The Night Mail

[monkeysarefun]

1 hour ago, polybear said:

 

Snakes....

Spiders....

Sharks....

Crocs....

Plants.....

Killer Field Ornaments.....

Mutant Ninja Chimpies....

 

 

Hence our enhanced health system, an NHS style one would be unsuitable:

 

"Jeez that bloke  just got bit by a @&$*@ Tiger Snake, get him on a waiting list quick !"

Edited June 14 by monkeysarefun

[iL Dottore]

2 hours ago, SM42 said:

A question I may about the Bismarck system you have.

 

Is the payment in addition to  tax or does the tax burden remain the same and a part is ring-fenced  in  a sort of personal  health insurance account?

 

Andy

The payment is in addition to your taxes (which are lower). The important thing is that the money raised is ringfenced for healthcare.

 

1 hour ago, DenysW said:

Accepting the £160 Bn price tag of the NHS (I thought it was a touch lower, but not enough to argue about) spread over the 30 million in work, then just the NHS needs a bit under £3,000/year/income-tax payer. And it's still cheap!

So it's cheap. But what about OUTCOMES? A damn sight more important than cost.

 

1 hour ago, Willie Whizz said:

NHS staff who have been trained (substantially) at Government and Taxpayer expense should be handcuffed to work in the NHS for five years at least before they are allowed to take their skills overseas. If they want to go sooner, they should repay a pro-rata part of their training costs. If they bu%%er off anyway, they should forfeit their pension pots, NHS and State. 

By the time a doctor qualifies in their specialty, they will have already given at least 5 years of their life to the NHS after getting their medical degree.

 

And if they disappear to sunnier climes, then they aren't gonna give a monkeys about the sort of pathetic pension the UK hands out.

 

If you want to keep them, what about this radical idea: pay them competitively with elsewhere, give them a good working environment with the modern tools they need and make sure they have a decent work/life balance and support from upper management. Sure, it will mean (some) more money, but first you've gotta fix the working environment...

 

Edited June 14 by iL Dottore
Wording

[PhilJ W]

32 minutes ago, iL Dottore said:

If you want to keep them, what about this radical idea: pay them competitively with elsewhere, give them a good working environment with the modern tools they need and make sure they have a decent work/life balance and support from get rid of upper management. Sure, it will mean (some) more money, but first you've gotta fix the working environment...

 

That's better.

[monkeysarefun]

1 hour ago, Willie Whizz said:

NHS staff who have been trained (substantially) at Government and Taxpayer expense should be handcuffed to work in the NHS for five years at least before they are allowed to take their skills overseas. If they want to go sooner, they should repay a pro-rata part of their training costs. If they bu%%er off anyway, they should forfeit their pension pots, NHS and State. 

 

 

 

I guess that if its a carrot or stick situation, the stick IS the cheaper option instead of offering larger carrots.

 

Superannuation (our version of a pension) is paid by employers and is additional to salary, not taken out of it. The current rate is 11% of salary, though many employers offer more in salary packages as an extra incentive,up to 20% or more, so you may need a bigger stick.

Edited June 14 by monkeysarefun

[Hroth]

Then there's the problem of the NHS buying in extra capacity for ops, etc, from the private sector. The private sector being staffed by many NHS doctors working part time in both spheres....

 

 

[polybear]

4 hours ago, iL Dottore said:

The monthly insurance cost is roughly the equivalent of the monthly chunk of your UK tax that goes into the NHS. All monies raised go into the health care system and can not be diverted by the government into other things and the truly indigent get government support for their insurance payments.

 

What about payments when you are retired and not working, yet have savings?

 

3 hours ago, Willie Whizz said:

NHS staff who have been trained (substantially) at Government and Taxpayer expense should be handcuffed to work in the NHS for five years at least before they are allowed to take their skills overseas. If they want to go sooner, they should repay a pro-rata part of their training costs. If they bu%%er off anyway, they should forfeit their pension pots, NHS and State. 

 

Airlines run a similar system (not the pension bit) for Pilot Training Costs.

