>>97364
Almnost, and hear me out here, like they get paid shit all and good will dies out pretty fast if you can barely feed yourself let alone a family.

Sucks for you, and commiserations, but aim your anger at the problem, not the symptom.

>>97366
This.

Also, if anyone wants to complain about rail workers getting fat salaries and massive pay rises, maybe ask yourself not why they're getting so much but why you're getting so little.

Big topic. I have thoughts.

My only issue with the nursing strike is that at this point, it should be a general NHS support staff strike. There are loads of people who are every bit as important as nurses, in fact I almost dare argue more important in some cases, but receive even more insulting pay. The rigid pay banding system only compounds the issue.

The only reason those people aren't capable of exerting the same leverage as nurses is because they don't have a professional body with the clout of the RCN. In that sense, while I support striking workers nearly all cases, there is an unfortunate truth to the fact that it only works if you have the leverage, and it only usually benefits that in-group. I would like to see nurses fighting on behalf of those people, and generally raising awareness that it takes far, far, far more than simply doctors and nurses to run a hospital.

>There is something in the British character that seeks to do the barest minimum possible

Yeah, there is, and you know what? It's one of the things that made this nation great. It's one of the reasons the British working class are nowhere near as (and I hate to use this word) conservativeed as the American proletariat.

It's not that we're incapable of graft, it's just that we're not willing to be taken the piss out of. I was attempting to explain this to my new psychopath Polish mate the other day, he was saying he finds it funny how British workers will pull a sickie so easily, we're weak and afraid of hard work and so on. I was saying yeah, we do, and that's why his lot are fucking mugs. You're a fool if you take The Man's cock fully un-lubed and be thankful for it, when you should be taking him for whatever you can.

>>97368

>conservativeed

Alright, fine.

>>97366 >>97367 I know that... hell, my Union's going on strike soon. But sometimes you fancy a rant. That said there's a difference between good will/compassion fatigue and not doing basic stuff. My surgery has often been like that. But you are of course right that the problem is down to political mismanagement.

>>97368
Also that explains why our authoritarians are so crap. It also means they get away with more than in the states, but only on low levels and it's due to apathy from the public rather than support. You don't see half the censorship through violence you get from the Yanks. Some lefties might've cheered at the thought of Jimmy Carr getting arrested for his gypsy Holocaust joke, but they wouldn't have cheered at him getting stabbed like Mr Chappelle's detractors stateside.

Who signed off on this headline thinking "heheheh, we've got 'em now"? The Tory press has gone bananas.

>>97374
Did they seriously think that those nurses wouldn't administer first aid if someone needed it right in front of them?

My friend used to work on an emergency admissions ward, doing 3 nights a week, for whatever the standard pay for his band was. After a couple of years of this, he switched to agency work. Same job, same ward, only he was covering unfilled shifts at short notice, and was getting three times as much money. Think he even registered himself as a company to reduce the tax he paid.

What a shit system - two equally qualified, experienced nurses on the same ward, but one is getting triple pay because they're going through a different channel. If the ward managers were competent, there'd be regular non-agency staff filling these sorts of gaps.

I was reading a Graun article this morning and it kept putting repeated emphasis on how the nurses wages aren't enough to live on. Now, I agree nurses get paid too little, but they start at band 5, and if that's "not enough to live on then just how the fuck do they think people in bands 2, 3 and 4 survive (band 1 no longerexist.sexists because it was overtaken by the minimum wage.)

It just seems like a very weak and self evidently dishonest way to talk about this. They have to spin it to some extent but why do they always leave that open goal of" but you're paid pretty well actually."

>>97376
>If the ward managers were competent, there'd be regular non-agency staff filling these sorts of gaps.

You can't combat basic human greed.

If it turned out you worked in a specialist role and someone said to you "Hey, I can triple your pay for the same role and all you have to do is come work for me." would you turn it down? They're effectively holding the NHS to ransom because they need someone working those roles and they're prepared to withhold their labour unless they can extract more money out of the system.

I worked for the NHS between 2008 and 2009. The amount spent on agency workers was eye-watering then and a massive issue, so fuck knows what it's like now after the Tories have been in for so long.

>>97376

>What a shit system - two equally qualified, experienced nurses on the same ward, but one is getting triple pay because they're going through a different channel. If the ward managers were competent, there'd be regular non-agency staff filling these sorts of gaps.

The problem exists because of collective bargaining and the NHS pay scale system. There is no solution that won't massively piss off a lot of people.

In a normal labour market, wages adjust in response to supply and demand. If I can't get enough chefs at my restaurant, I offer a bit more money - it doesn't have to be massively more, just enough so that a chef who is looking for work chooses me instead of the restaurant across the street.

Managers in the NHS can't do this. Rates of pay are fixed based on the skill and experience of each employee. There's a supplement for London and the South East, but otherwise it's completely rigid. A newly qualified nurse gets the entry rate for Band 5, which is £27,055. After four years of experience, they're eligible to be paid at the top step rate of £32,934.

It doesn't matter whether they're in a highly sought-after job in paediatrics, or a very unpopular job like A&E or geriatrics. It doesn't matter whether their employer is actually OK for staff or if they've got crushing shortages that are putting lives at risk. It doesn't matter if they're a star performer or a total dosser, as long as they aren't actually subject to disciplinary proceedings. Unless they have the qualifications to push them up to Band 6 (senior nurses, deputy ward managers etc) they're getting exactly the same pay as every other Band 5 nurse with their level of experience.

