NHS Reform

[parsforlife]

22 minutes ago, Inanimate Carbon Rod said:

Lol 

Disagreements about how police Scotland is being run doesn’t mean centralisation has failed.  Biggest issue to me is that the failures that ran Strathclyde were allowed to take over.  Started treating the rest of the country like their hell infested sectarian shitehole and lost respect of the rest of the country.

[BucksburnDandy]

33 minutes ago, Cyclizine said:

Although we still have the fourteen territorial health boards, to a degree we already have NHS North, West and East. Pragmatically, it makes a lot of sense to concentrate specialist services in certain centres and to provide a general service elsewhere. The difficulty is providing equity of access to those services to the whole population. This starts to become very political, very quickly and requires hard decisions that are universally unpopular, even If they make services safer and more effective. In particular, I think of the continuing saga that is Dr Gray's Hospital in Elgin, which is 65 miles from Aberdeen, in the same health board, yet 35 miles from Inverness, but it is a different health board. When women in labour have to go from Forres to Aberdeen, something is going wrong.

I agree with this pretty much. Where I work is providing low complexity arthroplasty operations to patients from Highland, Grampian and Tayside as well as cataract patients from Grampian. Equality of access across the "North of Scotland" I.e. Grampian, Highland, Tayside and three island boards is already underway without the Labour proposal, so sharing of services is going to be the way forward.

 

Whether people are in favour or not of the proposal from Labour, there are certain things that could be done far better on a Scotland wide basis in the NHS - an example being the numerous IT systems that don't talk to each other within boards let alone trying to navigate the systems of other boards which are different board to board.

 

The fear that I would have is rural services. The example of Dr Gray's in Elgin already shows that when a bigger population centre like Aberdeen is involved, services are sucked in to that centre, naturally, which then comes at the detriment of rural areas. Someone in Aberdeen taking decisions for the population of Caithness and Kintyre is absolute madness. Highland already struggles with that let alone adding in Tayside and Grampian to that mix.

 

I'd say there is a more pressing need to be looking at ways of freeing Consultants up with more theatre capacity to get waiting lists down and a huge improvement in the care services for older people to free up hospital beds. But Labour seem as blind as the SNP on that need, which is pretty grim.

 

Eclectic rambling post above, sorry for that.

[Left Back]

3 hours ago, coprolite said:

Devil’s advocate: if there’s higher capacity and Lower cost in a centralised (probably city) location then why shouldn’t that be exploited to increase the overall capacity and efficiency of the system. In theory?

In theory sure.  Does it increase or reduce efficiency though?  I can’t answer the question but can give you my own experience.

I live in an NHS Tayside area.  I had to go to A&E a couple of years back and they took me to Victoria in Fife as that was the closest A&E to where I live.  A few days in hospital and when I was discharged they said they’d contact my GP about my options, which they did after about a week.

A few weeks later I went to my GP with symptoms of the same issue again.  The GP asked if I wanted to go back to Victoria or to Perth Royal Infirmary for the next set of investigations.  I said PRI as that was far closer.  She was happy as she said it took a lot longer for her to get info back from NHS Fife as it’s s different health board.  One 5 minute phone call later and I was booked into PRI the next morning and speaking to my GP about the results the same afternoon.

[Inanimate Carbon Rod]

3 hours ago, parsforlife said:

Disagreements about how police Scotland is being run doesn’t mean centralisation has failed.  Biggest issue to me is that the failures that ran Strathclyde were allowed to take over.  Started treating the rest of the country like their hell infested sectarian shitehole and lost respect of the rest of the country.

Yeh thats not even remotely like whats happened, all the processes etc have been east driven, the last chief who oversaw much of the damage was ex l&b model being imposed, too much taking on everyone else’s work and mission creep. As someone who was Strathclyde (and not from a sectarian shitehole) i find this notion that ‘strathclyde dook ar jabs’ to be absolutely fascinating because police scotland is nothing like strathclyde police was. 

[Hard Graft]

12 hours ago, sophia said:

There's no reason why it shouldn't be considered

It's widely accepted that the police change saved a fortune and would've saved even more but for the refusal of Westminster to waive vat. What are your reasons for doubting the wisdom of the change? 

