If you were in charge of the NHS what would you cut?
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Original post by Biblio
I'd make ........ treatment they give out because they are dishing out braces willy nilly now.
Why would you cut the wages of higher medical professionals rather than GPs?
Original post by Huskaris
The heads off of all pissheads who come into A and E on a friday/Saturday
That's how I felt when I had someone puke in my direction and it just missed my shoes
.
Mostly devil's advocate:
Few issues with the above:
- £2 might be little money to someone, but to someone else it might be an absolute fortune and it's then you start to enter dangerous territory. Will people choose to feed their family or go to the doctor? More likely the former, and in the longer term you're going to 1) end up with a population that has poorer health and 2) increase the incidence of poor health in the lower social classes.
- Cutting wages - bad idea. Pay peanuts get monkeys, and medical professionals (just like any other professional) will go to the highest bidder - including abroad.. Look at EDs right now, I bet someone along the line said "don't worry about it, where else are the doctors going to work!" and see where we are now - a less desirable speciality and an entire department that is crumbling. Cutting wages is probably the worst (so last) thing the NHS should do to save money.
- As for charging for treatment, that is completely contrary to what the NHS is, what the law states, what the NHS constitution says, etc. so would need an immeasurable change in culture, law, services, etc.
- All that means is that the drunk will be back tuesday morning with septic shock, or the person with tummy ache will be back monday with a ruptured appendix and generalised peritonitis. You can't triage like that - all it does it cause problems down the line.
I agree with the ambulance charge though, but more of a fine. Similar to wasting police time - but could it cause a situation where somebody is not sure if they are serious enough to call an ambulance? Is a lay person OK to make that call? What if they think they just have the flu but instead are lying there with pyelonephritis +/- sepsis?
Original post by Biblio
I'd make people pay to see GPs to clear up the backlog. ( A small fee - £2, so no time is wasted by those coming in for every little thing when no treatment is needed, it costs allot of money to have a GP see someone)
I'd use private contractors to run the ambulance service.
I'd cut wages across the board for higher up medical professionals, the NHS is almost the sole employer of doctors etc, so they have huge market power, this could be used to drastically cut higher paid professionals wages. Surgeons and anaesthetists would be cut first.
I'd introduce league tables for surgeons and anesthetists, allowing patients to choose who cares forthem ( for planned operations) then I would pay them per operation. Making operations voluntary of course.
I'd stop those paying over the 40% rate of tax from claiming for non emergency treatment. For example rich pensioners should pay for their own hip treatments, rich middle class families should miss a holiday if their kids need braces.
I'd stop paying orthodontists per each treatment they give out because they are dishing out braces willy nilly now.
I'd use private contractors to run the ambulance service.
I'd cut wages across the board for higher up medical professionals, the NHS is almost the sole employer of doctors etc, so they have huge market power, this could be used to drastically cut higher paid professionals wages. Surgeons and anaesthetists would be cut first.
I'd introduce league tables for surgeons and anesthetists, allowing patients to choose who cares forthem ( for planned operations) then I would pay them per operation. Making operations voluntary of course.
I'd stop those paying over the 40% rate of tax from claiming for non emergency treatment. For example rich pensioners should pay for their own hip treatments, rich middle class families should miss a holiday if their kids need braces.
I'd stop paying orthodontists per each treatment they give out because they are dishing out braces willy nilly now.
Few issues with the above:
- £2 might be little money to someone, but to someone else it might be an absolute fortune and it's then you start to enter dangerous territory. Will people choose to feed their family or go to the doctor? More likely the former, and in the longer term you're going to 1) end up with a population that has poorer health and 2) increase the incidence of poor health in the lower social classes.
- Cutting wages - bad idea. Pay peanuts get monkeys, and medical professionals (just like any other professional) will go to the highest bidder - including abroad.. Look at EDs right now, I bet someone along the line said "don't worry about it, where else are the doctors going to work!" and see where we are now - a less desirable speciality and an entire department that is crumbling. Cutting wages is probably the worst (so last) thing the NHS should do to save money.
- As for charging for treatment, that is completely contrary to what the NHS is, what the law states, what the NHS constitution says, etc. so would need an immeasurable change in culture, law, services, etc.
Original post by arson_fire
I`d shut A&E at the weekends to all but life-threatening conditions - kick out the drunks with a cut finger or a tummy ache.
