that do ... only discourage the doctors from bothering to conduct operations on geriatric patients. We were just extremely grateful that they had a go.


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#7 Tiny Tim

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Posted 16 December 2013 - 04:06 PM

I've got many friends who work in the NHS from low level through to consultant and they are equally as bewildered at this plan. So now hospitals that are struggling will have more money taken off them.....that's obviously going to help improve the situation. 


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#8 JohnM

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Posted 16 December 2013 - 05:06 PM

I've got many friends who work in the NHS from low level through to consultant and they are equally as bewildered at this plan. So now hospitals that are struggling will have more money taken off them.....that's obviously going to help improve the situation. 

 

So now hospitals that are struggling will have more money taken off them.

 

Only if they are not  doing their job properly.



#9 gingerjon

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Posted 16 December 2013 - 05:10 PM

So now hospitals that are struggling will have more money taken off them.

 

Only if they are not  doing their job properly.

 

Struggling hospitals need more, not less, money.


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#10 Griff9of13

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Posted 16 December 2013 - 05:46 PM

An example of typical tory them and us philosophy; if you want to make them work harder/better you deprive them of money. If you want to make us work harder/better you reward them more. 


"it is a well known fact that those people who most want to rule people are, ipso facto, those least suited to do it."

#11 Bedford Roughyed

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Posted 16 December 2013 - 06:15 PM

I don't get the idea of 'choice' in the NHS.  I just want my local hospital or whatever department I'm ever sent to, to be good.  I don't want to have to choose.  They should all be up to a minimum standard.

 

Plus the NHS is a basket case anyway, MP's know that large central departments have better 'outcomes' (if funded correctly) but will fight to save their small local department because it's popular with voters.

 

Then there is the massive expansion of PFI's that have crippled so many hospitals.


With the best, thats a good bit of PR, though I would say the Bedford team, theres, like, you know, 13 blokes who can get together at the weekend to have a game together, which doesnt point to expansion of the game. Point, yeah go on!

#12 JohnM

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Posted 17 December 2013 - 09:21 AM

An example of typical tory them and us philosophy; if you want to make them work harder/better you deprive them of money. If you want to make us work harder/better you reward them more. 

 

Ah , the old "Protestant Work Ethic" eh? You know what you get if you pay your staff more?  A higher wage bill. 

 

How about this? Work smarter not harder, make good decisions, stop ####### money down the sink, take responsibility for actions and decisions, don't reward incompetence, put the customer( patient) first, look after your staff, ditch matrix management so there is no hiding place for jobsworth middle management ( remember Back to the Floor?)...the sort of ideas embraced at Director and Senior Management level in much ( but sadly nowhere near enough)  of the private sector. 



#13 Griff9of13

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Posted 17 December 2013 - 09:53 AM

Ah , the old "Protestant Work Ethic" eh? You know what you get if you pay your staff more?  A higher wage bill. 

 

How about this? Work smarter not harder, make good decisions, stop ####### money down the sink, take responsibility for actions and decisions, don't reward incompetence, put the customer( patient) first, look after your staff, ditch matrix management so there is no hiding place for jobsworth middle management ( remember Back to the Floor?)...the sort of ideas embraced at Director and Senior Management level in much ( but sadly nowhere near enough)  of the private sector. 

 

I agree entirely. 

 

One of the great leaps forward driven by the by the IT boom of the 80s and 90s was the ability, through the availability of the new electronic communications available, was the removal of layers of middle management and more direct communication from senior to junior levels. This organisational flattening improved productivity without greatly adding to workload. This is how most large private sector organisations are now structured. Unfortunately this message has yet to penetrate most of the civil service who, by and large, still maintain a rigid hierarchical structure. :(


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#14 Bleep1673

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Posted 17 December 2013 - 10:10 AM

I don't get the idea of 'choice' in the NHS.  I just want my local hospital or whatever department I'm ever sent to, to be good.  I don't want to have to choose.  They should all be up to a minimum standard.

 

Plus the NHS is a basket case anyway, MP's know that large central departments have better 'outcomes' (if funded correctly) but will fight to save their small local department because it's popular with voters.