The reduction in the number of officers on the street to start with.  The lack of community presence and ownership of an area. The number of offices being closed down. The number of crimes going uninvestigated. The lack of leadership and fall in moral. The constant lies that the crime rate is falling and the streets are safer.

It should have started with the 8 forces becoming 4 and running as such for a number of years then becoming 2 and again iron out issues and procedures before becoming 1 force.   Instead of having 8 local Police Authorities which were influenced by different parties the SNP in their infinite wisdom wanted just one which they could influence. It really has been a rip roaring success.

Regarding your comment about Vat the SNP were well aware that if they followed this path then they would have to pay Vat and again they choose to ignore this.

[Left Back]

28 minutes ago, Hard Graft said:

The reduction in the number of officers on the street to start with.  The lack of community presence and ownership of an area. The number of offices being closed down. The number of crimes going uninvestigated. The lack of leadership and fall in moral. The constant lies that the crime rate is falling and the streets are safer.

It should have started with the 8 forces becoming 4 and running as such for a number of years then becoming 2 and again iron out issues and procedures before becoming 1 force.   Instead of having 8 local Police Authorities which were influenced by different parties the SNP in their infinite wisdom wanted just one which they could influence. It really has been a rip roaring success.

Regarding your comment about Vat the SNP were well aware that if they followed this path then they would have to pay Vat and again they choose to ignore this.

Police Scotland having to pay VAT was scrapped years ago was it not?

[vikingTON]

31 minutes ago, Hard Graft said:

The reduction in the number of officers on the street to start with.  The lack of community presence and ownership of an area. The number of offices being closed down. The number of crimes going uninvestigated. The lack of leadership and fall in moral. The constant lies that the crime rate is falling and the streets are safer.

What evidence is there to show that these issues (whether real or existing in your head - as some are inherently subjective claims) were caused by centralisation policy? 

There's a yawning logical black hole in this myth of a happy, contended and flourishing society based on Local Decisions for Local People and What's Done in Scandinavia. I'll give you all some time to identify the fundamental difference in Scotland's context (no, not independence).

Edited January 9 by vikingTON

[Cyclizine]

13 hours ago, BucksburnDandy said:

I agree with this pretty much. Where I work is providing low complexity arthroplasty operations to patients from Highland, Grampian and Tayside as well as cataract patients from Grampian. Equality of access across the "North of Scotland" I.e. Grampian, Highland, Tayside and three island boards is already underway without the Labour proposal, so sharing of services is going to be the way forward.

 

Whether people are in favour or not of the proposal from Labour, there are certain things that could be done far better on a Scotland wide basis in the NHS - an example being the numerous IT systems that don't talk to each other within boards let alone trying to navigate the systems of other boards which are different board to board.

 

The fear that I would have is rural services. The example of Dr Gray's in Elgin already shows that when a bigger population centre like Aberdeen is involved, services are sucked in to that centre, naturally, which then comes at the detriment of rural areas. Someone in Aberdeen taking decisions for the population of Caithness and Kintyre is absolute madness. Highland already struggles with that let alone adding in Tayside and Grampian to that mix.

 

I'd say there is a more pressing need to be looking at ways of freeing Consultants up with more theatre capacity to get waiting lists down and a huge improvement in the care services for older people to free up hospital beds. But Labour seem as blind as the SNP on that need, which is pretty grim.

 

Eclectic rambling post above, sorry for that.

There does need to be a degree of pragmatism about what services it is realistically possible to provide locally. The Scottish Government's plan for Dr Gray's is total pie in the sky. There is a tertiary centre in Aberdeen and a big district general in Inverness. Does Dr Gray's, a hospital with 100ish beds (well below a standard DGH), serving a population of 90,000, that struggles to recruit and retain staff need a full district general service or should we consider looking at something approaching the rural model, like the Islands, Fort William, Wick and Oban? For example, Elgin has never had a "full" consultant-led maternity service. It has never provided high-risk care, never had resident obstetric and anaesthetic medical staff, never had an epidural service and never had neonatal. There are around 1000 deliveries per year in Moray - 3 a day. Is it realistic that a "full" service can be provided? How would you staff it around the clock? How would staff remain skilled? The current situation isn't ideal, but some cross-board working wouldn't go amiss.