Bill for ambulances where its blatantly not needed.
Stop giving junkies free methadone and bus passes.
Make a token charge to see a GP.
Bill for ambulances where its blatantly not needed.
Stop giving junkies free methadone and bus passes.
Make a token charge to see a GP.
- All that means is that the drunk will be back tuesday morning with septic shock, or the person with tummy ache will be back monday with a ruptured appendix and generalised peritonitis. You can't triage like that - all it does it cause problems down the line.
I agree with the ambulance charge though, but more of a fine. Similar to wasting police time - but could it cause a situation where somebody is not sure if they are serious enough to call an ambulance? Is a lay person OK to make that call? What if they think they just have the flu but instead are lying there with pyelonephritis +/- sepsis?
Original post by holly432
it's an interview question and I'm curious to see others views 
Charge people for continued self inflicted medical needs; if someone keeps needing medical attention because of a careless attitude to responsible drinking, drug abuse, smoking (tobacco), self harm ect.
I think that under no circumstances should medical aid be refused but I think people should be charged based on their income. It would be unfair to then put people in debt.
Some 60% of the NHS budget is used to pay staff. A further 20% pays for drugs and other supplies, with the remaining 20% split between buildings, equipment....
The NHS spends £3 billion a year treating alcohol-related sickness, according to new figures.
telegraph.co.uk/health/healthnews/5561217/3bn-cost-of-alcohol-to-NHS-every-year.html
(edited 10 years ago)
Don't you think that the government's refusal to institute minimal unit pricing and plain packaging for cigarettes (in an effort to please an Australian lobbyist) is a more significant reason for the problems we're facing?
In other words - don't blame individuals, look at the system we live in and who runs it.
Original post by Democracy
Don't you think that the government's refusal to institute minimal unit pricing and plain packaging for cigarettes (in an effort to please an Australian lobbyist) is a more significant reason for the problems we're facing?
In other words - don't blame individuals, look at the system we live in and who runs it.
In other words - don't blame individuals, look at the system we live in and who runs it.
I think an extreme solution would be no smoking in any public access place. I get so annoyed when walking behind someone as their cigarette smoke leaves a trail coming out. I see parents walking their children to school while smoking. It makes me sad. This won't go down well.
I would say I live in an average middle-bottom class part of London and it's sad to see even peers and very young guys at my school starting smoking.
The government should stop putting so much focus on those already smoking as the damage has already been done; I'm not saying ignore them, my point is that we should try to stop the root of the problem. Stop young people from picking up their first cigarette. More should be done in schools, the smoking minimum age should be raised to 18 or maybe more.
Original post by htr5
Charge people for continued self inflicted medical needs; if someone keeps needing medical attention because of a careless attitude to responsible drinking, drug abuse, smoking (tobacco), self harm ect.
What about people with sports injuries? Should they be charged too, after all they are self inflicting medical needs? Maybe we should charge everyone, except those who sit on the sofa all day and are totally risk averse... or would that be going against the purpose of the NHS?
(edited 10 years ago)
Original post by htr5
I think an extreme solution would be no smoking in any public access place. I get so annoyed when walking behind someone as their cigarette smoke leaves a trail coming out. I see parents walking their children to school while smoking. It makes me sad. This won't go down well.
I would say I live in an average middle-bottom class part of London and it's sad to see even peers and very young guys at my school starting smoking.
The government should stop putting so much focus on those already smoking as the damage has already been done; I'm not saying ignore them, my point is that we should try to stop the root of the problem. Stop young people from picking up their first cigarette. More should be done in schools, the smoking minimum age should be raised to 18 or maybe more.
I would say I live in an average middle-bottom class part of London and it's sad to see even peers and very young guys at my school starting smoking.
The government should stop putting so much focus on those already smoking as the damage has already been done; I'm not saying ignore them, my point is that we should try to stop the root of the problem. Stop young people from picking up their first cigarette. More should be done in schools, the smoking minimum age should be raised to 18 or maybe more.
Firstly, the minimum age for smoking already is 18 (and has been for many years).
Additionally, the reason why public health specialists are keen on getting current smokers (even of many years standing) to quit is because when you quit you immediately start to gain the benefits associated with not smoking.
