IOM DHSC & MANX CARE

[Manx Bean]

My first port of call would be to scrutinise all non front line roles. Let’s look at the management structure, how many data crunchers we’ve got, how many chief assistants to the assistant chiefs we have. 

We also need to phase out bank staff. If we got the basic pay bands right, nurses wouldn’t leave permanent roles and come back to earn a premium. I’d suggest that you could secure those here by paying above UK rates, and scrap bank roles.

Last but not least dissolve “Manx Care” and bring in a CEO who can actually do the job. 

[thommo2010]

58 minutes ago, wrighty said:

It used to be healthcare dogma that funding was split 60/20/20 into salaries/drugs and other consumables/infrastructure.  In recent years I think the infrastructure spending has been cut and a higher proportion (94% in the UK according to the Kings Fund) spent on the other two.  

So how do you save money? Cut salaries (can't fill posts as it is, and paycuts won't make it easier) or cut drugs spending (and hence stop doing various things)? 

And all this while there is more and more demand for more and more services.  In the UK at least, we're starting to think about what replaces the NHS model as there is wider agreement every day that it is unsustainable in its current form, and it really can't take any more reform and reorganisation (which doesn't work anyway).  If the NHS model is so great why aren't France, Germany, Australia etc copying it? It was designed in the 1940s. It's no longer fit for purpose 80 years later.

(Once again, for clarity, this is my personal view - I'm not the official spokesman for Manx Care, the medical profession, or the government)

And that is the question how do you save money? are there people in positions that might be nice to have but not essential? but even then to try and cut down 18 million that would be chicken feed. 

[lfc84]

It is sustainable. If the funding was there

[Ghost Ship]

1 hour ago, lfc84 said:

It is sustainable. If the funding was there

But by that argument anything would be sustainable...

[The Phantom]

Out of interest, is this overspend of £16m in addition to the £20m raked in from our tax rise that is supposed to be ring-fenced for the NHS?

[Manx Bean]

2 minutes ago, The Phantom said:

Out of interest, is this overspend of £16m in addition to the £20m raked in from our tax rise that is supposed to be ring-fenced for the NHS?

I suspect so, otherwise they’d be hailing an underspend!

[Ghost Ship]

1 hour ago, Manx Bean said:

My first port of call would be to scrutinise all non front line roles. Let’s look at the management structure, how many data crunchers we’ve got, how many chief assistants to the assistant chiefs we have. 

We also need to phase out bank staff. If we got the basic pay bands right, nurses wouldn’t leave permanent roles and come back to earn a premium. I’d suggest that you could secure those here by paying above UK rates, and scrap bank roles.

Last but not least dissolve “Manx Care” and bring in a CEO who can actually do the job. 

I can't speak for the Manx NHS but as someone who worked in the NHS in the UK from 1988 in what you would probably call a "non-frontline role", I was interested before the last election to hear from the King's Fund on "More or less" that the NHS - in the UK at least - is undermanaged compared to other organisations that can be compared to it.

Listen from 6 mins 20 secs:  More or Less - Election endings, tennis and meeting men in finance - BBC Sounds

I suppose you could argue that the King's Fund is not entirely independent, but I've attended courses provided by them and I'd say they're pretty even handed.  I see @wrighty has cited their research too

 

Edited Friday at 01:42 PM by Ghost Ship

[The Phantom]

21 hours ago, code99 said:

1.    The USA version where most health care is privatised,

2.    The (former) USSR version where all health care was nationalised,

3.    A middle-way where a mix of nationally funded and private health services are provided. In Australia, for example, if you earn (income, capital gains, etc) above certain amount you will either have to take out private health insurance or the Government will whack you with additional taxes. Incidentally, almost 30% of Australians are born abroad or are second generation immigrants – like everywhere else in the western world, their population is aging and therefore their Government has adopted a policy of attracting foreign born workers, especially for the health and social care sector.

 

It is effectively 3 now.  Most people I know in 'professional' (I suppose above average salary) have either private medical through work or pay for it themselves; even Doc friends! One problem is however that even if you go private here on the Island, you'll quite often need to get input from or access to something that is in the NHS.  Even if you are actively trying to avoid the system. 

Frankly the only way I'll use the NHS is if I wake up there.  Everything else I have done to myself and fixed over the last 15 years has been sorted privately in one way or another, either through insurance or out of my pocket. 

Edited Friday at 01:53 PM by The Phantom

[Moghrey Mie]

5 minutes ago, The Phantom said:

It is effectively 3 now.  Most people I know in 'professional' (I suppose above average salary) have either private medical through work or pay for it themselves; even Doc friends! One problem is however that even if you go private here on the Island, you'll quite often need to get input from or access to something that is in the NHS.  Even if you are actively trying to avoid the system. 

Frankly the only way I'll use the NHS is if I wake up there.  Everything else I have done to myself and fixed over the last 15 years has been sorted privately in one way or another, either through insurance or out of my pocket. 

But people are quite happy to come back to the NHS for after-care when the private company doesn't want to know.

[wrighty]

1 hour ago, Manx Bean said:

My first port of call would be to scrutinise all non front line roles. Let’s look at the management structure, how many data crunchers we’ve got, how many chief assistants to the assistant chiefs we have. 

We also need to phase out bank staff. If we got the basic pay bands right, nurses wouldn’t leave permanent roles and come back to earn a premium. I’d suggest that you could secure those here by paying above UK rates, and scrap bank roles.

