Here is why our NHS and Local Government is utterly shafted

Some of the lamps also stay on all day and night - the photocell arrangement fails - we learn about these from the public - it used to be a case that a guy would go around checking the lights - not sure if this happens now - it's been a 'few' years since I was involved in street lighinting.

Anyway, never mind all this - believe it or not - my 16 years old Peugeot 307 just passed it's MOT - unbelievable

 

Council's are required by law to put aside a minimum amount of cash as a reserve fund.

It's fair to say that many Council's did this and more in the day's before austerity - which is one reason why Council budgets were subjected to such savage cuts. The problem is that all the excess reserves have been used up to protect frontline services.

We (the public) haven't yet felt the full impact of austerity on Council services - we've been cushioned by the use of reserves - the reserves are now gone - so hold onto your hat.

More and more Council services will be provided by organisations whose motive is profit - the old days of providing the best possible service with the budget available are gone. I've seen Council's publish 'Commercial Strategies' - well that's not why I got into public service - and yet another reason why I am packing it in this year.

 

There isn't enough money coming in to maintain the current level of service - people moan when they see that a library is closing or that one of their refuse tips is closing - well this is because the money is needed to pay for the statutory services - primarily social care - which is itself under ever increasing pressure from the expanding elderly population

I shouldn't be saying this but I will - Council's have relatively high overheads compared to the private sector - this is why we are closing Council run services and replacing with private sector provision. The cost of Council overheads outweighs the profits that would be made by the private sector - hence they cost less.

Compare a Council run care home (if there are any left) with a private care home - one driven by the desire to meet the needs of the residents to the best of its ability and the other driven by the need to generate profits. We're moving towards more the latter because we can't afford the former.

Both provide an acceptable level of care - the Council IMHO provide a better level of care.

Council's will eventually end up as commissioning bodies - who don't provide services themselves but enter into contracts with the private sector to do so.

I'm not making this up - it is a reality - I know of several Council's that are actively pursueing this model of service delivery. It may take a number of years but it's coming....

 

Last time I saw an advert for an executive position in council, the salary was in the high 50k. That was about 10 years ago when a similar role in the private sector would have commanded mid 30s.

I spent over a decade on a government contract in a private company. My time was charged to the government at 750 per day for contract work plus 280 per day retainer. (I got a mere pittance of it). When my desk phone needed replacing the company that supplied it (a different Ltd entirely owned by the same company I worked for) it cost the government 300 quid just for a 20 quid phone. My pc was 3 grand despite me knowing I could buy one myself, retail, for 300. Even the lease for the building was passed on as an expense.

An independent auditing firm, PWC, was put in to make sure the government got value for money. PWC charged a grand a day per consultant just to turn up.

There is enough money. There's just too many greedy gits creating the bureaucracy needed to justify ridiculous payments for ridiculous expenses.

The government's procurement rules don't help. Unless the rules have changed recently, and company has to be a limited company or plc over a certain size, with a certain very substantial turnover 2 years in a row. That means smaller companies can't possibly tender for work, meaning the larger companies have the government over a barrel.

Those same procurement rules mean that if two government departments, or even two projects in the same department have overlapping requirements, the provider can't simply do both. They have to tender separately for both pieces of work. Both have to be budgeted for individually, and any resources have to be 100% dedicated to one project. In practical terms, as an example, when I developed software with common functionality for two different government projects concurrently ( because I only had to write the code once and it worked for both), the rules were that in my time sheet, I had to list time against each one, and both had to be charged for.

 

The Chief Executive of my Council receives a salary of £130k ish - I think that's entirely reasonable for someone in charge of and legally responsible for an organisation with a revenue budget of £160 million and a capital budget in the 10's of millions. We're talking statutory services which impact upon people's lives.

I suspect that you may have been working for central government? i work in local government procurement (have done for the last 30 years) - the rules have changed to accomodate more interest from SME's. Can't comment on the specific instances you have given - but we're not stupid enough to buy PC's at 10 times their retail price - we know how much we can buy a pc for from pc world and expect the tendered prices to be lower. If they're not we'll abandon the procurement (which the rules allow us to do as these would be 'irregular' tenders) and purchase directly from a retailer (after negotiating a discount).

Since before 2006, the EU have been telling us how we should procure - in fact my whole career has been based upon making sure that we follow these rules - and don't end up in court for non compliance.

Central Government are just as bad - telling us how we should procure services - in many cases their directives just don't make sense in the 'real' world.

There isn't enough money in local government - I've seen the budgets reduce significantly over the years and I've seen services reduce and whole services withdrawn - services which meet a need but which we now can't afford and in any case don't have a duty to provide.

 

Local, central, all part of the problem.