 

2 hours ago, PhilJ W said:

That's better.

 

Especially HR.

 

2 hours ago, Hroth said:

Then there's the problem of the NHS buying in extra capacity for ops, etc, from the private sector. The private sector being staffed by many NHS doctors working part time in both spheres....

 

Perhaps the only private sector allowed should be run by the NHS?  They run a private system for better/quicker treatment for those that can afford it, with the profits re-invested into the NHS for the benefit of all.  There's plenty of private healthcare companies in the UK so there's obviously money to be made.

[jamie92208]

Just a piccy or two from our eyrie at Bournemouth. First of all a passing seagull, fortunately  they don't seem to be able to bomb a window pane.

At work I used to say that the peripatetic senior officers that didn't stay long should be known as Seagulls and not butterflies as we had to clean up the mess they left behind.  

 

Finally an SPT.

 

Her Nanna and mummy's are in the background. Papa had to go on the big wheel. It's a hard life.

 

Jamie

 

 

[iL Dottore]

21 hours ago, polybear said:

I know of a Guy that is waiting for a gall bladder removal op;  22+ weeks wait on the NHS.  Private?  Eight Grand - with one night in Hospital....

That’s pretty much in the middle of the ballpark for what a cholecystectomy can cost the NHS (£3406 to £12011 depending upon complexity and pre-op work up https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609675/)
Worldwide costs vary from a minimum cost of £203 to a maximum of £12,500.

People have NO idea what the various procedures cost the NHS - which is a big part of the problem.

Perhaps the NHS should star billing people? No, NOT charging them any money,(i.e. “making them pay”) but simply present them an itemised summary of what their treatment cost the NHS. It might shake things up a bit (this is already done by the NHS for internal accounting)

2 hours ago, polybear said:

What about payments when you are retired and not working, yet have savings?

You continue to pay from your pension. Unlike in the UK, the Swiss tend to have three pensions: state (AHV) occupational (company pension) and private (“Dritte Säule”) Average pension for men in Switzerland (all 3 sources) is around SFr 52,735 (about £46,700)

2 hours ago, polybear said:

Perhaps the only private sector allowed should be run by the NHS?  They run a private system for better/quicker treatment for those that can afford it, with the profits re-invested into the NHS for the benefit of all.  There's plenty of private healthcare companies in the UK so there's obviously money to be made.

That’s a terrible idea. Apart from the fact that you can already get private treatment on the NHS, letting the NHS take over private provision would remove all the patient centred flexibility “going private” offers. Basically you’d end up with a second NHS  with the same problems - but one that is NOT free at the point of use.

 

Edited June 14 by iL Dottore
Added comparison texts

[Northmoor]

8 hours ago, iL Dottore said:

* apparently the NHS is the world’s last remaining big corporate customer for fax machines!

The school that Mrs Northmoor works at, kept receiving faxed patients' notes and information relating to appointments until quite recently.  One of Frimley Park Hospital's department fax numbers was almost identical and seemingly someone had been given the number with two digits transposed.

The school always destroyed the messages but clearly one or two people needed to attend a short online course on GDPR and how expensive and career-limiting not adhering to it, can be.

[Happy Hippo]

2 hours ago, jamie92208 said:

 

 

 

 

 

 

Did she really neck that gull?

[polybear]

47 minutes ago, iL Dottore said:

That’s pretty much in the middle of the ballpark for what a cholecystectomy can cost the NHS (£3406 to £12011 depending upon complexity and pre-op work up https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609675/)
Worldwide costs vary from a minimum cost of £203 to a maximum of £12,500.

 

Not sure I'd been keen on having it done in a place that only charges £203....

 

"Bite on this stick, Mr. Bear.....it won't hurt much......."

 

47 minutes ago, iL Dottore said:

People have NO idea what the various procedures cost the NHS - which is a big part of the problem.

 

I remember hearing of a Ward Consultant that got someone to write the cost of all the medical stock on the boxes in the store cupboard - the Dept. Supplies Costs went thru' the floor as it started to make Docs and Nurses think "do I REALLY need this?"

