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Old 26th May 2020, 12:12   #41
andymc
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It's not always just a case of there being no incentive to reduce waste. One recent example I know of comes from a plumber who has done a lot of work for me - in March he took a job in the nearest hospital as he'd been told there was a shortage of plumbers, especially for fitting out additional new facilities for all the additional hygiene control. This included putting in shower units, which he said were built at 1200mm wide as per specification - however the shower trays ordered were delayed. When they finally arrived, they were all something like 1250mm wide, i.e. too big for the newly-built stalls (tbh I can't remember if those were the exact measurements, but I remember thinking that the ones delivered were a very unusual size). They were possibly ones which had been held over in stock due to a manufacturing error. But the supplier obviously felt they could get away with offloading them to the hospital at this time in particular, as the hospital wouldn't have the time to waste returning them and waiting for replacement stock to arrive. And he was right - it was decided that it would be quicker to dismantle all the previously built shower enclosures and replace them with ones that would fit these trays, as this could be done in a matter of days rather than returning the wrongly sized ones and potentially waiting weeks for their replacements. The work of three plumbers for four days, together with most of the materials used for building the stalls, was wasted, just like that.

I've mentioned before that my other half is a school principal, and while I can't say with certainty how it works in the health service I imagine the procurement and tendering processes are similar. Years ago, the Department of Education contracted out all school IT systems to one supplier of a particular system. Now there are a lot good reasons for having one shared IT system across all schools, but anybody with experience of working in schools knows how unwieldy, bug-infested and user-unfriendly this system is. If the school IT goes down, she can't simply call up a local person to come and sort it out that day or the next day - she has to log an issue with the supplier's call centre, wait to find out whether they can fix it remotely, and/or wait for the technician to come out. This can leave her without centralised IT for 2 or 3 days at a time, and this is not unusual - it can be pretty much guaranteed to happen at least 10 times in a school year, sometimes even more. Even something as simple as changing one child's log-in details can take half a day!

Same principle applies to the school fire alarms, intruder alarms, CCTV, heating and electrical systems - there is one supplier for all schools in a particular area and she is not supposed to use any others. Now it's true that centralising purchasing power within the department can drive costs down and that can be perceived as getting value for taxpayers' money (please note my choice of words there). But the knock-on effect almost invariably seems to be a deterioration in the delivery of the services being paid for, and often - as with the IT system - no means of addressing poor service once the tender for supplying those services has been awarded. As always, cheapest does not necessarily mean best, and whether it's the NHS, schools, roads, rail or any other state infrastructure, it is almost always supplied by the lowest bidder in such a way as to maximise their return for minimum delivery.
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Old 26th May 2020, 12:49   #42
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Quote:
Originally Posted by edwardmk View Post
Brave comment.
The waste in the NHS is colossal and there is much scope to improve. Whistleblowers get suppressed, and there are no serious active incentives to reduce waste. The NHS pays out billions in damages due to botched operations and substandard care. Plenty of scope for improvement but in practice this is difficult to achieve.
It's wandering off the original subject - but how true.
The NHS has become an enormous, bloated money pit with no direction or incentive to become nor operate 'efficient'. The front-end medical bit is in many ways world class but the administration/support/supply management is turgid, unwieldy and highly unaccountable ghosting along within a complex organisation. A huge employer (biggest single 'business' in the UK?) with leadership/vision it could become a lean provider but prefers/continues to blot-up cash and amble along whistling it's own tune.
All attempts at kick's in the backside get deflected with cries of privatisation/we're sacred so nowt/little changes - other than we need even more dosh(only a little of which will be justified)!!
When all the dust dies down over Covid-19 I wouldn't be surprised to learn that the initial crisis over PPE shortages was down to the NHS distribution regime/process rather than national strategic procurement/availability of stock - we shall see.
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Old 29th May 2020, 15:04   #43
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Stevie, no I wasn't. The "no free meals" I thought explained it. If I went and worked in another country I find out what the health service arrangements are. If that country decides I should pay some premium up as a contribution to the system I am happy to do that. I accept my responsibility for my health, I don't expect something for nothing. And in the case originally stated the health workers are being paid as are the agricultural workers and others who are working in the uk etcetc. Hence "no free meals" Chris.S.
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