I remember a few years ago when I worked in County Durham, there is a road that I and many colleagues had to use to get to and from work. One harsh winter, that road snowed up repeatedly. Half of the road is under Durham council, the other half belongs to Sunderland. Both councils paid separately for snow ploughs to clear the road. Except they didn't coordinate because different snow ploughs did different stretches of the road on different days. It quite literally was a huge waste of money because some days you'd get half way along, then in the middle of nowhere, suddenly it becomes unpassable so you'd have to do a turn in the road and find a different route. Sometimes the Sunderland half was clear, sometimes the Durham half. Now if only the rules had allowed them to get their heads together and pool their resources, the whole road could be open at less than the cost of independently doing two halves with seperate billing.

 

Your NHS sounds like our Veterans Administration. Free Medical care for our veteran service members. But it is a quagmire of rules and regulations, poorly run, and our veterans are treated worse than welfare recipients. Sometimes veterans die while waiting on medical care. it is a disgrace. Our new President promises to fix a very broken system and I hope he can. My own brother went to the VA hospital in Houston, Texas for SIX YEARS, sick and getting sicker and NO diagnosis. He fell out in the floor one night and his wife called an ambulance. A private hospital came up with a diagnosis in a few days, too little-too late, and he died a awful death a few months later. And that is just one of many horror stories out there about our miserable treatment of our veterans. Why my brother didn't go to a real hospital to start with, I don't know, other than he probably couldn't afford it. Shame on our Senate and shame on our Congress. I wish they got their health care at the worst VA hospital in the country.

Before the Liar-In-Chief took over our health care, I could get a very good health policy for less than $300 a month, less if working for an employer who provided insurance. We were sold a pig in a poke, an UN-Affordable Health Care Act that we were promised would cost about $200 a month, no matter what health problems anybody had and I quote "If you like your Doctor, you can keep your Doctor." All lies. Insurance companies have dropped off and won't offer coverage any more. What a mess. Where it goes from here, I don't know. The payments are skyrocketing, the deductibles are in the tens of thousands-who can afford that? A lot of the people on the AHCA are subsidized by the government which means that people with a job are paying for their own health insurance, plus half of somebody else's to boot. But on a bright note, my son is covered if he gets pregnant!

On garbage collection, mostly private companies, some are nation wide. They offer good service for a fair price, because there is competition! Yes! If Company A has lousy service and charges too much, you can choose Company B or C. Capitalism sifts out the under performers and too expensive.

 

Went down to see the nurse practitioner for a Hypertension review this morning as I have had to go on to tablets for the time being due to having borderline high BP.

Anyway,got there at 8.35am which would give me five minutes before I got in to see her.When I told the receptionist my name and who I there to see and what time my appointment was for the lady looked at the computer screen and said I was due to see the nurse at 8.50am. I explained that the receptionist before Xmas had written the time down for me as by the time I got home I would have forgotten what she said if I just had to remember it.So I ended up spending twenty five minutes (she was over running by five minutes and I was her first patient) before I got in to see her,so had to sit and listen to a loud radio with stupid adverts blaring out of it

I had to explain to her what I was there for so she proceeded to take my BP.I was then told my BP was high and had I been waiting long,so I explained what had happened,so the nurse reckons I have the white coat syndrome again.I asked her what the reading was and she wouldn't tell me,she just said it was high

So I now have to do my own readings twice a day for a week and then hand them in so that she can average them out and will then let me know hopefully whether I need to stay on the tablets which she has re subscribed,but I reckon that now I am on them it will be for life.

I expect being with Mr Kandy 24/7 isn't helping my BP plus at the back of my mind I am getting a bit worked up about the foot operation that I am going to be having sometime in the next few months

 

I've been on BP tablets for more than15yrs.
Originally I was told if I stopped smoking I wouldn't need tablets, I did stop, not for that reason more it was about money.
Anyway within a few months my GP put me on BP tablets, been on them ever since.

I've heard that BP tablets are a bit of a racket that the GPs are involved in, they get more money from the NHS if they can get everyone on tablets, either that or its a drug company thing.
Anyway that is just what is going around on the street, possibly just a myth.

Its true they are very cagy about telling you what your BP should be, I ask, What it should be and my GP usually says weeeelllll, its a bit higher than I'd like to see it.

He told me to double up on the tablets about 6 months ago, but I'm not doing that, I've stayed on the same dose, went to see the nurse a few days ago and she took my BP and said absolutely nothing.

So there is something going on regarding BP, not sure what.

It's a bit like back in the 70s and 80s when the dentist drilled the life out of your teeth mostly for no reason other than profit, I'm still living with the backlash from those days.
I just wonder how long it will be before the BP racket is exposed.

 

This link may be of use to you @pete and @Kandy

My current (and previous) GP surgery had a blood pressure machine in the reception area. You sit on a seat, put your arm in, few seconds later, it gives a print out of your reading. No need to see the GP and *ask* what the reading is.
I had a text from the surgery, just before Christmas, stating I need a BP check:
"Please use the self-check BP machine in the reception. Thank you." Ok!
So, following their instructions: I popped in; used the self-check BP machine; got my print out; read it and ... left.

I don't understand why they don't just tell you anyway? Seems self defeating because knowing what it is and what the ideal should be can only heighten awareness and for those who take it seriously then they can take steps to do something about it.