 

Then there is the massive expansion of PFI's that have crippled so many hospitals.

Firstly, choice is about where you want to go for treatment, especially if your local Hospital does not supply the care you require. For instance, assuming you live in Bedford, your local hospital does not do Cardiothoracic work, therefore if someone in that area needed a heart operation they could choose to either go to Birmingham, or London, or Oxford, or anywhere you feel. The same with any other treatment.

 

Seconly, where are the NHS going to get the staff needed to cover the 24 hour services that the government are asking certain departments to open? Many services including Theatres are seriously understaffed, and have trouble recruiting, if we had to open more theatres at the weekend then the services would have to be cut during the week, or start recruiting from Romania and Bulgaria in the new year.

Specialist staff in other areas are also in short supply.

We also have toi watch something called NCEPOD (National Confidential Enquiery into Peri-Operative Deaths) which is concerned that over tired surgeons and Anaesthetists are making dangerous mistake, that why the working hours directive aimed at Junior doctors was forced through.

 

Finally, most NHS Trusts are under increasing inspections from the CQC (Care Quality Commission), and if this, or any, government knee jerk proposals through, no NHS Trusst would have the staff to provide a proper, and efficent service, triggering the wrath of the CQC even if they were providing the cover needed.

 

A case in point is Maternity services here in East Sussex, we have 3 birthing units, but not enough midwives to cover all the units 24/7/365, so there was a public outcry recently when maternity services were closed at Eastbourne and moved 12 miles down the road to Hastings, the Midwife led birthing unit at Crowborough is also under threat, and is being targeted for a takeover by Tunbridge Wells NHS Trust. Both of these incidents have been investigated by the CQC.


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#15 Tiny Tim

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Posted 17 December 2013 - 10:49 AM

A case in point is Maternity services here in East Sussex, we have 3 birthing units, but not enough midwives to cover all the units 24/7/365, so there was a public outcry recently when maternity services were closed at Eastbourne and moved 12 miles down the road to Hastings, the Midwife led birthing unit at Crowborough is also under threat, and is being targeted for a takeover by Tunbridge Wells NHS Trust. Both of these incidents have been investigated by the CQC.

 

Similar challenges over in West Sussex too. We are in the middle of three hospitals - Worthing, Princess Royal and East Surrey. When my son was born we were all set for a homebirth with the midwife coming from East Surrey but when it all kicked off we were told that the on-call midwife was off sick so this was not an option. We phoned Princess Royal and they said no problem they had midwives available then realised we were outside their 'catchment' area and said sorry can't help. We ended up in Princess Royal in the end where there were loads of midwives sitting around as they were having a quiet night, they were very apologetic but said they weren't allowed outside their area. They did make me several cups of very nice tea while my wife did the business so I forgave them.


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#16 ckn

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Posted 17 December 2013 - 11:46 AM

Ah , the old "Protestant Work Ethic" eh? You know what you get if you pay your staff more?  A higher wage bill. 

 

How about this? Work smarter not harder, make good decisions, stop ####### money down the sink, take responsibility for actions and decisions, don't reward incompetence, put the customer( patient) first, look after your staff, ditch matrix management so there is no hiding place for jobsworth middle management ( remember Back to the Floor?)...the sort of ideas embraced at Director and Senior Management level in much ( but sadly nowhere near enough)  of the private sector. 

Please don't take this as criticism of you, it really is not meant that way but:

 

"Work smarter, not harder", this is a pathetic scourge of the private sector where long hours get you noticed rather than smart working.  I've been to too many companies where people time their arrivals to 5 mins before their manager and leave 5 mins afterwards to "prove" they work hard.  One client I was at earlier this year had one of the directors clock-watching for when people logged onto the systems by when their instant messenger "online" light came on and wrote it in his journal.  By comparison, many of the NHS people I know have far better work-life balances with them seeming to understand the results-based work system far better than their private sector counterparts.

 

"Make good decisions", this is only possible when there's a combination of good information and a structure that allows them to make appropriate decisions.  There are far too many blocks to good information from idiot Ministerial level decisions and targets down to IT systems that are about as effective as a chocolate teapot.  Yes, there are undoubtedly a lot of weak managers involved but until you can give a quality assessment of those managers you can't just make a blanket assessment that middle-management = poor management.

