Where is the money going?

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Not sure if this post is in the right section of the forum, however here goes.

I have been wondering about the future of the NHS and to be honest, from a carer's perspective it does not look to bright. I think how often I have had to dig down in my pockets to provide care and not a single penny came from benefits. So heres my question. If carers are saving billions for the NHS, then why is the NHS in so much debt? Where is all the money going?

Hope someone can enlighten me.
Boob jobs, gender reassignment, gastric bands could be blamed. Then there's WHO the NHS are treating for free - have they paid their dues? Then there's the question of hospital food. Personally I think it would be fair to charge for some "housekeeping" costs. Then there's all the modern technology - only to save my life I had to pay for this privately, very sore subject. However, "bed blocking" is often blamed in my area. My mum would probably now come under this category. She was admitted at night with a UTI, without her Zimmer frame, and she can't walk without that! She was shuffled around a bit and ended up in a ward for "elderly care". She was asked to get out of bed to use the commode, but couldn't get out of it. Most likely reason, it was too low! Mum is very bent, but still has legs reflecting her 5ft 9" original height. As a result of this failed attempt to get out of bed, nurses were told to hoist her in and out of bed. So far, she has walked only a couple of steps in a fortnight. They don't have a recliner like the special one she has at home, rise and fall, at first she had a high straight backed chair, hopelessly unsuitable for her bent back. Now replaced by a much softer backed chair, supposedly a recliner only guess what, it doesn't work!!!!! Mum's already poor mobility has gone down the pan.
Technology is is very expensive, 30yrs ago CT and MRI scans were unknown, now they are regularly used, they cost thousands of pounds each and this is only the tip of the ice-berg. Every department now has highly sophisticated computerised equipment. Then there is the key-hole surgery - that also uses much more expensive equipment - joint replacements, lens implants to replace cataracts, new extremely expensive drugs for cancer and other conditions - these are all new, but are considered mainstream now. There is also the rise in population (more people requiring treatment), the rise in diabetes and improvements in techniques mean that more people survive strokes and accidents, but then carers like you and me then have to look after them.
And, of course, the rise in managerial staff which accounts for, literally, hundreds of posts in every hospital. In fact, I think I am right in saying that clinical staff in hospitals are actually in the minority now.
So basically its because we are

- All wanting to live longer and have the technology to do so, but that is so expensive.
- A rise in population requiring access to limited resources
- Managerial staff costing a lot of wages
- Expensive computerized data systems, some which do not work.
- Expensive treatments going to those who do not pay taxes

Am I missing anything?
That seems to cover most things. However, if I think of my family, sister in law would have died in childbirth 40 years ago without an emergency C section, so no niece, nephew, etc. on her side; I'd have died in my thirties; another nephew would have died (born at 24 weeks); and mum would have been gone long ago. I know many disabled children who would not have survived without a lot of medical intervention. So where do we set the boundaries?
To be fair, the data systems probably work out cheaper than it would cost to store all the paper copies of our notes used to...
To be fair, the data systems probably work out cheaper than it would cost to store all the paper copies of our notes used to...
Actually, very few medical notes are computerised - only small data systems like GP records. I dont know of a single hospital that doesnt use paper records, although I know of several that have tried and failed (costing thousands, if not millions, of pounds of IT costs - dedicated hardware, all the software, staff training, dedicated experts for trouble-shooting etc) I suspect that the answer, rather than huge grand schemes, is to gradually increase the small data systems and start to link them up.
So basically its because we are

- All wanting to live longer and have the technology to do so, but that is so expensive.
- A rise in population requiring access to limited resources
- Managerial staff costing a lot of wages
- Expensive computerized data systems, some which do not work.
- Expensive treatments going to those who do not pay taxes

Am I missing anything?
Yes, there are more managers at the hospital where I work than there are clinical or admin staff. Certainly, the doctors are rushed off their feet but all the managers do is send demanding emails to us Medical Secretaries, telling us to type more and more letters as we're getting behind on the digital dictation. And why are we getting behind? Because there aren't enough secretarial staff or typing pool resources. Not that I'm advocating backroom staff who do very little (I experienced this in the NHS when I temped at this hospital in 2005) but now there are far too few of us. And yes, the computer systems are to blame. They introduced a massive new one yesterday but they did it in a cack-handed way and I've not been able to do any typing for 2 days now (only answering the phone, filing and dealing with emails). If the system was working, I wouldn't be on this forum at this very second! I don't like wasting the NHS's money but if they can't provide me with the equipment I need to do the job, how am I supposed to do it?
Trippedup,

This echos the conversation I had with a friend who is an NHS temp. She gets hired on day 1, gets access to relevant databases by day 5 (so 4 days doing practically nothing), usually by the same hospital trust. However, different access, different systems depending on which site she is at. Her job? to check and frequently retype the letters done in India to save money!
Yup, Anne - I can believe it.

There are also government targets and initiatives - Choose and Book is a classic
When C&B was introduced the computerised scheme wouldnt "talk" to the computerised hospital appointment system, so everything had to be done twice. The scheme also doesnt allow the GP referral letter to be downloaded until after the appointment is booked.
So....
Hubby has epilepsy, lets imagine what would happen if he were referred now:

GP refers hubby to the neurologist via C&B. Hubby gets letter in post asking him to phone a number (which might not even be in the hospital) to book an appointment. Hubby phones up and chooses a date/time out of a very limited choice and thinks he has an appointment. WRONG. You see, our hospital has an epilepsy specialist neurologist - but until hubby has booked the appointment the referral letter wont come through and no-one knows why he has been referred. The consultant that he has booked the appointment with then looks at the referral letter and (unless he is very lucky), it wont be with the epilepsy specialist. So this consultant sends the letter back to the people who booked the appointment with a note saying, please book this appointment with Dr X instead. The appointment gets duly changed and the letter then gets sent to the epilepsy specialist neurologist who might look at it and say "actually I need an EEG done first", so the appointment gets changed a second time.

What a waste of time and money AND the patient hasnt chosen the date/time of the appointment anyway.
In our local hospital Choose and Book is known as Choose and Loose