Of course, I do agree with you that looking at why people start smoking in the first place and tackling that as a root cause is most important, but equally, we can't ignore or make accessing services and treatment difficult for those who are already smokers.
It's not cutting exactly, but I think if someone has already been to A&E for alcohol abuse once before, the subsequent times they go to be treated for alcohol-related symptoms, they should have to pay to be treated. It's absolutely disgusting how much alcohol abuse costs the NHS.
Original post by FlavaFavourFruit
Cut the pay of the top nhs managers, they get paid crap loads...
but the money saved up from that alone is so small compared to the nhs budget lol.
Scrap homeopathy too, imo it's bull.
but the money saved up from that alone is so small compared to the nhs budget lol.
Scrap homeopathy too, imo it's bull.
They get paid 'crap loads' for a reason.
Original post by KingKumar
They get paid 'crap loads' for a reason.
Too much imo.
i know what they do and why we have them but it's too much. Anyways it'll hardly make a significant impact to the savings.
Original post by Democracy
Firstly, the minimum age for smoking already is 18 (and has been for many years).
Wow, didn't even know that (maybe that's just me). Just goes to show how well it's working. I think this age restriction should at least be better enforced. I thought you had to be 18 to buy the things but 16 to smoke them. You don't see people walking down the street with a crack pipe (at least not where I live) but I do see people still in school uniforms (under 16) smoking casually. Better discipline of this rule should be implemented.
Original post by bibos
What about people with sports injuries? Should they be charged too, after all they are self inflicting medical needs? Maybe we should charge everyone, except those who sit on the sofa all day and are totally risk averse... or would that be going against the purpose of the NHS?
Depends on the nature of the sport. A rough game like rugby would be allowed but this goes for the doctor's judgement. In other words, doctors should be allowed to charge people if they feel it's necessary. The rugby injury is not a deliberate act of stupidity in terms of a physical injury.
Drunkenly jumping down the stairs would require a charge.
Original post by FlavaFavourFruit
Too much imo.
i know what they do and why we have them but it's too much. Anyways it'll hardly make a significant impact to the savings.
i know what they do and why we have them but it's too much. Anyways it'll hardly make a significant impact to the savings.
You are 100% Correct, the government has a monopoly on the healthcare industry, it has enormous power in that medical professionals have little choice in their employer, this power should be levied to add downwards pressure on professionals wages ( only high earners of course) Surgeons, Gps etc should not be earning 100k + a year cut it in half, they have to work for the NHS, there is no demand for their labour elsewhere
I really hope at least half of these suggestions aren't genuinely things you guys would say at interview (or indeed say anywhere). Doctors should judge if the patient deserves treatment or not depending on how self inflicted it is? You're applying to be doctors, not God. We shouldn't treat drunks? Let's ignore the fact that for every drunk you see, you have a chance to prevent that drunk being your next cirrhosis patient - long term cost saving. As for charging people, I think Aneurin Bevan is already spinning in his grave... Think of the bigger picture - you charge someone for access to healthcare, the rich turn up more with minor things, because the charge is so minimal it doesn't affect them, and the poor don't turn up even when they're really sick. If anyone's actually interested in this, the Black report is a good read. Also, the minor charge for access that was suggested will probably end up costing you more than you take in, because you then need to employ people to actually run that payment system. Throw in payment by income and you need even more finance people to check that it's being done properly.
Utter bull. Do that and you'll see a massive rise in private practice and emigration. The rest of the world needs doctors too, and it doesn't have an NHS.
Original post by Biblio
You are 100% Correct, the government has a monopoly on the healthcare industry, it has enormous power in that medical professionals have little choice in their employer, this power should be levied to add downwards pressure on professionals wages ( only high earners of course) Surgeons, Gps etc should not be earning 100k + a year cut it in half, they have to work for the NHS, there is no demand for their labour elsewhere
Utter bull. Do that and you'll see a massive rise in private practice and emigration. The rest of the world needs doctors too, and it doesn't have an NHS.
Woah. Some of these answers are ridiculous!
Cutting managers?! Are you crazy? You cut out the organised part of an organisation and it will become anarchy. Cutting managers will create far more work for others. In my current job I deal with a lot of service managers within the biggest hospital trust in the country and I can assure you that my job would be virtually impossible without them.
Smoking age is already 18, so that point is nullified.