Agency staff are the workaround for this rigidity. It's expensive, it means that agencies profit handsomely, but as an NHS manager, it's your only option for filling gaps in your roster that can't be filled with overtime and goodwill.

Better pay will reduce the need for agency staff, but it won't eliminate it entirely. Increasing wages across the board will lure some people back into the NHS from agencies or other careers, it'll reduce the exodus of qualified staff to Australia, it might persuade a few more people to subject themselves to the Hostile Environment and come over here to work, but it won't address the massive and long-standing disparities in staff shortages between different parts of the NHS.

>>97379
Better pay and conditions would, however, make a sizable dent in the overall shortfall. Nurses are going to agencies and leaving the profession entirely, mostly because they aren't prepared to put up with NHS management's bullshit anymore.

If the will is there, they could put grades 2-6 up 10% today and another 10% in April, and grades 7-9 up 5% both times. (Or just pick the most appropriate spine point if they're still overlapping ranges.) They can just do it. They won't do it because they don't want to do it, and even if they did Treasury wouldn't let them, for no good reason. Health and care professionals are perhaps the exact people you'd want the WTR enforced strictly for, but if you're on the front line you often don't really get to opt out.

>>97380

>Better pay and conditions would, however, make a sizable dent in the overall shortfall.

I agree, but I think we should be cautious about getting overly fixated on the current state of affairs. The NHS is fucked because of austerity, but it'd still be in serious trouble without it.

Agency staff are expensive (~£3bn in 2021), but a 10% pay increase for NHS staff would cost £6bn in direct costs (every year, forever), plus a substantial long-term impact on pensions liabilities. We talk about the NHS being run on the cheap, but we're still in the top 10 globally for healthcare spending as a proportion of GDP. Our European peers spend fairly similar amounts to us on healthcare (some more, some less) and they have broadly similar long-term challenges.

Our population is getting older and sicker at a rate that we really don't know how to handle. The number of doctors and nurses in the NHS has grown consistently over the last decade, it just hasn't grown fast enough to keep up with demand. The demand for healthcare is growing faster than we could possibly grow GDP even with sane economic policies. Either we have to accept that healthcare costs will inexorably gobble up an increasing share of our economy and make us all poorer, we have to accept that healthcare will get inexorably worse, or we have to gamble on a radical reimagining of how healthcare is delivered.

>>97381
>a 10% pay increase for NHS staff would cost £6bn in direct costs
You say that like it's somehow both a substantial sum of money and just disappearing out of the economy.

>Our population is getting older and sicker at a rate that we really don't know how to handle.
How much of the "sicker" part is because we're not treating them effectively due to resource constraints? How much is that costing us already, and how does it compare to the cost of just paying people properly?

>Either we have to accept that healthcare costs will inexorably gobble up an increasing share of our economy and make us all poorer, we have to accept that healthcare will get inexorably worse, or we have to gamble on a radical reimagining of how healthcare is delivered.
Or, and this is going to sound radical, we could do none of those things, stop pretending that the status quo is some neutral state of affairs and be honest about how much of the problem is self-inflicted. We've deliberately and artificially limited the number of training places available, while also creating the Hostile Environment which has dissuaded people from many places from coming here, which has only been compounded by Brexit.

>>97382
>We've deliberately and artificially limited the number of training places available

We've also fucked over local councils and left them without enough money to run care services as demand gets higher and higher. Borises goverment sat on a "ready to go plan" for years, before finally announcing a plan to put everyones taxes up to save the middle classes from having to sell their houses but not actually doing anything to improve care services, and then that plan got binned with no replacement by Sunak.

When the Tories first took over and began austerity, they cut paramedic training from 5 years to 3 to save money. A big chunk of the training that paramedics have lost in that missing two years consists of when and how to safely leave patients at home if they dont need immediate hospital care. The result is that over the past ten years as more and more newly trained paramedics have came into the service there has been a shift towards taking much more patients directly to hospital and putting more workload on A&E to triage patients who could have been cared for at home more effectively.

>>97381

>Or, and this is going to sound radical, we could do none of those things, stop pretending that the status quo is some neutral state of affairs and be honest about how much of the problem is self-inflicted.

I refer you to this: "Our European peers spend fairly similar amounts to us on healthcare (some more, some less) and they have broadly similar long-term challenges."

Some of the damage is self-inflicted, certainly, but every developed country is facing quite dire problems with their healthcare systems. If you read the newspapers in just about any European country, you'll see very similar stories about healthcare - staff shortages, burnout, increasing waits, poor care. Britain is doing badly, but it isn't doing exceptionally badly. Austerity is part of the problem, but it isn't the problem.

A little over 13% of our national resources go towards healthcare. We can hypothecate about part of the wage bill coming back to the treasury in taxes, but we have a finite number of people who can work a finite number of hours. Bringing in immigrants to work in our healthcare system is fundamentally a good idea, but they still need houses to live in, food to eat, schools for their kids. Providing healthcare consumes resources that we can't use for other purposes.

