The Mea Has Nothing On The Dhss

[stookie]

If you look at the figures you will find that the total you quote includes income to the DHSS, cost of social services and social security as well as health costs. The largest budget is the Social Security which is in excess of £150m which is paying benefits and pensions. Getting behind the figures gives a more accurate picture and avoids making generalisations that are inaccurate.

 

Juan is right - there is lack of financial control (the chief minister has admitted this) and mismanagement that frankly were it to go on in a private enterprise with the budget the DHSS has would result in heads rolling. That doesn't happen to government departments for who knows what reasons, but nobody is careful enough with the taxpayers money.

 

Are pensions not paid for out of the national insurance fund - maybe I'm wrong?

 

While I know the DHSS is more than just the health service, what is it they threaten to cut back on when there is a cash crisis? Exactly!

 

There are ridiculously wasteful practices going on in the health service and they should be dealt with. For example, why does my daughter HAVE to make 3 trips to a doctor with her newborn for routine vaccination now she's living in Peel when it took one visit when she lived in Douglas? Maybe that explains why, when she wanted an appointment for her (sick) infant on Monday this week, she couldn't have one because it wasn't urgent enough, and then on Wednesday had to have an emergency appointment because no help was forthcoming earlier in the week and the problem had spread to her other children? I bet there are lots of people with stories like these. We are supposed to be enjoying good times (probably for the most part courtesy of the private sector) and public services should be improving with ever expanding budgets, not the other way round.

[Juan Kerr]

A bit over simplified there Juan. You are indicating that the entire budget is spent on Health Care.

 

About £150m is pensions and other benefits. But that is money theoretically paid out of NI contributions (by and large) banked over the years. The NI fund is separate, as I understand it, and is to pay future benefits, whilst current pensions are paid out of general government revenue allocated to the DHSS budget. Either way, these disbursements are out of money that has already been paid into the system via NI. You can't cut these benefits back as the credits have been earned.

 

A lot of money credited "into" the DHSS I would guess is UK NI credits for people moving to the IOM it is not "profit" as others have suggested.

 

That leaves £225,000,000 on a broad rule of thumb which is still £2,800 per head.

 

I have not spoken to anyone yet who has used the health services here that is of the opinion that this is nothing other than mismanagement on a gargantuan scale.

 

Budgetary controls are needed, and proper micro management of every aspect of service is needed.

[Galen]

"That leaves £225,000,000 on a broad rule of thumb which is still £2,800 per head."

 

£2,800 per head - this sum is also spent on the other benefits (e.g. Job Seekers Allowance, etc etc), and the cost of Social Services and all Health cost s- i.e. it is not £2,800 per head for health services alone. The health budget also covers the costs of running both the hospitals, and all primary care (GPs, Dentist, Chemists, and Opticians - who are contractors and are "for profit" organisations) and a contribution to the hospice (often not cited) amongst other things. Further, it also covers the provision of the out of hours emergency service and A&E - none of which are cheap! (just look at what consultants pay is now !!)

Add to this the Do Not Attend rates - my GP surgery in Douglas regularly shows 20 -30 patients don't turn up but the resources have to be there on the basis they will - pro rate that across all the GP surgeries, add in those that fail to turn up for hospital appointments and a hefty sum of money is being wasted - not by the DHSS but by us the patients!

If the notion of putting services to a purely private market still appeals - Guernsey GPs charge circa £36 / visit which the patient pays and only gets part repayment from the state.

 

 

 

 

A bit over simplified there Juan. You are indicating that the entire budget is spent on Health Care.

 

About £150m is pensions and other benefits. But that is money theoretically paid out of NI contributions (by and large) banked over the years. The NI fund is separate, as I understand it, and is to pay future benefits, whilst current pensions are paid out of general government revenue allocated to the DHSS budget. Either way, these disbursements are out of money that has already been paid into the system via NI. You can't cut these benefits back as the credits have been earned.

 

A lot of money credited "into" the DHSS I would guess is UK NI credits for people moving to the IOM it is not "profit" as others have suggested.

 

That leaves £225,000,000 on a broad rule of thumb which is still £2,800 per head.

 

I have not spoken to anyone yet who has used the health services here that is of the opinion that this is nothing other than mismanagement on a gargantuan scale.

 

Budgetary controls are needed, and proper micro management of every aspect of service is needed.