 

47 minutes ago, iL Dottore said:

That’s a terrible idea. Apart from the fact that you can already get private treatment on the NHS, letting the NHS take over private provision would remove all the patient centred flexibility “going private” offers. Basically you’d end up with a second NHS  with the same problems - but one that is NOT free at the point of use.

 

 

Of course it'd have to be run in the same way as a BUPA etc. Hospital - with the NHS getting the profits rather than BUPA.

[Northmoor]

51 minutes ago, iL Dottore said:

People have NO idea what the various procedures cost the NHS - which is a big part of the problem.

Perhaps the NHS should star billing people? No, NOT charging them any money,(i.e. “making them pay”) but simply present them an itemised summary of what their treatment cost the NHS. It might shake things up a bit (this is already done by the NHS for internal accounting)

I REALLY like this idea.  Especially when they discover that the ambulance, A&E and overnight monitoring for concussion after they drank too much, fell over and banged their head - typical of thousands of cases the NHS has to deal with every week - cost the NHS about nine grand.

If nothing else it might silence those poisonous people who say it's all the fault of (a very small number of) foreigners abusing the system.

[SM42]

32 minutes ago, Northmoor said:

I REALLY like this idea.  Especially when they discover that the ambulance, A&E and overnight monitoring for concussion after they drank too much, fell over and banged their head - typical of thousands of cases the NHS has to deal with every week - cost the NHS about nine grand.

If nothing else it might silence those poisonous people who say it's all the fault of (a very small number of) foreigners abusing the system.

 

It would start an Internet craze as to who could get the biggest bill on a night out. 

 

I'm intrigued as to how the costs ramp up that much.

 

Staff time, maybe a grand or so for a simple procedure, ( 5 staff on,  say a generous £20   - £30ph for 10 hrs each + employment costs)

 

 Theatre time is neither here nor there as the marginal cost is zero. 

 

Ward recovery time ( if there is any,) again is a marginal cost as the staff and facilities are there regardless. 

 

so it must be the drugs,  tests and admin that ramp it up. 

 

Andy

Edited June 14 by SM42

[PMP]

9 hours ago, polybear said:

 

They did a pretty good job with the 146 - although not large by the standards of the time.

What killed Hatfield Aircraft Div. was building in ££ but having to sell in $$ - the exchange rate making the product unviable, sadly.

 

The dollar rate didn’t help that’s for sure, and the Fokker70 was eating big chunks four of the same market with two less engines per airframe. The Hatfield site was terrible for efficiency, large sub components were brought in eg wings and main fuselage, and that had a big impact on production costs. Every time an aircraft moved on the line, the whole production line was partially disassembled, then re-assembled just to move the aircraft. This was because the 146 was too tall for the assembly hall and there was insufficient clearance with the roof support.

[polybear]

15 minutes ago, SM42 said:

 

It would start an Internet craze as to who could get the biggest bill on a night out. 

 

I'm intrigued as to how the costs ramp up that much.

 

Staff time, maybe a grand or so for a simple procedure, ( 5 staff on,  say a generous £20   - £30ph for 10 hrs each + employment costs)

 

 Theatre time is neither here nor there as the marginal cost is zero. 

 

Ward recovery time ( if there is any,) again is a marginal cost as the staff and facilities are there regardless. 

 

so it must be the drugs,  tests and admin that ramp it up. 

 

Andy

 

Not even warm.....

I hear an iD rapidly approaching.......

 

 

 

[SM42]

26 minutes ago, polybear said:

 

Not even warm.....

I hear an iD rapidly approaching.......

 

 

 

 

Good.

 

Junior doctors are allegedly on £14  per hour. 

A consultant I'd expect to be on at least double that, even if you quadruple it , it still doesn't add up to thousands per medically trained head. 

 

Genuinely am interested on the costs involved. 

 

Like most, I have no idea about them. 