Last but not least dissolve “Manx Care” and bring in a CEO who can actually do the job. 

I don't think we're overmanaged.  I do agree that there are a lot of people whose roles seem a little unclear - often that's because their job description contains too much for one person to do, or their role covers many areas such that each individual 'frontline worker' sees them doing very little and has the impression that they're either useless or dispensable.  In the olden days it was perfectly normal for a single handed GP to practice from his front room and carry out minor operations, with unsafe anaesthesia and dubious infection control, on his dining table.  I'm not exaggerating much.  These days there have to be practice managers, GDPR compliance officers, accountants, regulators, policy managers... These things are demanded, indirectly, by the public in the name of increased safety and financial transparency.

You have a point regarding bank staff.  The utopian state is that we have enough staff on proper salaries such that we never need to use bank or agency staff because there are enough people, with slack in the system, to cover all the wards and clinics etc.  By increasing base pay such that it is higher than the adjacent isles we might be able to recruit and retain such staff.  That won't come cheap, at least in the early phase.

And finally, dissolve Manx Care to be replaced by what? I agree that on an island of 85000 we don't really need a purchaser/provider split.  Having DHSC and Manx Care means inevitable duplication - there may be something to look at there but blithely dissolving Manx Care is not the way forwards in my view. And as for the CEO - and she hasn't paid me to say this - she works bloody hard, more hours than almost anyone else there, and genuinely cares about doing the best job she can for the island's population.  And actually lives here, which is a big step in the right direction compared with the last one.  It is pretty much impossible for her to achieve everything demanded of Manx Care within the current funding envelope.  Replace her with an NHS hatchet man (based on a LinkedIn profile showing a track record of cost-cutting and 'transformational change') at your peril.

[Boo Gay'n]

2 hours ago, wrighty said:

Bloody hell Derek, bit much to do that in a forum post, but I'll give it a go with some basic principles I think are needed.

• Keep the primary care/secondary care split.  Charge patients for GP appointments (with checks and balances in place such that the most impoverished can still access care they need).  Limit what GPs can refer to secondary care, with criteria.  
• Secondary NHS care is largely for emergencies/serious problems such as heart attacks/strokes/cancer.  Charge patients for A&E visits.
• Proper integrated digital records.  I see a medical record as much like your Amazon home page.  From any computer in the world I, and those with access to it, can see exactly what I've bought, I can order more stuff, I can send messages to customer services etc.  If a medical record were similarly set up it could be used for storage of information, referrals, communication between professionals, ordering tests, prescribing medication etc.  If I were king I'd be in touch with Amazon or Google and ask them to design something from scratch along those lines.
• Rationing - some treatments would not be available on the NHS.  Have an NHS formulary consisting of only generic medication rather than branded high cost drugs.  Same for implants such as joint replacements.  If a patient wants a different brand they pay.
• Somehow, stop getting tied up in red tape over GDPR and confidentiality.  Vladimir Putin is absolutely not interested in Mrs Miggins' forthcoming gall bladder operation, so it doesn't have to have the same level of security as the nuclear codes.  Similarly, society needs to accept risk.  Not everything that goes wrong should mean a payout.
• Private practice.  I'd hate to see a US system, which is widely recognised as the worst of all worlds, but we need to embrace private practice and facilitate it as taking pressure off the NHS, rather that objecct to it on ideological grounds.

That's not, obviously, a coherent plan for change, more a brainstorm really listing a few things I think might help stem the inexorable rise in NHS expenditure.  We need to raise money and cut costs and be more efficient, so that means charging, rationing, and better tech.  All three are required otherwise we fail.

Can I constructively criticise two of your points, Ian?

Rationing will work if all prescribing professionals in the service accept such a restriction of their clinical autonomy.  Over the years, pharma, prosthetic and many other manufacturers have courted the professionals to sway their 'autonomy' and get their various products prescribed.

Private practice, at least in a British NHS context has hardly ever genuinely taken the pressure off.  Its medical practitioners have almost always been moonlighting from their NHS roles (yes I know about part-time contracts) and it has a long history of cherry-picking those treatments that are more straightforwardly able to turn a profit.

[Boo Gay'n]

4 hours ago, Jarndyce said:

I suspect you’re being ironic: but, compared to the Three Stooges…

Saint Kate was in the mix for 15 months.

PS  When has this pink dog ever been ironic??

[The Phantom]

41 minutes ago, Moghrey Mie said:

But people are quite happy to come back to the NHS for after-care when the private company doesn't want to know.

I wouldn't say 'happy' and I never have.  I have spent a fortune on Private Physios etc over the years though.  Admittedly I don't got to A&E or my GP when I have a headache or grazed my knee though. 

[Banker]

1 hour ago, The Phantom said:

Out of interest, is this overspend of £16m in addition to the £20m raked in from our tax rise that is supposed to be ring-fenced for the NHS?

I expect a large proportion of the overspending will be the pay rises given to nurses etc which were well above budgets . 

[Jarndyce]

59 minutes ago, Boo Gay'n said:

Saint Kate was in the mix for 15 months.

I know.   I was suggesting that she was slightly more effective (or at least, did less damage) than the other three, even allowing for her unpopularity in the role.

Which I guess is why she was missed off the list in asitis’ post…

Edited Friday at 03:23 PM by Jarndyce
Typo