If we want to continue having an acceptable level of care, that share of our national resources that goes towards healthcare will increase to 20% by 2050. The people who consume the vast majority of healthcare - pensioners - mostly don't pay tax and mostly don't do nursing shifts. We can keep increasing our healthcare spend, but young people will have to bear the costs, with obvious effects on standards of living and inequality. We might consider that to be a fair and worthwhile tradeoff, but we have to accept that there is a tradeoff. However we slice it, someone is going to have a shit time.

https://www.theguardian.com/society/2022/dec/14/a-ticking-time-bomb-healthcare-under-threat-across-western-europe

>>97381
Where are you getting numbers that put us in the top 10 globally? The closest I can get is that we were 12th in 2019 according to the OECD. (I'd be suspicious of taking figures from 2020-21 for obvious reasons.)
This chart is a little dated and unrelated, but might help make the fun point that the US has burned 15% of their resources on Healthcare for a while, and the Swiss broke 13% closer to 10 years ago than not. (But then, America is awful and the Swiss are weird, so...)

>>97384
"Our European peers" depends very heavily on who you think our peers are. France and Germany, the two we'd typically compare ourselves with, spend more as a share of GDP. Italy, with whom we share a tradition of economic mismanagement and who occasionally overtake our GDP if we do something stupid like Thatcherism (Il Sorpasso!), spends less. Spain and Portugal are usually in the same ball park.
So you can accept that we're on a level with "our peers", but that might entail accepting that Britain is a second rate European economy hiding behind the fact we speak the same language as Americans, haven't got the climate for becoming a package holiday mecca, and didn't adopt the Euro because Gordon Brown fucking hated Tony Blair.

(Anyway, here's a mad proposal: Have hunt raid private pension funds. Then you'll get inter-generational equity as the old pay for the old, a reduction in inequality more broadly as everyone finds out they're getting roughly the same pension, and a ton of US development aid after all of the free world invade us for having the sheer brass neck...)

>>97384
>Britain is doing badly, but it isn't doing exceptionally badly.
Britain is, in fact, doing exceptionally badly.

>they still need houses to live in, food to eat, schools for their kids
So we build houses and schools, and let the resulting increase in the economy pay for the increased food supply.

>Providing healthcare consumes resources that we can't use for other purposes.
This is just the usual "how do we pay for it" bollocks. We pay for it the same way we're already paying for the adverse consequences of our self-imposed inability to care for people properly, which is making people sicker and creating a greater burden down the line.

>>97386

>Britain is, in fact, doing exceptionally badly.

Your graphs don't show that. We have an under-capitalised healthcare system by design. We aggressively sweat those assets as a means of controlling costs. MRI scanners don't help patients when they're sitting idle or being used inappropriately.

If you look at patient outcomes, the thing we actually care about, the UK is keeping up with our economic peers. We do worse than average on some things, better than average on others, but our healthy life expectancy is well ahead of the OECD average and well ahead of a lot of richer countries with better-funded healthcare systems.

I'm not saying this to excuse austerity or defend the NHS, I'm saying this because everyone else's healthcare system is fucked in basically similar ways. Nobody knows how to cope with the kind of demographic pressures that the western world is facing. Spending more money might take the edge off, but it's not a problem we can spend our way out of.

The vast majority of healthcare resources are expended on elderly people who are well past retirement age. There is no payback on that spending, because those people don't contribute to the economy. Anything we do save on future costs through preventative healthcare are rapidly offset by increased pension expenditure and the basic fact that those people will continue to get sick and continue to consume healthcare resources until they eventually die. This is absolutely a zero-sum problem.

Go to your local A&E and look at the people waiting on trolleys. They overwhelmingly aren't young people experiencing acute illness who could be back at work if they were getting better healthcare; they are overwhelmingly elderly people with complex, chronic and incurable health problems that will continue to get worse regardless of how much healthcare they receive. Our healthcare system isn't designed for that kind of demand; our economy isn't designed for that kind of burden. Nobody's healthcare system and nobody's economy is equipped for that. We aren't facing up to the fact that, in a very real sense, the western world is dying of old age.

https://www.health.org.uk/sites/default/files/HowDoesTheNHSCompareWithHealthSystemsInOtherCountries.pdf

One thing we could do if renationalise all the bollocks PFI hospitals and stop throwing money down the drain on that.

>>97387
Here's an unspeakable thought: has anyone thought of quietly re-jigging healthcare budgets to quietly kill off the old while cutting waiting lists for the young?
I can't say I'd support it (I'll be old one day too and I don't want the precedent) but someone somewhere has surely thought about it.

>>97388
Don't worry, our forward thinking future leadership will undoubtedly do precisely the opposite and build more of the fuckers. What matters is what works. Well, what sounds vaguely trendy if you're the type to masturbate to 1990s Fabian Society literature, even if it has proven to be total bollocks in practice.

>>97389

>someone somewhere has surely thought about it

It's hard not to think that's precisely what they were trying to do by dumping all the oldies straight out of hospital and into care homes without any testing or oversight in the middle of the pandemic. But the truth is it was likely just sheer and utter incompetence.

Either way if the present situation continues, it will likely correct itself via homoeostasis.