Cosmetic procedures are mostly done through private practices now, so that point is also pretty irrelevant.
Cutting pay will just lead to mass emigration of doctors, as we are currently seeing with emergency doctors leaving for Canada and Australia. The medical training in the UK is second to none, but if people can't see any benefits beyond the training, their skills will be just as good elsewhere, and they'll have a nicer life!
It's hard to pinpoint individual areas to cut directly. It's more the knock on effects of other policies that will have the greatest influence. Making alcohol much more expensive to buy would significantly reduce teenage alcoholism and the binge-drinking culture this country is infested with. Same goes for cigarettes. In my hospital trust they are about to completely ban smoking in any area on hospital grounds. How strictly that will be enforced is another issue, but the thought is there at least. I believe investing in public health and in health education will be very important in reducing costs nationwide, but I'm no expert on this and can't really offer any specific suggestions.
I believe privatisation of elements of the NHS could work. Around 90% of ancillary staff and privately sourced, while admin and clerical staff are also often sourced from private agencies. This is fine for non-medical staff as their roles don't require as much working in a tight team, lengthy training, knowing each other's strengths/weaknesses etc., but I believe it's better to keep medical staff predominantly on a more permanent basis, employed by the NHS. However, saying this, this probably won't reduce costs that much.
Cutting managers?! Are you crazy? You cut out the organised part of an organisation and it will become anarchy. Cutting managers will create far more work for others. In my current job I deal with a lot of service managers within the biggest hospital trust in the country and I can assure you that my job would be virtually impossible without them.
Smoking age is already 18, so that point is nullified.
Cosmetic procedures are mostly done through private practices now, so that point is also pretty irrelevant.
Cutting pay will just lead to mass emigration of doctors, as we are currently seeing with emergency doctors leaving for Canada and Australia. The medical training in the UK is second to none, but if people can't see any benefits beyond the training, their skills will be just as good elsewhere, and they'll have a nicer life!
It's hard to pinpoint individual areas to cut directly. It's more the knock on effects of other policies that will have the greatest influence. Making alcohol much more expensive to buy would significantly reduce teenage alcoholism and the binge-drinking culture this country is infested with. Same goes for cigarettes. In my hospital trust they are about to completely ban smoking in any area on hospital grounds. How strictly that will be enforced is another issue, but the thought is there at least. I believe investing in public health and in health education will be very important in reducing costs nationwide, but I'm no expert on this and can't really offer any specific suggestions.
I believe privatisation of elements of the NHS could work. Around 90% of ancillary staff and privately sourced, while admin and clerical staff are also often sourced from private agencies. This is fine for non-medical staff as their roles don't require as much working in a tight team, lengthy training, knowing each other's strengths/weaknesses etc., but I believe it's better to keep medical staff predominantly on a more permanent basis, employed by the NHS. However, saying this, this probably won't reduce costs that much.
Original post by Biblio
that was labour not toryies
You mean Tories.
Why would you start with cutting the pay of surgeons and anaesthetists?
Consultant surgeons and anaesthetists working for the NHS earn exactly the same basic wage as every other specialty of consultant.
Why would you privatise the ambulance service?
What would be the benefits of allowing patients to choose which surgeon does their operation? (apart from the miss-guided perception that you're choosing a better surgeon).
Original post by Biblio
... they have to work for the NHS, there is no demand for their labour elsewhere
You've forgotten the very large and lucrative private sector...
Original post by Hellz_Bellz!
It's not cutting exactly, but I think if someone has already been to A&E for alcohol abuse once before, the subsequent times they go to be treated for alcohol-related symptoms, they should have to pay to be treated. It's absolutely disgusting how much alcohol abuse costs the NHS.
What about drugs, smoking, obesity etc? Same rules for all lifestyle illnesses?
Also, what's alcohol related and if they can't pay do you just turn them away? I imagine you'd be playing merry hell with the Hippocratic oath if you were to turn away someone with severe injuries who got hit by a car drunk simpply because they couldn't afford the thousands of pounds for treatment. You could draw analogies to other sectors, eg. access to justice in law due to inability to pay lawyer's fees which can run to hundreds or even millions of pounds, but it'd be quite a hard argument.
OP. You should definitely say senior doctors, the interviewers will love that, particularly if you reference their own specialities.
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