 

"Look after your staff", assuming we're talking about the non-managerial classes of staff, the last 15 years have seen the public sector's pay and benefits either enhanced or at least maintained while the private sector has seen benefits seriously eroded and pay essentially frozen for the last 5 years.  The old guideline of public sector being poor pay, great retirement benefits has gone and now public sector staff get decent to good pay and benefits along with the same great retirement benefits while private sector is getting stagnating (albeit still often above private sector) pay, reducing to non-existent benefits and retirement benefits just above junk level.

 

"Ditch matrix management", done properly, matrix management is an outstanding management tool, essentially allowing managers to share staff and resources.  The correct way to do it is to ensure that there's a single accountable manager for every single staff member, resource or decision, you can have multiple responsible managers but only one accountable manager.  This is how I do 99% of the work I do in project management, one of the very first things I do at a new project is to find out exactly the accountability chain for any decision, staff or resources allocated to me, if they want me to be accountable then I want far more say into making of the decisions and final say into the making of that decision.  My job would be almost impossible to do without matrix management, again to dismiss it with "ditch it" fails to recognise its utility just because for some decisions no-one wants to be accountable.

 

Conversely, I've seen in the last 5 years a reversal of this in the private sector, well-run matrix-management organisations have brought in more "professional" management who refuse to take accountability for anything, pushing this down the chain and destroying the utility of matrix-management and creating distrust, much like the public sector model that gets rightly laughed at by everyone.  This is the blame culture: "something went wrong, who can we blame so that I don't cop it for the failure"


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#17 shrek

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Posted 17 December 2013 - 01:49 PM

One client I was at earlier this year had one of the directors clock-watching for when people logged onto the systems by when their instant messenger "online" light came on and wrote it in his journal. 

I'm coming to the end of a stint at a place like that, I found if you set your status to away and never log off it serves to both throw out there system and identify the "online" watchers as they are the only ones that make a point of asking why your always flagged as away!

 

Back on topic, not sure I understand the point either in fining the NHS or any other part of the public sector, seems counter productive.



#18 Tiny Tim

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Posted 17 December 2013 - 03:13 PM

I found if you set your status to away and never log off it serves to both throw out there system and identify the "online" watchers as they are the only ones that make a point of asking why your always flagged as away!

 

I have mine constantly set to do no disturb. If people want something urgently then they can phone me.


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#19 Johnoco

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Posted 18 December 2013 - 08:06 AM

I am not using this as a criticism of the NHS, at all. But one thing I don't understand is why there is a difference between the staff working weekends and the ones Monday-Friday. In the print (and others) industry they pretty much moved to 24-7 operations many years ago. And that's in a relatively unimportant area like that.
Why can't they introduce a form of continental shift pattern that covers every shift, every day(as opposed to just day-night shifts?) This would mean that the quality of care or staff is constant and possibly a more stable work pattern for the staff? Is there a reason why quality of care should vary? I mean, do they actually have these shifts already but certain people don't work them?

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#20 Bleep1673

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Posted 18 December 2013 - 06:22 PM

I am not using this as a criticism of the NHS, at all. But one thing I don't understand is why there is a difference between the staff working weekends and the ones Monday-Friday. In the print (and others) industry they pretty much moved to 24-7 operations many years ago. And that's in a relatively unimportant area like that.
Why can't they introduce a form of continental shift pattern that covers every shift, every day(as opposed to just day-night shifts?) This would mean that the quality of care or staff is constant and possibly a more stable work pattern for the staff? Is there a reason why quality of care should vary? I mean, do they actually have these shifts already but certain people don't work them?

NHS staff do work a 24/7 work pattern, however what the idiots in Government want is more work, with less staff, with less recuitment, with less funding, and an increased exit level. It's not going to happen without a major injection of capital from central funds, unfortunatly because there is a Short Arms, long Pockets attitude, then you're going to have to book a Taxi in future, rather than call an ambulance if you're bleeding to death


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