Intrigued as to how they come to such sums

 

Andy

[Happy Hippo]

We are back from the Portland trip.

 

Instead of enduring the misery of the M5 on a Friday, we left early and travelled 'cross country' following part of the route of the old S&DJR.

We wriggled through parts of Bristol and got onto the old M4 crossed the Severn Estuary, into Chepstow and then up the Wye Valley to Monmouth.  Then it was Hereford, Leominster, Ludlow and a final charge up to Much Wenlock and home.  It was about 45 minutes longer than the down trip, although we did stop twice en route.

 

The big difference is we were moving instead of standing in endless queues of traffic.

 

I probably bored Nyda senseless as I was able to burble on about the various points of disused railway interest, including Pensford viaduct which I'd walked over  with a friend, shortly after the track was lifted.

 

At that point in the journey, I could have sworn I heard snoring! 

 

 

[iL Dottore]

I'm no expert on running a hospital, but the costs that have to be factored in include:

 

> cost and depreciation of equipment

> cost of ALL staff (and that includes not only lab people, radiology techs, housekeeping and the like but also HR and the D&I folks)

> cost of consumables (excluding, dressings, drug administration kits and medications)

> drugs, dressings and single use medical items

> heating and electricity

> financial repayment on PFI contracts

> administration (including secretarial services)

The other thing to consider is that very little of what is used in medicine and dentistry benefits from mass production. Sony probably sells more playstations  in one day than the entire radiology equipment manufacturers sell in a year. 
 

This means that the equipment is expensive. (A state of the art MRI scanner (just the scanner) runs about £400,000 to £500,000)

 

So, returning to the cost of a cholecystectomy, that £8,000 or so it costs pays for a hell of a lot more than the surgeons, theatre nurses, anaesthesiologist and drugs & bandages.

[Northmoor]

1 hour ago, SM42 said:

 

Good.

 

Junior doctors are allegedly on £14  per hour. 

A consultant I'd expect to be on at least double that, even if you quadruple it , it still doesn't add up to thousands per medically trained head. 

 

Genuinely am interested on the costs involved. 

 

Like most, I have no idea about them. 

Intrigued as to how they come to such sums

 

Andy

You've assumed theatre costs etc. are free because they're there anyway.  That's not how facility charges are applied in other organisations, including some public sector ones.

 

When working for a branch of the MoD, the costs of our facilities were accounted for in our personal charge-out rates by dividing them across the annual chargeable hours of all staff (in proportion to salaries).  In combination with our employment costs - allowance for non-chargeable time e.g. annual leave, pensions and other benefits etc. - our chargeout rates tended to be about 2-4 times our salaries.  Once privatised, it became more like 4-6 times, funnily enough; perhaps it was the greater proportion of senior managers we had to pay for (please don't believe the private sector is always more efficient than the public, they're just better at calling overheads by other names).

 

In an equipment and tech-heavy environment like an NHS hospital, I would expect the same 2-4 times salary rates for staff, enough to generate a small "profit" (~2%) which covers for the effects of inflation.  Compared to some of the complete numpties I sometimes came across on >£100/hr over a decade ago, £50/hr for a junior doctor would be an absolute bargain IMO.

[Northmoor]

13 minutes ago, iL Dottore said:

This means that the equipment is expensive. (A state of the art MRI scanner (just the scanner) runs about £400,000 to £500,000)

 

And that MRI scanner probably has a working life of about ten years before the hardware and software become unsupportable and it has to be replaced.  So you have to write down your scanner's value by a grand a week (plus the cost of dismantling/removal unless the supplier of the new one includes that in their quote).

[SM42]

4 minutes ago, iL Dottore said:

I'm no expert on running a hospital, but the costs that have to be factored in include:

 

> cost and depreciation of equipment

> cost of ALL staff (and that includes not only lab people, radiology techs, housekeeping and the like but also HR and the D&I folks)

> cost of consumables (excluding, dressings, drug administration kits and medications)

> drugs, dressings and single use medical items

> heating and electricity

> financial repayment on PFI contracts

> administration (including secretarial services)

The other thing to consider is that very little of what is used in medicine and dentistry benefits from mass production. Sony probably sells more playstations  in one day than the entire radiology equipment manufacturers sell in a year. 
 

