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I've just experienced the very best of the NHS.

Without going in to too much detail I have just been diagnosed, operated on and had a follow up op in very short order.

The staff that dealt with my problem have been fantastic.

Now a tiny example of the waste in the system.

After the op I was given some antibiotics and a leaflet explaining how to take them. The leaflet said any left over drugs should be disposed of.

The penicillin course I was given was 3 x tablets per day for 5 days.

I was given 28 tablets, I queried why I had 28 tablets when I only needed 15.

The reply was that the boxes could not be opened without compromising the contents.

With the cost of drugs being as they are why can't NHS purchasing order in quantities that are actually needed.

If a course of antibiotics is only for 15 why should the manufacturers only supply in 28's.?

It's only a tiny detail but it will add up over a year if it's replicated and the leaflet I was given indicates that it is common practise.

Ron Banks

Midlands Hurricanes and Barrow

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It's mainly for patient safety.  You used to be able to get individual tablets in little bottles (remember that from years ago!) but they were far too easy to overdose from.  Its a well-established thing that people who are suicidal take far fewer drugs if they have to pop blisters from lots of packets rather than just down a bottle of tablets.  They were also abysmal at keeping tablets contaminant free and provably within usable dates.

 

Some tablets can be cut and diced by just cutting the blister packs into the right numbers but they generally have to be really long-life ones.  Antibiotics and other similar drugs rarely get prescribed without sealed boxes, especially if they have short shelf-lives, as you can't easily see their expiry dates if that part is cut away.

 

Also, if you order small numbers of variants in large quantities then you can cut costs far more than if you order lots of variants in smaller quantities.

 

Finally, unless you're getting the latest generations of antibiotics, the cost is actually quite small and it's cheaper to order standard sized packs than it is to get pharmacists to mess around with smaller variants.  For example, erythromycin costs £1.82 per pack of 28.

 

If you don't mind, put the name of the antibiotic up and I'll get you the cost the NHS paid for the 28 pack.

"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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It's Co-amoxiclav and upon checking I was issued a 21 tablet box.

Your explanation has clarified it for me. But if a standard dose is 3×5days why boxes of 21 and not 15?

Ron Banks

Midlands Hurricanes and Barrow

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21 pack of Co-amoxiclav is £3.85.

 

I checked with one of the nurses that works for me on this one to be double-sure.  Antibiotics are traditionally prescribed for seven days but operations are usually given with a broad-spectrum antibiotic, such as co-amoxiclav, that accounts for a two day dose meaning that the remaining five days are done by tablets.  Some doctors will just say take the seven day dose anyway as it can't hurt to extend it a little, but that's up to the individual prescribing doctor to override the standard.

 

The amount of prescriptions given after surgery are massively dwarfed by standard prescriptions, even in hospitals, given meaning it just isn't efficient to do anything other than a single sized prescription box.  I suppose they could do it but I can't see how you could cut the costs by too much, even then you'd annoy the pharmacists as they'd have to find space for an extra set of stock

"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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A separate post here as it's a different point.

 

There are far easier ways to save millions per year in the NHS.  The first one that came to mind was a consequence of the Lansley reforms.  Prior to 2012, the NHS licensed all its software at an NHS level, meaning they had the negotiating power of over 1 million user accounts to lower costs.  The Lansley reforms essentially split up the NHS into little components that have minimal to zero legal status and the NHS-wide deals stopped.  The NHS went from having the negotiating power of one of the largest organisations in the world to having the negotiating power of an individual consumer in many cases; I know one massive NHS organisation that pays the same price from Microsoft as a one-man company because the only discount they get is being able to reclaim VAT.

 

The NHS went from having a large multi-million pound per year central software expenditure, but at massive discounts, to having no central expenditure, that looks good as a "saving", but forcing all individual organisations to negotiate their own deals with software companies.  Just another idiot consequence of the idiot reforms from Lansley.

 

If that nice Mr Hunt made a ruling to centralise software licensing discounts then he'd save the NHS into 8 figures per year.  Easily.  But then that would make it far harder to break up the NHS.

"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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A separate post here as it's a different point.

 

There are far easier ways to save millions per year in the NHS.  The first one that came to mind was a consequence of the Lansley reforms.  Prior to 2012, the NHS licensed all its software at an NHS level, meaning they had the negotiating power of over 1 million user accounts to lower costs.  The Lansley reforms essentially split up the NHS into little components that have minimal to zero legal status and the NHS-wide deals stopped.  The NHS went from having the negotiating power of one of the largest organisations in the world to having the negotiating power of an individual consumer in many cases; I know one massive NHS organisation that pays the same price from Microsoft as a one-man company because the only discount they get is being able to reclaim VAT.

