IOM DHSC & MANX CARE

[Jarndyce]

3 hours ago, wrighty said:

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

The population would need to understand why they weren’t getting NICE-approved treatments which they would get in England - and the tertiary centre prescribers would need to be completely on board.

[wrighty]

1 hour ago, Boo Gay'n said:

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.

Well aware of both of those.  A degree of autonomy has to be lost if you accept you're an employee of an organisation rather than an independent contractor.  I can't easily use whatever hip prosthesis I like whenever I like - the department chose one we'd all use.  

Cherry-picking is an issue.  It happens whenever outside contractors are brought in to reduce waiting lists etc.  I think it'd happen less if private practice were more integrated into NHS work rather than it being a moonlighting visit to the 'golden nugget' in the middle of a fracture clinic (no, that no longer happens, but it used to)

[wrighty]

1 minute ago, Jarndyce said:

The population would need to understand why they weren’t getting NICE-approved treatments which they would get in England - and the tertiary centre prescribers would need to be completely on board.

My views are pretty much on the UK NHS not our own branch of it here.  I think it's hard enough running things on a small island, without us going it alone in terms of policy etc.

[Jarndyce]

36 minutes ago, Banker said:

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

Any workable ideas about how to improve recruitment/retention, allowing reduction of spend on bank staff?   Assuming you are against pay rises?

[Jarndyce]

2 minutes ago, wrighty said:

My views are pretty much on the UK NHS not our own branch of it here.  I think it's hard enough running things on a small island, without us going it alone in terms of policy etc

I completely agree, 100%.

But following NICE like England means spend more, not less, on drugs, therapies, procedures, etc - doesn’t it?

Edited September 13 by Jarndyce
Formatting

[cissolt]

Reform is all well and good, but manxcare have been in for years now and have made zero effort to fix basic things. 

GP appointments a mess

Hospital appointment system is a mess

Dental waiting lists are a shambles

Mystery departure of the medical director on full pay.

7 data breaches in July alone.

The cancer diagnostic report below has shown red every month for a year.

[Banker]

35 minutes ago, Jarndyce said:

Any workable ideas about how to improve recruitment/retention, allowing reduction of spend on bank staff?   Assuming you are against pay rises?

I didn’t say that, I said a lot of overspend would be due to wage increases in excess of budget. I support frontline staff being paid well, not high ranking civil servants 

[Alanbellend]

14 minutes ago, cissolt said:

Reform is all well and good, but manxcare have been in for years now and have made zero effort to fix basic things. 

GP appointments a mess

Hospital appointment system is a mess

Dental waiting lists are a shambles

Mystery departure of the medical director on full pay.

7 data breaches in July alone.

The cancer diagnostic report below has shown red every month for a year.

Scans to. If you want an ultrasound scan the waiting time is about 6 months minimum (it was over a year not long ago). But you can pay £350 and amazingly have a private MRI scan in Nobles within 10 days. 

[Jarndyce]

7 minutes ago, Banker said:

I support frontline staff being paid well, not high ranking civil servants 

Your post didn't mention civil servants, high ranking or otherwise.

Your post did mention nurses.

[WTF]

nurses on bank staff is effectively nurses giving themselves zero hours contracts for better pay ( take home ) and the choice of when to work , they may lose some things but many of those that left to go on the bank will be nurses that have paid enough into their NHS pension pots to not need to stay employed to pay more into it for nothing extra, it's a win win for them.

[Auntie Depressant]

I came back on a flight from across with a nurse from the U.K. brought over to do a couple of day’s shifts. She told me how much she was getting paid and it was an eye watering sum and that, together with flights and accommodation made it even more eye watering. Apparently it’s a regular occurrence. We need nurses for sure but bringing them over from across must be making huge inroads into that overspend.  

[The Phantom]

48 minutes ago, Alanbellend said:

 But you can pay £350 and amazingly have a private MRI scan in Nobles within 10 days. 

£500 and less than a week.