This means that the equipment is expensive. (A state of the art MRI scanner (just the scanner) runs about £400,000 to £500,000)

 

So, returning to the cost of a cholecystectomy, that £8,000 or so it costs pays for a hell of a lot more than the surgeons, theatre nurses, anaesthesiologist and drugs & bandages.

 

The actual cost of any procedure is quite low then. 

 

It's all the ancillary accountancy that makes up the cost, some of which is dubious to add in  as a cost per treatment I would suggest in a public sector, publicly funded service. 

 

In your scanner example, if it has a  1000 treatment life then it costs £500 per go. I would hazard a guess that they last a little longer than that.

 

The last MRI scan I had ( private and not the UK , Poland unsurprisingly,  around 8 years ago) cost £100. 

I accept that the abroad element ( probably around 50% cheaper)  could make a difference, but the hospital still had all the other stuff to pay for. 

I also had a copy of the scan on CD and a written report to take where I liked for treatment 

 

As an aside, when Mrs SM42 called to make the appointment, we were told it was a 4 month wait.

When we said we would be paying privately,  they asked if we could be there at 2030hrs

 

The private sector has all such things to consider and I appreciate the price charged as a  consequence.

 

Andy

[jamie92208]

1 hour ago, iL Dottore said:

I'm no expert on running a hospital, but the costs that have to be factored in include:

And the D&I folks)

 

I knew that Dr's are often heavy drinkers but why should they be chargeable when they are Drunk and Incapable

 

Jamie

Edited June 14 by jamie92208

[AndyID]

12 hours ago, Hroth said:

 

Having been following the thread about remotoring a Class 50 with steam turbines 

   I looked at the first picture and thought it was a similar effort involving solar power, those large black sunshades look like solar panels...

 

Then I realised it was a drinking den for sports spectators.  Those steps are going to be difficult for drunks! The operators will have to keep a squad of bouncers to tidy them away when the drunks fall down the steps, and to hose away the vomit...

 

 

I'm glad to see at least someone is taking hydrogen seriously. Best if used in a fuel-cell but nothing wrong with burning it. I get slightly wizzed-off when I see wind-turbines idled because there is no demand for their output. They should be storing energy by producing hydrogen. Our planet is awash in all sorts energy (solar, wind, tidal) and hydrogen is the best way to capture and store that energy.

 

The usual argument is "it's not efficient". Indeed it is not but why let it go to waste? Politicians need to go back to science class.

[SM42]

2 minutes ago, AndyID said:

 

I'm glad to see at least someone is taking hydrogen seriously. Best if used in a fuel-cell but nothing wrong with burning it. I get slightly wizzed-off when I see wind-turbines idled because there is no demand for their output. They should be storing energy by producing hydrogen. Our planet is awash in all sorts energy (solar, wind, tidal) and hydrogen is the best way to capture and store that energy.

 

The usual argument is "it's not efficient". Indeed it is not but why let it go to waste? Politicians need to go back to science class.

 

The usual way is to pump water uphill, but creating hydrogen sounds a good alternative. 

 

I  have managed  to  persuade a few people that on windless days, they drive wind turbines by electrity to keep up appearances 

 

Andy

[pH]

2 hours ago, SM42 said:

…

Junior doctors are allegedly on £14  per hour. 

A consultant I'd expect to be on at least double that, even if you quadruple it , it still doesn't add up to thousands per medically trained head. 

…

I used to work with a system which calculated estimates for work on electrical distribution systems. When calculating personnel costs, we included ‘overheads’ on top of basic hourly rates. Those were for things like pro-rated annual vacation allowances. The factor we used was 107% of a person’s basic rate i.e. we doubled the rate. Personnel costs quickly added up.

 

Edit - I see Northmoor has said much the same thing above.

Edited June 14 by pH