[Inanimate Carbon Rod]

6 hours ago, Hard Graft said:

The reduction in the number of officers on the street to start with.  The lack of community presence and ownership of an area. The number of offices being closed down. The number of crimes going uninvestigated. The lack of leadership and fall in moral. The constant lies that the crime rate is falling and the streets are safer.

It should have started with the 8 forces becoming 4 and running as such for a number of years then becoming 2 and again iron out issues and procedures before becoming 1 force.   Instead of having 8 local Police Authorities which were influenced by different parties the SNP in their infinite wisdom wanted just one which they could influence. It really has been a rip roaring success.

Regarding your comment about Vat the SNP were well aware that if they followed this path then they would have to pay Vat and again they choose to ignore this.

Sophia’s post talks about ‘saving money’ in terms of a success, it wasnt a success, money hasnt been saved, what has instead happened is provision and services have been cut. Working out of buildings which are a health and safety nightmare and driving a fleet that was so ridiculous you could only have 3 people in an estate car before we even talk about reduction in officers on the front line isnt a saving, its a cut, its a massive cut. The much maligned ‘1000 extra officers’ doesnt consider that many of these had to go into back office roles including call centres, control rooms, citation service, custody duties and other roles that were previously done by civi staff. They fudged the figures by feeding the public nonsense, counting the officers who post citations through doors as ‘front line’ and same for people in internet investigations etc too because they argued the internet was public facing etc. Meanwhile youve got response policing shifts which in 2007 may have had 25 cops mustering at a station and today you’re lucky if you’ve got 11/12, the demands havent changed, all thats happened is theres less who require to do more. 

[Hard Graft]

8 hours ago, virginton said:

What evidence is there to show that these issues (whether real or existing in your head - as some are inherently subjective claims) were caused by centralisation policy?

"Whether real or existing in your head" - great statement - how about from 30 years experience in doing the job from both front line and managerial roles.

Edited January 9 by Hard Graft
spelling

[KingRocketman II]

8 hours ago, virginton said:

I'll give you all some time to identify the fundamental difference in Scotland's context (no, not independence).

and whilst we are at, give us the opportunity to bow to the superior intellect who has graced us all with their presence on this forum. I for one feel truly blessed. 

[vikingTON]

1 hour ago, Hard Graft said:

"Whether real or existing in your head" - great statement - how about from 30 years experience in doing the job from both front line and managerial roles.

 

1 hour ago, KingRocketman II said:

and whilst we are at, give us the opportunity to bow to the superior intellect who has graced us all with their presence on this forum. I for one feel truly blessed. 

Perhaps one of this weirdo tag team can answer the very straightforward question then:

What evidence is there to show that these issues (whether real or existing in your head - as some are inherently subjective claims) were caused by centralisation policy?

[BucksburnDandy]

9 hours ago, Cyclizine said:

There does need to be a degree of pragmatism about what services it is realistically possible to provide locally. The Scottish Government's plan for Dr Gray's is total pie in the sky. There is a tertiary centre in Aberdeen and a big district general in Inverness. Does Dr Gray's, a hospital with 100ish beds (well below a standard DGH), serving a population of 90,000, that struggles to recruit and retain staff need a full district general service or should we consider looking at something approaching the rural model, like the Islands, Fort William, Wick and Oban? For example, Elgin has never had a "full" consultant-led maternity service. It has never provided high-risk care, never had resident obstetric and anaesthetic medical staff, never had an epidural service and never had neonatal. There are around 1000 deliveries per year in Moray - 3 a day. Is it realistic that a "full" service can be provided? How would you staff it around the clock? How would staff remain skilled? The current situation isn't ideal, but some cross-board working wouldn't go amiss.

Fair point well made and I think there does need to be a real degree of pragmatism. The enthusiasm we have seen from Moray patients at my own work at the opportunity to come to Inverness for their operation over Aberdeen shows the opportunity for sensible sharing of services along the A96 corridor. It is the future for this area.

 

DGH is a bit of a problem child, as the population of Moray justifies a hospital that offers more than Caithness or the Belford, but with Raigmore less than 40 miles away, a fuller service will never be achieved due to the small nature of the hospital and the lack of enough work for consultants, see your maternity service example.