[Theskeat]

The Island pension fund has a great big black hole in it at the moment due to the known £85 million borrowed by the DHSS to pay for the over costs to the new Hospital, the borrowings could be more but on speaking to my MHK today he would not go into it except to say the DHSS have not paid the loan back to date and the longer it goes on the likelyhood is that the next DHSS Minister will apply to Tynwald to have the loans wiped out.

[Juan Kerr]

£2,800 per head - this sum is also spent on the other benefits (e.g. Job Seekers Allowance, etc etc)

 

There are around 500 unemployed people on the IOM. What is job seekers allowance - £50,000 a year??

[manxchatterbox]

If you spend a million pounds a day / £365million a year how many accountants do you need to keep control and be responsible for signing off the accounts??

 

CM Don Gelling is quoted as saying about the DHSS "unitil we can get that financial control and we can monitor it to know where the money is being spent we can't actually do very much"

 

The IOM Examiner this week says the DHSS has only two accounting officers, financial director David Rodgers and chief executive David Killip.

 

The article also says a report critises the practice of "parochial accounting" should be removed. Does this mean they don't use any sort of double entry book-keeping? what is "paraochial accounting" ??

 

Surely just the two of them don't look after all the accounts of the DHSS? How many are involved in say purchase ledger control? and how many reconcile bank statements etc? How many produce monthly manangement accounts etc?? how frequently is actual expenditure monitored to budget??

 

- topic merged with this one - Mod

[stookie]

Add to this the Do Not Attend rates - my GP surgery in Douglas regularly shows 20 -30 patients don't turn up but the resources have to be there on the basis they will - pro rate that across all the GP surgeries,

 

The surgeries should learn a lesson from the private sector, like say the airplane industry. They know statistically there will be a percentage of no-shows for every flight and therefore use a variety of tactics such as book people on standby and over-selling seats. If the doctor's practices are so certain there will be no shows, they should offer people the option of a standby appointment, in the sure knowledge they can slot them in most of the time.

 

Wouldn't that be better than the dictator receptionsists who tell us there are no appointments for a week?!

[Galen]

There are some interesting points being raised in this thread, but the problems are more complex than the understandings that are being offered. I know a couple of quite senior people in the DHSS and the issues I am told are complicated by bureaucracy, much of which is politically and Treasury led. The FD referred to by "manxchatterbox" apparently had a heart attack last year due to the pressure he was put under.

The PWC report is, by some of those who have seen it, largely a regurgitation of what many staff told the consultants. The same staff wanted to put these actions / controls inplace some time ago and do the things that PWC are now suggesting, but were not allowed to. But because a consultant, on undoubtably a big fee, has decreed that it should be done, the CM and his colleagues have stated it should be. I think the whole thing stinks !!!!! Surely those next to the coal face know what needs to be done?

[momo65]

the doctor's practices are so certain there will be no shows, they should offer people the option of a standby appointment, in the sure knowledge they can slot them in most of the time.

 

To all intents and purposes they do - but slotting people in usually means that things end up running very late and that doesn't go down well either. In reality there's some evidence that appointments should be booked at 15 mins each - 10 mins has only just become the norm - but of course a 50% increase in length of appointments needs rather a lot more consulting hours - and thus more doctors and more expense.

 

The UK average GP has about 1800-2000 people on their list - many European countries have half as many patients per GP

[hboy]

the doctor's practices are so certain there will be no shows, they should offer people the option of a standby appointment, in the sure knowledge they can slot them in most of the time.

 

To all intents and purposes they do - but slotting people in usually means that things end up running very late and that doesn't go down well either.

 

I don't understand why doctors can't charge for no shows. If people are that ignorant that they can't call in and advise that they don't need the appointment they should stick them with a £25 fee. They will be the same people moaning when it takes 2 days to see a Doctor because they are fully booked.

 

Many no shows might be genuine (missing a bus, or replacement hospital appointment) but it is the height of ignorance not to phone in - particularly as most have mobiles in this day and age. I would suggest the DHSS stick a fee on for any doctor / dentist / hospital appointment missed without good reason.

[momo65]

 

I would suggest the DHSS stick a fee on for any doctor / dentist / hospital appointment missed without good reason.

 

 

Almost anyone can miss an appointment - however, there are those who make a habit out of it!