 

The NHS went from having a large multi-million pound per year central software expenditure, but at massive discounts, to having no central expenditure, that looks good as a "saving", but forcing all individual organisations to negotiate their own deals with software companies.  Just another idiot consequence of the idiot reforms from Lansley.

 

If that nice Mr Hunt made a ruling to centralise software licensing discounts then he'd save the NHS probably into 8 figures per year.  Easily.  But then that would make it far harder to break up the NHS.

Obviously the finger should be pointed at Lansley for the shambles he's made of the NHS, and at Cameron for allowing this to happen when he promised during the 2010 campaign there'd be no more "reforms" to the NHS.  But surely the largest part of the blame belongs to the Lib/Dems who effectively nodded through a policy that has wrecked the NHS.  Not only was that policy not in either party's 2010 manifestos, but neither was it in the Coalition agreement.  They could have stopped it dead.  They didn't.  It's among the worst charges that could be levelled at Clegg and co. The biggest charge of course was letting Dave into Downing Street in the first place.  Surely they must have realised the power a PM has to manipulate the economy and the media agenda to suit his party.  They campaigned in 2010 on policies to the left of the Labour government and then got into bed with a right wing party, and allowed that party to begin to dismantle the pride not only of Labour but of the Liberals too (Beveridge was a Liberal)  Really Clegg should be taken out and shot for that piece of work.

“Few thought him even a starter.There were many who thought themselves smarter. But he ended PM, CH and OM. An Earl and a Knight of the Garter.”

Clement Attlee.

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21 pack of Co-amoxiclav is £3.85.

 

I checked with one of the nurses that works for me on this one to be double-sure.  Antibiotics are traditionally prescribed for seven days but operations are usually given with a broad-spectrum antibiotic, such as co-amoxiclav, that accounts for a two day dose meaning that the remaining five days are done by tablets.  Some doctors will just say take the seven day dose anyway as it can't hurt to extend it a little, but that's up to the individual prescribing doctor to override the standard.

 

The amount of prescriptions given after surgery are massively dwarfed by standard prescriptions, even in hospitals, given meaning it just isn't efficient to do anything other than a single sized prescription box.  I suppose they could do it but I can't see how you could cut the costs by too much, even then you'd annoy the pharmacists as they'd have to find space for an extra set of

stock

Thanks that's interesting.

Now I've had a text message asking how likely it is that I would recommend the department to family and friends.

Ron Banks

Midlands Hurricanes and Barrow

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Thanks that's interesting.

Now I've had a text message asking how likely it is that I would recommend the department to family and friends.

Trusts get monitored on this, both on performance and or percentage of patients who complete the returns. If I recall, the scores are out of 5. If scored as a 3 (ie average), then that is deemed as a poor score, as 3 of the marks are poor and two are good.

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Trusts get monitored on this, both on performance and or percentage of patients who complete the returns. If I recall, the scores are out of 5. If scored as a 3 (ie average), then that is deemed as a poor score, as 3 of the marks are poor and two are good.

So it's in the hospitals interest to get a good score and the patients interest to give them a bad score so that they have to improve.

If they are getting good scores where is the incentive to look for improvements?

Ron Banks

Midlands Hurricanes and Barrow

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So it's in the hospitals interest to get a good score and the patients interest to give them a bad score so that they have to improve.

If they are getting good scores where is the incentive to look for improvements?

If they do a good service then they deserve good marks otherwise where's the incentive for them to actually give good service.

 

If they get enough bad scores then they can be fined for poor performance.  Until April this year, that "fine" had to be used specifically to rectify any finding of fault, from April, it goes directly to the Exchequer.  That means a poorly performing organisation will be fined money it doesn't have meaning services will suffer more than if they had simply been left alone.

"When in deadly danger, when beset by doubt; run in little circles, wave your arms and shout"

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If they do a good service then they deserve good marks otherwise where's the incentive for them to actually give good service.

 

If they get enough bad scores then they can be fined for poor performance.  Until April this year, that "fine" had to be used specifically to rectify any finding of fault, from April, it goes directly to the Exchequer.  That means a poorly performing organisation will be fined money it doesn't have meaning services will suffer more than if they had simply been left alone.

Good job I gave them an excellent rating then.

Ron Banks

Midlands Hurricanes and Barrow

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