 

Despite the gripes of Douglas Ross about Moray needing the world at DGH, I agree that pragmatic solutions do need to be found, but I think that comes better with working with a more rural health board like Highland (yes Inverness is a small city but it isn't hugely urbanised) rather than Grampian where, naturally, a large degree of the population is urban based with the focus on the tertiary centre at ARI. Plus the geography makes sense too.

 

Where we have an issue in Highland is attracting and retaining very skilled staff. While the Think High Think Highland campaign has worked well for certain staff grades, me and my wife are incomers to Highland like so many we work with, attracting consultants is brutally tough with not many willing to commit to living up here. The shared service idea with DGH may help but it doesn't overcome the geographical remoteness.

 

Nor does it overcome the absolute kip that Raigmore Hospital is, which is hugely out of date and too small as it is for the population of Inverness, let alone the wider Highland area. Given the financial state of the board, that won't be replaced for at least another decade. Consultants wouldn't be rushing to work at Raigmore.

[KingRocketman II]

11 hours ago, virginton said:

 

Perhaps one of this weirdo tag team can answer the very straightforward question then:

What evidence is there to show that these issues (whether real or existing in your head - as some are inherently subjective claims) were caused by centralisation policy?

Don't understand your big words.....

 

[HibeeJibee]

Think tank highlights ‘concerning’ fall in hospital productivity in Scotland | STV News

Scottish NHS "doing less with more" despite increases in funding and staffing

The NHS in Scotland is treating fewer patients than it did pre-Covid, despite health spending and staffing levels rising, a new report has found.

Research by the Institute for Fiscal Studies (IFS) found that measured hospital activity “fell rapidly” during the pandemic and has “still failed to recover fully”. The think tank described this fall in NHS hospital productivity as being “particularly concerning given the challenging fiscal situation the Scottish Government continues to face”. A new report looking at health and the Scottish budget said the number of patients on the NHS elective waiting list in Scotland had grown by 87% since the start of the pandemic. 

Meanwhile, the number of patients who wait 18 weeks or less for hospital treatment, and the number of those in accident and emergency who are dealt with inside the four-hour target time has “fallen substantially since the start of the pandemic”. The report warned: “Until the NHS can deliver more hospital activity than pre-pandemic, it is likely waiting lists and waiting times will continue to rise.”

It found that over April to June last year “the Scottish NHS treated 8% fewer elective day-case patients, handled 8% fewer emergency admissions and 8% fewer outpatient appointments and treated 21% fewer elective inpatient admissions than pre-pandemic”. However, staffing levels had “increased substantially” since the start of the pandemic, it said, saying by July to September 2023 NHS Scotland employed 11% more consultants, 16% more junior doctors and 8% more nurses than it did prior.

Spending on health meanwhile was said to have “grown considerably”, going from £1,659 per person in 1999-2000, when the Scottish Parliament was established, to £3,073 per person in 2022-23. The first 10 years of devolution saw health spending increase “rapidly” and while rises slowed from an average of 5% a year over this period, to 0.4% over the following decade, they then “rose rapidly during the Covid-19 pandemic”. While the report added this had fallen since then, it noted: “Spending per person remained 10% higher in 2022–23 than in 2019–20.”

It went on to state that the “apparent fall in hospital productivity in Scotland is similar in magnitude to that observed in the English NHS” – but the report noted England had “increased staff by more than Scotland, so the recovery in hospital activity has been much greater”. And while the Scottish Government plans to increase the health and social care workforce by 1% over the five years from 2022, the IFS noted that NHS England is planning for a 20% to 21% increase in staff over the same period.

[vikingTON]

1) Does anyone seriously expect NHS England to actually increase staff by those levels? 

2) The significant increase in health spending per head of population over the past 25 years is largely down to a) an ageing population of boomers per head needing treatment and b) medical advances making treatment long-term, expensive but ultimately preferable to 'hard lines, nothing we can do'. 

The issue of productivity since the pandemic is worth taking seriously and should absolutely be questioned but as the reporting itself concedes, that's not a uniquely Scottish issue.

Edited February 11 by vikingTON