>>97389

If you believe the more sensationalist reporting, Canada are putting suicide booths on every street corner.

https://www.theguardian.com/world/2022/may/11/canada-cases-right-to-die-laws

NHS workers are asking for a 19% raise, and Oliver Dowden, the world's ugliest politician, went on the news to say we couldn't possibly afford such a sum. Now, that sounds reasonable, but:

The 19% figure is based on how much wages have dropped so far under the Conservatives since 2010. So surely, as a proportion of the national income, we afforded it in 2010. 19% would just bring us back to that same proportion. If we can't afford it now, the economy is worse than it was in 2010, in real terms. I accept that my maths might be a touch wonky (we probably spend a greater proportion of GDP on green initiatives than we did in 2010, for example, so there'd be fewer percentage points to share with the NHS), but this really is fucking shambolic and I hate that newsreaders don't rip these clowns's bollocks off on TV more often. Paxman wouldn't stand for this shit.

>>97392

Between 2010 and 2019, healthcare expenditure has increased as a proportion of GDP. It doesn't feel like that, but that's because demand has been increasing much faster. The government really aren't lying when they say that they're spending record sums of money and hiring record numbers of doctors and nurses. That's the essential problem that we aren't confronting - we have to spend a bigger and bigger proportion of our national income on healthcare just to stand still, because our population is getting older and sicker.

If we take the RCN's own data on the number of NHS nurses and their average pay, a 19% pay rise for nurses would cost about £2bn per year. That means every household in the UK would have to pay about an extra £87 per year in tax to fund it. Obviously we wouldn't actually distribute the cost like that, but it gives an idea of how the cost of that salary increase would impact public finances. It's not grossly unaffordable, but it's a meaningful chunk of money, especially at a time when everyone is feeling the pinch.

There's a totally legitimate argument that we could afford that kind of spending much more easily if we increased taxes on wealthy individuals and companies. Taxes in the UK are still somewhat lower than many of our European peers. With that said, the share of national income that is collected as tax is higher now than at any point in the last 70 years. Liz Truss was bonkers for thinking that massive unfunded tax cuts would magically create economic growth, but persistently high taxes can act as a brake on growth in an otherwise sound economy.

>>97393
Coincidentally, the NHS pisses away more than £2bn a year on PFI debts despite having long covered the capital cost of the investment recieved ( https://www.newstatesman.com/spotlight/healthcare/2022/05/pfi-repayments-are-costing-some-hospitals-twice-as-much-as-drugs )
Maybe instead of sending the army out to replace striking nurses, we could send them door to door asking the relevant private sector managerial staff to gift the hospitals back to the NHS...

>>97394

That £2bn figure includes debt repayments, but in most contracts also covers maintenance and services. I don't doubt that some bad deals were made that delivered poor value. Some hospital trusts were lumbered with relatively expensive financing because they signed a deal without foreseeing that interest rates could fall to near-zero for the best part of a decade, but most of those deals have been refinanced.

I do have great doubts that PFI is a meaningful drag on the NHS, given that the total profits of all PFI schemes are about £140m per year - about 0.1% of the NHS budget in 2019/20.

The NAO found that, taken as a whole, PFI-managed hospital services are run to comparable standards and at comparable cost to non-PFI services. The problem for hospital trusts is mainly inflexibility - the contractor delivers a pre-agreed quality of service for a pre-agreed price, when hospital managers would quite like to cut corners to save a few quid. That's understandably inconvenient, but I don't think it constitutes a national scandal.

https://www.nao.org.uk/reports/the-performance-and-management-of-hospital-pfi-contracts/

>>97395
Surely comparable standards at comparable cost would imply that the best one can say of PFI is that it was a big, somewhat risky waste of time undoubtedly part-motivated by cynically massaging the public finance figures? (At the cost of, for example, reduced flexibility.)
Too many words to constitute a national scandal, but not exactly a point of pride either. Reach outside the NHS a little: Throw in a Skye Bridge here and a collapsing school there, and you've the makings of a fun little Medium piece.

>>97396

>Surely comparable standards at comparable cost would imply that the best one can say of PFI is that it was a big, somewhat risky waste of time undoubtedly part-motivated by cynically massaging the public finance figures?

Perfectly fair - PFI was a dubious idea that wasn't implemented particularly well, I just think it has been massively overblown as an issue. It was never going to transform the NHS, it hasn't crippled the NHS, it's just an accounting trick that has a mix of costs and benefits but doesn't really change the underlying economics.

>>97397

The trouble is you're looking at it from a zoomed out perspective that averages out all the costs and benefits over the entire NHS. But the thing with PFI is that it's not uniform- There are some trusts that it works/worked pretty well for, but other it absolutely does cripple, because it puts a massive weight on their balance sheet they can't ever meaningfully control.

My own feeling is just that on a gut instinct, low-depth level, you can never square that circle of saying "you can get better value out of the private sector" when the private sector has inherent interest in profit. It might be true you can save on costs that way, but it's self evidently true that saving is going to be translated into profit, leaving you with at best, no net change. And it's never not going to work that way because any company that did otherwise and left profit on the table would have to be stupid.

>>97393
>That means every household in the UK would have to pay about an extra £87 per year in tax to fund it.
So basically fuck all, then? Especially when you weigh that against the sum of the benefits of proper staffing and the consequential costs of poor staffing.

>>97399

There are about 300,000 nurses, out of a total public sector workforce of 5.7 million. If the government give the nurses 19%, there are a lot of other public sector workers (many of them on much lower incomes) who will want similar pay settlements. Most of them wouldn't get anywhere near that amount because they don't have the same level of bargaining power or public sympathy, but a lot of them are likely to try.

