• Welcome to DOSBODS

    Please consider creating a free account to be able to access all the features of the DOSBODS community. It only takes 20 seconds!

Sign in to follow this  
sarahbell

improvement nhs

Recommended Posts

https://improvement.nhs.uk/

reckons 140 minutes of wasted theatre time a day.

Looking to make efficiencies or increase spending? Which first... 

https://improvement.nhs.uk/resources/overseas-patient-upfront-tariff/

it's got a costings sheet!

wow.

Radiology   Category D Overseas Tariff  Category F Overseas tariff 
Plain Film    £                   24.87  £                   37.30
MRI    £                 159.56  £                 239.34
Cardiac MRI    £                 331.00  £                 496.50
CT    £                   99.61  £                 149.41
Contrast Fluoroscopt    £                   75.98  £                 113.97
Ultrasound    £                   49.41  £                   74.11
DEXA Scan    £                   62.00  £                   93.00
Echocardiagram    £                   79.00  £                 118.50
Nuclear Medicine    £                 329.67  £                 494.50
       
Regular Day Attenders   Category D Overseas Tariff  Category F Overseas tariff 
Radiotherapy - per session    £              1,070.68  £              1,606.02
Haemodialysis - per session    £                 264.92  £                 397.38

Share this post


Link to post
Share on other sites
53 minutes ago, sarahbell said:

Presumably these are actual costs of things...

 

For an org with such bad accountability and costing as the NHS, Im very suspicious about them providing numbers down to the last penny.

For a hospital, Id be happier with a reasonably accurate rough figure, down to the nearest £100 rather than an precise, incorrect one.

 

 

How longs a theatre day?

 

Share this post


Link to post
Share on other sites

Costing is full of assumptions, for instance how is the cost of the hospital building itself going to be dealt with, part of the cost of each procedure (how?) or taken as a prior cost of being a hospital in the first place. What they actually need is pricing not costing, a fairly direct cost for each procedure plus a markup that will cover the cost of the hospital itself. Pricing numbers will look like 225, 1250, 10750 not 210.27, 1107.13, 11023.54

Edited by Panther

Share this post


Link to post
Share on other sites
26 minutes ago, Panther said:

Costing is full of assumptions, for instance how is the cost of the hospital building itself going to be dealt with, part of the cost of each procedure (how?) or taken as a prior cost of being a hospital in the first place. What they actually need is pricing not costing, a fairly direct cost for each procedure plus a markup that will cover the cost of the hospital itself. Pricing numbers will look like 225, 1250, 10750 not 210.27, 1107.13, 11023.54

What they need is to keep the bean counters out of decision making.  They tend to know the price of everything but the value of nothing

Share this post


Link to post
Share on other sites

The prices are apparently based on reality, each year each hospital submits data showing how much all procedures / stays cost them (reference costs), NHSI then average this*, then add a weighting for geographic area to produce the document I linked, which every hospital then must use to bill commissioners, at patient level.

 

*( I think, out of my area of knowledge)

Edited by Workingfortheman

Share this post


Link to post
Share on other sites
3 hours ago, One percent said:

What they need is to keep the bean counters out of decision making.  They tend to know the price of everything but the value of nothing

And how would you attribute costs to particular activities? 

Perhaps you could enlighten me as to whether you would like it to be done on a marginal cost basis or total absorption costing basis to start with and what elements would you start your analysis of the costs with?

Derogatory remarks about accountants don't tend to be based on a detailed knowledge on the theories and principles of accountancy. The basic principle that no one wishes to acknowledge is that every action has a cost, the decision on whether the cost is worthwhile is a matter for the decision maker to arrive at. The decision maker may or may not be an accountant, but as always it is easier to lay the blame elsewhere.

One of the basic activities of an accountant is to measure activities, this is done by converting them into financial terms to give a consistent unit of measure. And as you know what is measured is managed. Whether it is managed well or not is not necessarily the fault of the person measuring. 

Share this post


Link to post
Share on other sites

It is all made up.  There are two teams:

  • One needs to spend all the money it gets, and then a little bit more.
  • The other needs to pretend to be worried about how much money is spent.

All this arguing about beans is just their too-and-fro.

Share this post


Link to post
Share on other sites
3 minutes ago, sleepwello'nights said:

And how would you attribute costs to particular activities? 

Perhaps you could enlighten me as to whether you would like it to be done on a marginal cost basis or total absorption costing basis to start with and what elements would you start your analysis of the costs with?

Derogatory remarks about accountants don't tend to be based on a detailed knowledge on the theories and principles of accountancy. The basic principle that no one wishes to acknowledge is that every action has a cost, the decision on whether the cost is worthwhile is a matter for the decision maker to arrive at. The decision maker may or may not be an accountant, but as always it is easier to lay the blame elsewhere.