[Two-lane]

5 hours ago, wrighty said:

• Charge patients for GP appointments
• Charge patients for A&E visits.

This is just talking about money. What will the charges be, and how will they be decided? An A&E visit is £1, or £100 or £1000? Messing about with this trivial stuff does not change that fact that people have to pay.

The politicians and Civil Servants will be in endless meetings discussing if a GP visit is a tenner or not – discount for quantity.

How will the fees be collected, and at what cost? If the fees are small, the collection cost will be greater than the income. If the fees are high, even the not-so-poor will be affected – to the extent that there will be dead bodies lying outside A&E until someone collects them for spare parts.

What will be the deal at A&E – a doctor at the entrance doing a real-time estimate – “That’s a broken ankle, that is. £500. Sign here. Can’t afford that? It’s your lucky day. We’re doing a special on broken ankles - £400 cash in advance. No VAT. No guarantee”.

Some things in life need insurance, no matter what. The house. The car. Maybe some people insure the wife. Health insurance is essential.

So you go through the competing insurance companies, some of which go broke, and all that stuff. The simplest, most cost effective way is just to have one insurance company, and everyone has to pay.

How to collect the premiums? Well, the gov. has got a department that is solely concerned with getting people to cough up money every year.

In the early days of the Royal Mail someone had the idea to simplify the varying charges by having a single flat rate for everything.  Simplicity is best. The same should be done for health insurance.

As for private patients jumping the queue – I do not agree with that. The equipment that is being used is presumably the same equipment  that the low-paid have also contributed to. If private patients want immediate treatment, they can buy their own operating theatre or fly off to somewhere cheaper.

I would restrict private patients to having their own private room, attended to by a nurse wearing black stockings with seams up the back.
NHS patients would be in Emergency Ward 10 with Hattie Jacques as matron.

 

[code99]

Given the UK Govt has so far been adamant about keeping the NHS ‘free at the point of use’, Manx Care/ the IOMG will have to be super careful about any consequences of (part) privatisation of our NHS. I can envisage all sorts of issues that would come from charging for services such as GP appointments and/or A&E visits, e.g.:

•  Some people would be put off by any level of charges and instead of consulting a doctor stay at home. This ‘cost-deterrence’ could potentially result in patients having very serious (and very costly to NHS) long-term illnesses that could have been avoided;
•  In the absence of a suitable digital NHS administrative/accounting system, the administration of these charges is bound to be cumbersome and inefficient;
• If the difference between NHS charges and private GP charges becomes marginal, then some people will avoid the NHS altogether (their personal NHS records, which are crucial for understanding a patient’s medical history, will become incomplete). It will also mean that Manx Care will generate less income than they expect;
• People have only so much money to spend. If they are forced to spend money on what are currently free (government funded) health services then they will have less money to spend in local cafes and restaurants, charity events, etc.

The IOM population is going to keep aging, hence more demand for health services. If Cannan manages to achieve his goal of increasing the total population to 100,000, surely, we will need another hospital, or at a minimum, an extension to the current one. When he announces his ‘Manx Care reforms’ at next week’s Government Conference (I won’t be there) hopefully someone will ask him what he plans to do about that.

[doc.fixit]

Just struggling to recover after a terrible interlude in Nobles. Maybe they saved my life, I dunno. If so , most grateful but booo hiss to the couple of thoughtless, unkind folk who bruised me so badly. Accolades to those who were kind and thoughtful.

My thoughts for what they are worth?

1. communication.....chaotic. innacurate, don't come in and tell me your complex name, or fill me details ar instructions when I can't understand you because of my state, nearly out of it, don't even understand what date it is.

2. inter staff communition and shift........might fill the tick boxes but actual on the ground info. exchange...hmmph. Don't bother to tell me its time and cost restraints. IF there was a proper, patient orientated communication code it would make working conditiond easier and save costs.

My sincerest thanks to those kind, thoughtful, considerate people. 

Especially one older nurse who was soooo kind and the pink ladies who saved the day

 

Thank you, I'm now rambling and very, very tired.