If most rank-and-file public sector employees get a pay rise roughly in line with inflation, then we're looking at the thick end of £1000 per household per year - remember that this is an ongoing cost, not a one-off expense. That's a very long way from "basically fuck all". If we aren't willing to stump up that sort of money, then who doesn't deserve a pay rise? Hospital porters and HCAs? Teachers? Bin men? Soldiers?

I won't pretend to know what a nurse deserves to get paid, but I do know that the pandemic has made this country a lot poorer. Workers have every right to go on strike, but every lost day of work makes the country a bit poorer. A lot of people are justifiably angry about the squeeze on their standard of living, a lot of people are disillusioned by a government that clearly doesn't care, but the economy is in an incredibly fragile state and things could still get a lot worse.

>>97400
>then we're looking at the thick end of £1000 per household per year
That's a gross figure, and assumes the status quo is free. Chronic underfunding of public services has a direct budgetary impact, as well as societal and economic costs that have an indirect impact through reduced tax take.

>remember that this is an ongoing cost, not a one-off expense
Sure, that means we're going to have to pay taxes next year as well as this year, but thankfully most of us will also get a salary next year too.

>>97400
>If the government give the nurses 19%
Sure, but the government is refusing any and all offers of negotiation. 19% is the starting offer, not what anyone in the unions genuinely expects to get, that's how haggling works.

>>97400

>who doesn't deserve a pay rise?

Well...

>Hospital porters and HCAs?

Absolutely and unequivocally.

>Teachers?

Nah, fuck 'em.

>Bin men?

Already went on strike and got what they were after earlier in the year, if I recall correctly. Remember all thep ictures of Glasgow under piles of rubbish? Goes to show how quickly people realise how important you are when you walk out, in certain jobs.

>Soldiers?

Arguably, but then, they are replacing them with drones soon aren't they.

>Labour leader Sir Keir Starmer has said the NHS must reform in order to survive.

>He told the BBC the NHS should always be free at the point of use but there was also a role for the private sector, including to help clear waiting lists. He also proposed allowing patients to make self-referrals for conditions like back pain to cut bureaucracy.

>Asked if any reforms for the health service were off the table, Sir Keir told the BBC's Sunday with Laura Kuenssberg programme: "No, we want to look at all sorts of reform. The reason I want to reform the health service is because I want to preserve it. I think if we don't reform the health service we will be in managed decline," he added. "It will always have to be free at the point of use, it of course should be a public service. But that doesn't mean we shouldn't use effectively the private sector as well."

>The interview came after the Labour leader set out his vision for the health service in an article for the Sunday Telegraph. He argued the idea the NHS is still the envy of the world is "plainly wrong" and that the situation for patients was "intolerable and dangerous". Sir Keir also said his party would double the number of graduating doctors and district nurses, increase training placements for nurses and midwives, and gradually turn family doctors into direct employees of the health service.

https://www.bbc.co.uk/news/uk-64279654

>>97409
It's funny how the emphasis on "reform" always translates to more reheated Blair-era private sector payola and never to (say) copying NHS Scotland or other more centralised, more government-led systems .
But I've said that so often I'm half tempted to argue the opposite just to spice things up. Maybe Starmer's a genius and understands that if you hand off the NHS to the private sector they'll lobby for more money far more effectively than the current NHS and healthcare will finally get the funding it needs. (Plus a small bonus for all those aspirational, entrepreneurial shareholders, naturally.)

>>97410

>never to (say) copying NHS Scotland or other more centralised, more government-led systems

NHS Scotland is at least as fucked as NHS England; the Scottish government have substantial devolved powers to raise taxes and set budgets, they do very well out of Barnett, so there's only so much they can blame on Westminster. There aren't any other more centralised systems; the NHS is the extreme outlier in that respect.

Regardless of where you stand in terms of private sector involvement, the NHS undoubtedly does a lot of fucking daft things a lot of the time. NHS staff work very hard and put in very long hours, but they're spending a lot of that time chasing their tails because of a severe lack of management.

We've got consultants on six-figure salaries doing basic admin because ideological opposition to "NHS bureaucrats" left their departments without secretaries and clerks. The disastrous Fujitsu IT contract means that medical records are still often sent by post or by fax; doctors spend an inordinate amount of time copying something from their computer into a letter or vice-versa, because there's no standardised system for exchanging medical information. GPs are the gatekeepers to almost all NHS resources, but they aren't actually NHS employees - they're private businesses working under contract and their interests often run counter to the interests of the NHS as a whole.

The NHS needs more money, it needs more doctors and nurses, but it also desperately needs a management structure and an information architecture that's fit for purpose. If you know anyone with a chronic health problem, you'll know just how much time and effort is wasted because of a lack of coordination and information sharing.

>>97411
>We've got consultants on six-figure salaries doing basic admin because ideological opposition to "NHS bureaucrats" left their departments without secretaries and clerks...
Does "we" here mainly refer to NHS Scotland, NHS England, or both? Management structure was the primary thing I was thinking you could just copy and paste without much buggering about. Looking at it from the opposite angle: if both systems are approximately equally fucked now, but lots of time, effort and money was thrown into reforming the English NHS under Blair but not the Scottish one under devolution, one can only be left with the impression that the time and effort spent on reform would've been better spent practically anywhere else.