One of the basic activities of an accountant is to measure activities, this is done by converting them into financial terms to give a consistent unit of measure. And as you know what is measured is managed. Whether it is managed well or not is not necessarily the fault of the person measuring. 

Oh, touched a nerve there.  o.O

tbh, I wouldn't. Yes there is an overall budget. I would tell each organisation what their total spend was. I would then expect this to be devolved down within the organisation, to be used as the professionals in charge chose to use it.  

As it stands, experts (and I count myself as one) are told what things should cost. They are told how long a specific task should take. 

Meanwhile in the real world things just don't work like that. It frankly needs devolving down and those that actually know are left to get on with the job. 

Share this post


Link to post
Share on other sites

I work for the NHS.

My manager is terrible, as I have said here before.

She for reasons I do not understand was lined up as our future manager years ago.

The job description matched her profile and the post advertised internally.

Only one person was interviewed and she got the job.

Since she's been in post countless people have left. To keep the place going contractors have have filled the gap at mega wages. One at 3x my wage. Madness!

Share this post


Link to post
Share on other sites
19 minutes ago, One percent said:

Oh, touched a nerve there.  o.O

tbh, I wouldn't. Yes there is an overall budget. I would tell each organisation what their total spend was. I would then expect this to be devolved down within the organisation, to be used as the professionals in charge chose to use it.  

As it stands, experts (and I count myself as one) are told what things should cost. They are told how long a specific task should take. 

Meanwhile in the real world things just don't work like that. It frankly needs devolving down and those that actually know are left to get on with the job. 

They way management accountancy is supposed to work is that the accountants tell the management how much the various activities cost, and how much income they make. The financial costs and benefits of activities can then be weighed up with any other concerns or issues and activity planned accordingly to maximise profit.

The trouble with public sector stuff, is that there's no income. Instead you get a politically determined allocation.

That leaves you with a finite amount of money that you need to spend to achieve an amorphous and subjective range of benefits.

In that environment the only financial management that goes on is cost control. Everything else is politics.

So I'd be very surprised if the actual accountants in the NHS have any real power. Control will all be with "policy" people targeting the latest bullshit government performance metric.

Your issues sound like they relate to a workload planning model. If so I doubt any actual accountants have been anywhere near it. Those things are just a stick with which to beat a little bit more performance from the staff, rather then any sort of actual meaningful costing tool.

xD

 

Share this post


Link to post
Share on other sites
1 hour ago, One percent said:

Oh, touched a nerve there.  o.O

tbh, I wouldn't. Yes there is an overall budget. I would tell each organisation what their total spend was. I would then expect this to be devolved down within the organisation, to be used as the professionals in charge chose to use it.  

As it stands, experts (and I count myself as one) are told what things should cost. They are told how long a specific task should take. 

Meanwhile in the real world things just don't work like that. It frankly needs devolving down and those that actually know are left to get on with the job. 

Yes you did. And Spectrum FX has given a reasoned argument why the basic principles are disregarded and political expediency becomes the determinant factor.

These days most cost decisions are driven by marketing. The marketeers, usually those who couldn't understand accountancy, work out the price the market will bear, determine the features that are needed to make the product/service desireable and then leave it to everyone else to make the sums work. Inevitably value engineering is brought into play and the end result is a crap product/service because of penny pinching. And who gets the blame?

Who spoilt the ship for a 'alf penny worth of tar?

Share this post


Link to post
Share on other sites
2 minutes ago, sleepwello'nights said:

Yes you did. And Spectrum FX has given a reasoned argument why the basic principles are disregarded and political expediency becomes the determinant factor.

These days most cost decisions are driven by marketing. The marketeers, usually those who couldn't understand accountancy, work out the price the market will bear, determine the features that are needed to make the product/service desireable and then leave it to everyone else to make the sums work. Inevitably value engineering is brought into play and the end result is a crap product/service because of penny pinching. And who gets the blame?

Who spoilt the ship for a 'alf penny worth of tar?

Whoever makes the decisions, it isn't those at the coal face, public facing, who have to make it work. 

Share this post


Link to post
Share on other sites
56 minutes ago, JackieO said:

I work for the NHS.

My manager is terrible, as I have said here before.

She for reasons I do not understand was lined up as our future manager years ago.

The job description matched her profile and the post advertised internally.

Only one person was interviewed and she got the job.

Since she's been in post countless people have left. To keep the place going contractors have have filled the gap at mega wages. One at 3x my wage. Madness!

