loss of RURAL doctors.

[unlinkedstudent]

Why on earth can't they prescribe 3 months supply at a time for certain drugs?

The frequency somewhat regulates misuse.

 

Also, correct me if I'm wrong, but I believe if an individual on medication comes to the point where they no longer require it (including deceased), the medicine whether sealed or not cannot be re-used or put back into circulation and must be destroyed. Bulk batches would obviously add to this wastage.

 

So if you've got someone who is asthmatic or diabetic or on blood pressure tablets, the contraceptive pill and medicines along similar lines, you seriously think giving 3 months' supply instead of one will lead to mis-use? We're talking 3 months' supply here, not 6 or 12 months. Given the life span of most folks up here, I hardly think the majority of us are going to keel over and die /suddenly misuse medications. If other NHS Trusts can manage it and do it effectively, then surely the reduction in payments to GPs and less admin costs outweigh any wastage - or is it a case they never bothered to ascertain that it did?

[Silvercloud]

Stug, you don't get rid of all admin staff and managers just some and combine those that aren't doing alot like some deputies. The payroll is done in Grampian anyway which was a good cost cutting exercise *only* if those who were doing it before have been got rid of and not just doing less work for the same money or found another role to do just keep them employed.

 

The trouble with Shetland because it's detached from the mainland its easier with some things to get away with or hide so less people notice things and perhaps not to be so scrutinised by other NHS trusts.

 

Perhaps soothmoothers and others who been away for sometime notice more of how things are being done here and it sticks out like a sore thumb eg the number of non hands-on jobs there are in NHS Shetland in relation to the number of patients.

[Stug]

Silvercloud the Scottish government has a policy of no compulsory redundancies in the NHS so unfair to have a go at them for not "getting rid" of the payroll staff. The gov calls for savings then tells the NHS they cannot make people redundant or cut front line services - not an easy thing to do when you consider that the majority of the spend is on staff and front line services! So what are they supposed to do? Not a decision I would like to make. Damned if you do and damned if you don't.

 

You are assuming I am not a "soothmoother" because I can look at the situation from both sides. Yes there may be some things which need changed but given the current rules re compulsory redundancies what are they supposed to do? If they make the difficult decision to get rid of some of the managers as you suggest what are they to do. There will be no savings as they cannot make them redundant, they will still have to find them some work to do as they are having to be paid and the managers who have been "gotten rid of" will be demoralised and less inclined to give their best. It a "lose lose" situation.

 

NHS Shetland suffers from diseconomies of scale - there may be less patients but not all costs can be reduced accordingly. Some costs are fixed costs which do not vary with the number of patients. We are lucky with the services we have here - I have family on the mainland and the level of service they receive compared to what we have here is shocking.

[Silvercloud]

Hi,

 

You do not need to make compulsory redundencies as you only have to look at the vacancy lists over the past few years. The jobs that are being advertised are mainly admin staff therefore "payroll " could have been given one of these jobs which may have been done.

 

All that needs to be done is when people leave or retire do not readvertise the posts. This is what happens with the nurses so why not managers and clerical staff as they could take on more roles to cut costs.

 

If they close a ward and move nursing staff they put those nurses where they don't want to go (still giving them a job). They get demoralised and leave - compulsory reduncies via the backdoor. We need our nurses.

 

It's not the nurses we need to deperately get rid off it's clerical and managers that are just duplicating jobs for the sake of it.

 

As for the NHS services being better up here, having family all over UK too I have to strongly disagree in *some* areas of services here.

They supply bare minimum of service up here just about calling themselves a hospital.

[paulb]

our services are ok. but if you compare them to say london then they look poor at best.

 

its not so much that there is a lack of provision. but there is a serious lack of access.

 

take cancer care my sister is in the process of being treated. she has been to 3 specialist units over the last few weeks with no waiting. mri scans done on the day requested surgery within a week.

 

yes you will get treated up here but its not as smooth.

 

the cat scanner is a god send. however is very limited to when it is allowed to be used. for example before treating strokes you should have a scan within hours to determine if the stroke can be treated with clot busting drugs or needing surgical intervention.

 

this does not happen up here due to a contract that limits its use.

 

the management has many ways around the no redundancy policy as silvercloud says not filling posts is their preferred method.

 

yet they never seem to have problems inventing new management posts.

 

its dead simple let the doctors manage the doctors. The nurses the nursing and supply he other services as back up.

 

the back up services that are not face to face can be done off site as the payroll is done.

 

we simply dont need tiers and tiers of mangers doing the same thing. a simple management system would be.

 

GENERAL MANAGER

MEDICAL DIRECTOR

MATRON

hotel services manager

admin/finance manager

 

note the last two not being directors

[Silvercloud]

Here ,here well said.

 

It is that simple.

 

Paul having been treated in very small hospitals in rural parts of UK myself, some of the services here are still very poor, compared to the services small hospital offer elsewhere and using less mangers and clerical staff to run things.