For clarity: I don't object to reform in the areas you describe, but (except for GPs if you're optimistic) it seems very unlikely that this is what Starmer or Streeting mean when they talk about "reform" either. If they take power I expect the list of fucking daft things the NHS does to grow much faster than it shrinks.

>>97412

>it seems very unlikely that this is what Starmer or Streeting mean when they talk about "reform" either. If they take power I expect the list of fucking daft things the NHS does to grow much faster than it shrinks.

Pretty much.

Thing is it does need reform, but nobody's going to give it the kind of reform it needs. It also needs a fuckload more money- But they want to act like reform is a magic bullet that means it doesn't need more money. It's not a binary, the NHS needs both.

There's no getting around that one though, if we want the same standard of care we've got used to, we'll have to pay for it. It'll have to come from somewhere, but we will have to. And I think people would be willing to- It's just that it would be a much easier pill to swallow (ha) if we didn't always have that subconcious assumption half of it always just disappears into the black hole of PFI contracts, extortionate procurement fees, dodgy "consultancy" firms who spunk half of it up the wall just thinking about maybe considering a proposal of what to do, and so on.

That lot is the dead weight we need to reform out of the NHS, but we've all become so accustomed to it and so wearily accepting of it, because that's just how our crooked gangster economy works, that we just take it for granted. That's why we don't want to spend more, because we know only maybe half of it actually gets to where it's needed.

>>97411
If only there were another NHS on the mainland you could look to for ideas. One that doesn't have many of those problems because they actually put in the effort into (very slowly but surely) solving them.

>>97414

Wales doesn't count, it's not so much a country as it is a kind of self-perpetuating public sector ouroboros.

>>97415
A self-perpetuating public sector ouroboros where consultants don't have to spend inordinate amounts of effort copying and pasting, GP files don't need to be shipped by motorcycle courier, standardised systems for exchanging medical information exist, nurses don't have to tell patients to store their own samples because the hospital is in a different trust to their GP, and referrals don't get lost because someone put a folder full of forms in the wrong drawer.

Perhaps the best thing we did was put fascists in charge of our NHS IT. There is one service offering, providers can take it and do as they're told or they can fuck off. WanaCry was little more than an expensive weekend of overtime mostly watching screens and doing nothing, with fewer infections than Boris Johnson has children and fewer appointments cancelled than Boris Johnson has mistresses.

>>97414

I disagree with the basic premise that the NHS in the devolved nations is any better run than NHS England. They spend more money, but their outcomes aren't meaningfully better; in the case of Scotland, life expectancy is significantly shorter than in England and the gap isn't shrinking. Scotland has been catching up with England on measures like waiting times, but that hasn't actually translated to health outcomes. Having a simpler organisational structure or spending more money is a bit pointless if it doesn't result in comparatively better performance on the outcomes that actually matter, i.e. the rates of sickness and death.

https://www.nuffieldtrust.org.uk/research/the-four-health-systems-of-the-uk-how-do-they-compare

>>97417

In fairness that gets into murky waters because you're directly conflating health outcomes with NHS performance, which isn't true. There's plenty of lifestyle and environmental factors that would affect a population's baseline health, which would obviously thus affect outcomes.

Scottish people, for instance, are the second lardiest fuckers on earth after the Yanks, with endemic gingivitis, because all they live on is deep fried Mars bar, Bucky and heroin- The Scottish NHS might be the best healthcare organisation in the world for all we know, but it's barely keeping the comically unhealthy Scottish diet and lifestyle at bay.

>>97417
>They spend more money, but their outcomes aren't meaningfully better
Wow, it's almost as if there's some difference in context between Scotland and England that might affect how much money they need to spend to achieve similar outcomes.

It's funny because every time this sort of report comes out people usually go for "do you really think they haven't accounted for that?" and pretty much every time when you look deeper it turns out that they really didn't account for that.

>>97418

>In fairness that gets into murky waters because you're directly conflating health outcomes with NHS performance, which isn't true. There's plenty of lifestyle and environmental factors that would affect a population's baseline health, which would obviously thus affect outcomes.

The Nuffield Trust analysis takes into account those baseline differences. Health outcomes across the four nations have improved over recent decades, but they've improved at the same rate. Devolved powers, greater funding and a different organisational strategy haven't made any actual difference. If anything, Scotland's performance has been worse, because they've got more low-hanging fruit available - improving the health of a very unhealthy person has a much greater impact on quality and length of life than improving the health of an already quite healthy person. There are very few interventions that can extend the lifespan of someone in the home counties with a life expectancy of eighty-odd years, but there are lots of relatively cheap and easy interventions that could extend the lifespan of a Glaswegian with a life expectancy of sixty-odd years.

The fact that Scotland haven't plucked those low-hanging fruit points to one of the fundamental issues that Labour are seeking to address; namely that we've got a National Illness Service rather than a National Health Service. Preventative interventions have a ridiculously good cost-to-benefit ratio, but they account for a tiny fraction of NHS spending. Obviously in a budget-constrained environment there's a temptation to focus on acute care at the expense of prevention, but that quickly becomes a vicious cycle. Politicians bear some of the blame, but the unwillingness to defend preventative budgets is also a failure of NHS leadership.