The single biggest issue that fucks up the public sector more than any other is the habitual practice of promoting internally, rather than genuinely seeking to appoint the best candidate available.

The fact that they go through the farce of pretending that they're not doing it, while it being obvious to everyone that they are, makes it much worse.

:PissedOff:

 

Share this post


Link to post
Share on other sites
13 minutes ago, SpectrumFX said:

The single biggest issue that fucks up the public sector more than any other is the habitual practice of promoting internally, rather than genuinely seeking to appoint the best candidate available.

The fact that they go through the farce of pretending that they're not doing it, while it being obvious to everyone that they are, makes it much worse.

:PissedOff:

 

I totally hear you. Its absolute shite.

Share this post


Link to post
Share on other sites
16 minutes ago, One percent said:

Whoever makes the decisions, it isn't those at the coal face, public facing, who have to make it work. 

What you're lacking is price signals.

That's the secret sauce of capitalism.You get price signals.

"The right thing" isn't subjective.

If your manager is an idiot, and you know that you can do it better, then you can just set up on your own and put him out of business.

Take away the price signals, and what's the right thing to do? 

 

Share this post


Link to post
Share on other sites
3 minutes ago, SpectrumFX said:

What you're lacking is price signals.

That's the secret sauce of capitalism.You get price signals.

"The right thing" isn't subjective.

If your manager is an idiot, and you know that you can do it better, then you can just set up on your own and put him out of business.

Take away the price signals, and what's the right thing to do? 

 

In the public sector?  

I hardly think that a first class honours degree from the university of one percent would have much credibility. 

Share this post


Link to post
Share on other sites
20 minutes ago, One percent said:

Whoever makes the decisions, it isn't those at the coal face, public facing, who have to make it work. 

From what I've seen of many of those at the coal face I'm glad they're not making spending allocation decisions. Ex nurses who think they can manage aren't as good as they think they are. 

My experiences of the NHS when my wife had need of their services really led me to question the competence of the medical staff she came into contact with. The poor experiences she encountered were nothing to do with lack of resources, poor buildings and lack of equipment. If the medical staff  just did their jobs effectively rather than standing around chatting, laughing and joking then there wouldn't have been a problem. For Christ's sake NICE recommend a CT scan immediately or within 24 hours, it took 5 days before she had a scan, including sitting in the waiting room of a hospital ward for 10 hours until she was told "sorry we cant carry out the scan today as the staff have gone home and the department is shut"!!! When the scan was finally carried out it took 10 minutes!!

Share this post


Link to post
Share on other sites
6 minutes ago, One percent said:

In the public sector?  

I hardly think that a first class honours degree from the university of one percent would have much credibility. 

That's the fundamental issue. The public sector will always be managed on the basis of "that sounds like a good idea".

Quite often it turns out that it wasn't.

Rather than admit that a few more "good ideas" are put in place to fix the issues.

The end game is a clusterfuck. 

 

Edited by SpectrumFX

Share this post


Link to post
Share on other sites
27 minutes ago, SpectrumFX said:

The single biggest issue that fucks up the public sector more than any other is the habitual practice of promoting internally, rather than genuinely seeking to appoint the best candidate available.

The fact that they go through the farce of pretending that they're not doing it, while it being obvious to everyone that they are, makes it much worse.

:PissedOff:

 

Promoting friends, relatives, fellow evangelical churchmembers, from my school guv review of why the fuck x was employed.

Nepotism doesnt close to describing the cliques in councils, schools and hospitals.

Share this post


Link to post
Share on other sites
2 hours ago, One percent said:

Oh, touched a nerve there.  o.O

tbh, I wouldn't. Yes there is an overall budget. I would tell each organisation what their total spend was. I would then expect this to be devolved down within the organisation, to be used as the professionals in charge chose to use it.  

As it stands, experts (and I count myself as one) are told what things should cost. They are told how long a specific task should take. 

Meanwhile in the real world things just don't work like that. It frankly needs devolving down and those that actually know are left to get on with the job. 

In the real world it works exactly like that, lots of constraints being pushed down, it's called productivity/efficiency, do the same with x% less where x is a number dreamed up at top level

Share this post


Link to post
Share on other sites
19 hours ago, spygirl said:

Promoting friends, relatives, fellow evangelical churchmembers, from my school guv review of why the fuck x was employed.

Nepotism doesnt close to describing the cliques in councils, schools and hospitals.

I take me comment back.

NHS managers are titans that stand astride the worlds of tech, business and healthcare.

https://www.theregister.co.uk/2017/10/25/nhs_to_pilot_airbnbstyle_care_room_service/

 

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

  • Recently Browsing   0 members

    No registered users viewing this page.