[Stug]

Paulb - of course there is a difference to the access to services in London and here primarily because we live on an ISLAND! It is one of the factors people have to take into account when moving here - yes you will have a safer, more relaxed way of life but you have to balance that with the fact that you will not have access to the same services offered on the mainland. If access to those services is the most important thing to you then Shetland is not the place for you. You will have the ease of access in London but you will also have the increased crime rate, the rat race and all the other things people move here to get away from.

 

With regard to your comment about the management the doctors are managed by a doctor and the nurses by a nurse. It would not be possible to have an admin/finance manager who is not a director as it is a mandatory requirement for each board to have a director of finance. There are also other posts which are mandatory requirements for a board including non executive directors who are appointed by the Government. Perhaps next time one of these post become vacant you should apply to be appointed and put yourself in a position to influence the management of the services.

 

Mind you that might require some difficult decisions and coming up with solutions to problems which is always much more difficult that just complaining.

[Silvercloud]

Hi,

 

Just get rid of the whole of the board and make Shetland satelite of Aberdeen with a manager in charge of the hospital.

You could also reduce any PA's and combine some of their jobs, reduce staff development and HR - do not readvertise once left or retired or do what do with the nurses and move to somewhere they don't like or want to

when they close a ward.

 

As for complaining its easier to try and come up with possible solutions to sort out the NHS board than complain as they try to dodge any questions and ignore the facts there are any faults. In fact they would make excellent politicians .

 

I think people are well aware that Shetland is a Island,however its an over used excuse for not offering some services depending on what managent would prefer here.

 

What about higher management travel expenses ? do they get put up in other hospital accommadation when it's available if on course/meeting or whatever or a local travel lodge or are they using more expensive hotel accommadation and travelling 1st class ?

[bresail]

From Stug.

Paulb - of course there is a difference to the access to services in London and here primarily because we live on an ISLAND! It is one of the factors people have to take into account when moving here - yes you will have a safer, more relaxed way of life but you have to balance that with the fact that you will not have access to the same services offered on the mainland. If access to those services is the most important thing to you then Shetland is not the place for you.

Stug, are you saying that we have a lesser quality of health care in Shetland due to geography and that we must expect that? We are at the moment still part of Great Britain/Scotland/EU and we must expect the same standards.

I know we have problems with the NHS here but, why? Because we have lost the priorities and heirarchy of why the NHS was founded.

 

In order of importance My own list.

1. Everyone has the right to free health care.

2. Doctors of the same standard as the mainland

3. The Nursing Staff as above.

4. The relatives and loved ones of the patients.

All of the above should be protected by law.

5. The Admin staff.

They should be made responsible and encompassed by law.

The dead wood, inefficient, lazy should be pruned.

The NHS itself is an empire, when it should be a democracy.

Petty local empire building that costs us money is ridiculous and that is why we have our problems. We have given away too much money to quieten people This must stop.

The admin staff know full well that there are inefficiencies and they also know why..

Feel free to alter my priorities list.

[shetlandpeat]

If I were to move 10 miles further away from an ambulance station, I would not then expect it to reach me in the same time. It may be difficult to justify having a replica of a service that would serve 100,000 say for 22,000. There would then be a disparity as those 100,000 May then want 5 times the cover.

You would need to know if there are more problems per head of population because you think there are not enough services to then ask for the extra funding to cover it all.

I do agree that it should be the same for all, but, it can never be. Imagine the extra staff that would be needed.

[Silvercloud]

Hi,

 

Its the general attitude of trying to get out of providing what we do have or can have up here using any excuse they can .

 

The travel expenses/accommadation for senior staff/management definately need looking into definately some money to be saved there .

[Silvercloud]

Hi,

 

Its the general attitude of trying to get out of providing what we do have or can have up here using any excuse they can .

 

The travel expenses/accommadation for senior staff/management definately need looking into definately some money to be saved there .

[enkelt skapninger]

The travel expenses/accommadation for senior staff/management definately need looking into definately some money to be saved there .

 

Please expand on this, and how you think it should be done.

[paulb]

and now imagine all these new 1 person practices the doctors go sick/family crisis. what happens then. we don't want an equal service as you peat we just want one that can cope and is safe. is that to much to expect after all we pay the same amount for our health care as you.

 

or would it be ok for say a sick person from northmavine to have to go to lerwick.

 

we will either have a worse service or one propped up by temp doctors. neither is wise.

 

if they have learnt that the level of cover was such and that was what met the health needs but now they have strangely found that the system can cope with a third less is just a plain lie. its just a plain cut not an improvement in patent care.

[Silvercloud]

Hi,

All staff from higher management/consultants down to eg staff nurse/midwife etc throughout the NHS uk should do the following,

 

Any courses,meeting conferences held at other hospitals, then that particular hospital that holding such meeting/conference may quite possibly or another nearby hospital have staff accommadation that could be used.

When this is not available 1st option , 2nd option should be using Travel lodge type similar star accommadation always look /search for best value.

As cuts need to made as we are told, then also all staff should use standard public transport where absolutely possible to include on planes and trains etc.

 

I think this is pretty obvious where potential savings could be made.