I'm not sure analysis of performance even should be adjusted taking those lifestyle and environmental factors into account, as though they're independent of the health body. Your GP will tell you to eat less lard or to take more exercise, and the NHS as a whole does stuff like publicity campaigns to make us run more, drink less or eat less lard. They're not just A&E and surgery, they advise on preventative measures too and the efficacy of that should probably be assessed with the rest of it.

>>97420
>Devolved powers, greater funding and a different organisational strategy haven't made any actual difference.
Equally: greater private sector involvement, the various management reforms and restructurings, NHS Foundation trusts and all the rest of it obviously haven't made any actual difference. But Labour's clearly still keen on giving them another go - and it's very obvious they're far more keen to tackle resistance to another ride on the reform merry-go-round amongst healthcare staff than they are to tackle lifestyle factors, which might be rather difficult for a health secretary who gleefully welcomes McDonalds to his party conference.

But I'd dispute the point on funding too: Relative to other services, my recollection is that the NHS has arguably been quietly squeezed in Scotland. That is to say, it's been getting more money in real terms, but less compared to other services than it was pre-devolution. This was true under both Labour and SNP administrations. Also, the Nuffield Trust offers the North of England as a closer analogue for devolved countries and shows that it got both increased funding and improved outcomes. Spending money on cures rather than on prevention may not be the best way to go about things if it can be avoided, but it's nonsensical to imagine the money does nothing just because reduced A&E waiting times are of no aid to the people who get eaten by the Loch Ness monster.

They were on about the ambulance strike on Jeremy Vine's radio show. They had lots of paramedics and 999 call centre workers ringing in to say that people are abusing the system by requesting ambulances if they've got a tummy ache or small graze. They've undoubtedly got a point, but the message of the show was clearly blaming the public for abusing the system and taking the NHS for granted rather than holding the government accountable in any way.

>>97452

This is really a case where I'd be fine with seeing enough resources go to the NHS that peripheral "abuse" of the system like this would be annoying but negligible. I think this only frustrates workers because things are so bloody tight at the moment.

>STRIKES RANT THREAD

I'm on strike tomorrow which you think would mean I can look forward to a nice midweek rest. Unfortunately the Mrs has now unexpectedly asked if we might go to the swimming pool tomorrow and I'm taking a look in BHF at second-hand furniture they have in stock which should only be the start of things.

And I'm only going to come back to more work the next day. Arse biscuits.

>>97470
Good luck with it mate

>>97470
A good premise for a sitcom episode would be a main character getting a reputation as a scab after going into work during a strike, but only because he didn't want to go furniture shopping with his girlfriend. Unfortunately this sitcom doesn't exist so by writing this I've wasted my own time and yours. I'm sorry.

>>97472

I was on the Rudgwick earlier and people were talking about parents and their kids being scabs for still sending them in. I don't think they quite understand the concept.

>>97470
>I'm on strike tomorrow which you think would mean I can look forward to a nice midweek rest

Get out on that picket line and earn your £50 you lazy fuck.

>>97452

NHS resources would be better spent if people actually turned up for their appointments too. We could make huge progress in reducing waiting list numbers if only people would let us know that they can't turn up for clinic or surgery, and free up the slots for someone who can. Hospitals get fined for breaching the 18-week referral to treatment pathway, seriously impacting their individualt budgets, so this really is something that the public can do something about. Or maybe just petition the Government to change it to a 3-year pathway so it looks like the DHSC is performing better.

>>97474
>earn your £50 you lazy fuck

Strikers earn £50/day? How does that work?

>>97475

Most unions have a strike pay fund to compensate their members for lost pay due to strikes. Obviously those funds aren't infinite, but they're a useful tool in motivating people who might otherwise be tempted to cross a picket line.

So who else are on strike today? I've just found out that the Land Registry are so I'm guessing a lot of civil servants will be.

Saw the video of that husband calling in to Nick Ferrari's radio show to carry on an argument about going on strike that he lost with his wife, who's a teacher. Absolutely pathetic. There's no way she isn't going to have an affair.

>>97478
And the producer of Nick Ferrari's show now has their phone number! Although I know a guy who does a bunch of these shows, and apparently he is very successful so it could be him doing it, and if Dave is the producer then Dave is gay and it'll be fine.

>>97474
>>97476
You fucking what, I understand there's an emergency strike fund but it's something where I'm paying over a fiver more into for people in genuine hardship. I didn't realise I was paying normal people's bennies.

Fucking socialism for ya'

>>97479
The thought that it was "too good to be true" did occur to me while I was listening to it. But I think that about basically everything I see online these days so it's hard to tell when I'm being paranoid.

I didn't have my pay deducted last month for the strike. Obviously I didn't think to make any noise about it and just assumed that they would eventually take it out of some future pay. Or forget. Now I'm hearing that some people had two days pay deducted and their employer has told them they will be paid the missing monies on their next paycheque.

Glad I'm not working in HR at the moment, the whole thing sounds like a complete shitshow.

There was a ballot notice went around at my work the other day, so pathology services might be joining in on the strike.

Not that it will matter, because no fucker knows we exist anyway. We're only involved in 90% of diagnoses, with doctors entirely leaning on us to cover their own arses (and to blame us when they fuck up), and were the people carrying the entire fucking health service through covid, but if you ask any average person what a biomedical scientist does, they'll have no bloody clue will they.

I mean, it would totally half the process of appointments and surgeries and everything if we all put tools down and stopped doing people's pre-appointment bloods and MRSA screenings and what have you; but just imagine fucking Munchetty trying to explain what that means to the nation on Breakfast.

>>97558

>half

* Halt.

>>97558
What is your one asking for? I'm wondering if the cancelled train strike is a sign of things settling.

>>97559
Maybe those perfidious doctors have a point?

Munchetty is like a sip of hot caramel on a cold morning. I will not have you disparage her.

>>97560

They didn't really tell us, presumably because they haven't made their mind up about exact demands yet, but I assume just to make sure we're not left out if they reach a settlement with the nurses and ambulance drivers etc. Or to keep the pressure up if they get to negotiations.

We've already had localised strikes for the last few years already about various trusts consolidating their labs, moving staff to sites that are a pain in the arse to commute to, offer worse turnaround times because they're harder to transport specimens to, and making redundancies; but none of them succeeded. So while I hate to be defeatist, I already know we don't have all that much leverage in the grand scheme of it.

It also doesn't help that (at my place, at least) half of us are in Unite and half of us are in Unison, and it was only Unison sending the ballot. So at best they'll only have half a strike. But it did say "to all pathology departments", so presumably it's a general walkout rather than just a local tiff.

We will see I suppose.

>>97561
>half of us are in Unite and half of us are in Unison
That there's a split between two groups of those names is beyond parody. And by beyond I mean not very good. A throwaway joke at best.

>>97562
After the chronic wage stagnation, the worst thing about the crushing of the unions in the 80s and 90s has to be that we lost nearly all the good names. No more fun with acronyms like NUPE, NALGO, or APEX sitting around in tripartite negotiations on wage differentials, no more names that make sure to leave no doubt who's in the union like the Prudential Staff Union, the National Union of Dock Labourers, or the Oldham and District Weavers', Winders', Reelers', Beam and Sectional Warpers' Association. Sooner or later they'll probably even take away your throwaway joke by merging Unite and Unison into a new union with a name like Consignia, and then what will we do?

>>97562

Well, you see, it's the result of what happened when they previously merged labs, and all the staff from one lab were Unite, and all the staff from the other were Unison.

If they carry on with it we'll just have one super-lab that serves the whole of England, and it'll have about 40 staff, but with efficient management and a couple of WASP machines they'll comfortably be able to process 30,000 samples a day. To ensure reliability it'll be located centrally, somewhere with good access to rail and motorway links, such as Aberystwyth.

It'd be quite funny if it didn't mean I might be out of a job one day. But oh well.

>>97564

>To ensure reliability it'll be located centrally, somewhere with good access to rail and motorway links, such as Aberystwyth.

After three years of logistical disasters, they'll decide to build thousands of miles of pneumatic tubes. The project is finally delivered, just ten years late and £80bn over budget, at which point they realise that they don't have any means of access if a pod gets stuck. After a failed effort to dislodge a pod stuck in the Cornwall-Aberystwyth leg with a 300 mile long drain rod, someone will have the bright idea of turning up the pressure to force it loose. Somewhere around the 300 bar mark, the whole of England bursts, flinging large chunks of countryside into low earth orbit. Rishi Sunak will declare it a tremendous success for the British space industry.

>>97565

Implying any of these clowns will be in office by then. Labour will be forced to accept the blame for the eruption of pressurised diarrhoea that devastates a small south Wales mining village. They will solve the issue by bringing in private contractors to manage each region's stretch of tube.

What exactly am I supposed to do when I join a picket line? Do I just stand around awkwardly, occasionally shouting some pre-approved lines and waving a sign menacingly?

I thought I might go march on Number 10 tomorrow because a news report featuring with a load of people would distract from whatever goodies come out of the Spring statement but it's a lot of effort to get there with TfL's strike.

>>97567
Take a guitar and sing a song like Lisa Simpson.

>>97567

>What exactly am I supposed to do when I join a picket line? Do I just stand around awkwardly, occasionally shouting some pre-approved lines and waving a sign menacingly?

Basically, yeah. In theory you're there to discourage people from crossing the picket line and going in to work, but in practice you're mostly there to be seen by the general public. Your union will almost certainly send a rep down to hand out banners and make sure that no-one does anything illegal.

>Ministers have made a breakthrough in their talks with civil servants over pay after backing down to offer officials in less senior roles a one-off payment of £1,500 to help with the cost of living.
https://www.theguardian.com/politics/2023/jun/02/uk-ministers-back-down-and-offer-civil-servants-1500-to-end-pay-row

How does a one-off 'cost of living payment' of £1,500 stop the effects of inflation outpacing wages?

>>97732
Every day a deal is delayed is a day when those workers are without the pay rise that should have already been agreed and implemented by now. If this helps cement a deal sooner rather than later, then they're going to start receiving the agreed pay sooner rather than later. This deal should have been agreed in time to be paid in April. We are now into June, and there's a possibility that it's already too late to get a deal signed off in time to hit June payroll. Obviously it doesn't do anything about "sticky" inflation (i.e. prices for some goods subject to crisis inflation not returning to pre-crisis levels), but at the same time back pay received in September doesn't help people today.

Junior doctors and consultants are going out on the 20th of September and the 2nd to 4th of October. Try not to die.

https://www.bbc.co.uk/news/health-66674058