buctootim

Can he end global hunger after that? Making the trains run on time would be nice too.

Yes but how did the Catch 22 come about? The supply of qualified nursing staff no longer matched the demand so hospitals started going to agencies to fill the gaps - and because staff were scarce prices were high. Existing staff learned they could get far more working for an agency than their current employer and so left to work on a an agency basis, thereby exacerbating the problem. Sky high expensive agency staff is not the only problem cutting nursing training places created, it also drove the massive influx of overseas nurses as hospitals tried to fill gaps.

If they have a good record in areas where you can objectively measure their performance against other countries, is it not reasonable to having a starting position that they are competent in areas where comparisons are more difficult? My experience of the NHS is that almost everytime you look into things which appear odd, it turns out there is either a good reason for things being that way, or there is some Government imposed regulatory requirement that they should be.

Agreed. Im not saying there is never room for improvement, a few drugs appear expensive compared with peers. However overall the NHS has a very good record in procurement - especially given that in many cases there is only one supplier of newer non generic drugs so no opportunity for playing one off against another.

One of the Romanian made ones?

Why does Britain pay some of the lowest prices for drugs in the developed world? Because NHS procurement is crap and dont know what they're doing? It would be so much better if we broke up the huge purchasing power of the NHS into small blocs and contracted out so people had a fair and reasonable opportunity to make profits on cancer drugs. Then we could be like the US - paying a fortune for the same products. http://usu ****.com/news/us-drug-prices-in-the-us-are-literally-insane-when-compared-to-other-nations/ remove the space between usu and **** on address, it should say us un cut http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00449-0/abstract

The temp crisis is a classic product of poor central government policy. Why are hospitals paying through the nose for agency staff? because they have to, they cant get permanent staff. Why no permanent staff? because the Government thought it was a whacko wheeze to save £10 by cutting nursing training and ended up landing the trusts with a bill for millions a few years down the line.

There is a middle ground. The trouble is social care is nothing like making widgets in a factory, developing an IT project or buying in supplies. In those examples you have scope to design better, get quicker machines, import cheaper from low wage countries, use an existing software package developed elsewhere etc. There is no scope for that in homecare. In a council directly managed service your costs are basically a manager, workers who are already on minimum wage or near to it and some transport. If you contract out to a private company you start running up additional costs. The council needs to pay for a competitive tendering process and they need to employ contract managers to oversee that process and the subsequent contracts. The bidders have costs in preparing the tender process, in tendering for the contract, employing their own contract managers (in addition to service managers) and they cant employ people at less than minimum wage - and after paying those additional costs they still need to need to run the service cheaper in order to make a profit. Where are the savings going to come from? The savings come from reducing the service, cutting corners, not doing things properly so you can do them quicker. If you want to buy TVs for a hospital, contract out. If you want to build a hospital contract out and pay for it, don't PFI it. If you want to run core services, keep it in-house and create an Audit Commission type body to oversee.

Non league and council recs - he's forward planning

You missed the point. The waste is there because of the contracting out. Contracting out brings in additional costs and inefficiencies which weren't there before.

You know contracting out was how the waste got introduced in the first place? - cost of competitive tendering, two sets of contract managers, IT systems, recording of activity, billing and profit all taken out before you even pay for the service? Oh of course you didnt, just another headbanger who thinks most publicly run services must be wasteful and all you have to do to get almost free services and zero tax is to hand it all to a private company.

I dont know how that figure is arrived at. Presumably it includes some people with relatively minor issues http://www.dlf.org.uk/content/key-facts

Are you one of those people who demands an external market, detailed record keeping, background checks, qualified staff, close supervision of care givers, regular needs assessment, eligibility interviews and 365 day service - but complains about bureaucracy? If it wasnt for bureaucracy the country could care for the 10 million disabled people, including 6.7 million of working age all for the price of a pint of milk and a copy of the Daily Express dontchaknow.

My neighbour in her 80s has had homecare - 2 people four times a day, seven days pw for the past seven years

At some point we are going to have to make some hard decisions. People are living much longer, but the number of healthy years of life isnt increasing. Demand for healthcare is growing massively each year and increases in public spending wont be able to keep up with need. We are going to have to consider some kind of cut off age, after which you only get palliative care. I read last week of a 99 year old being aggressively treated for cancer. What is the point?

He's right GM. You dont want to miss the right time to sell and then be stuck with a pile of turd you can't get rid of when there are no buyers. If things got really bad he'd have to start borrowing all over the place, maybe even from sub-prime lenders.

This is the one you're looking for. Its down 17.1% against the dollar since the referendum. hth.

You see those little handy hint numbers at the bottom? Those are times. you see the black line in the middle? That separates days. When the numbers get to zero and there is a black line, thats when the day changes. Need any more help on reading a chart or using a cashpoint, I'm here.

Schoolboy error. The rise was yesterday. The fall is today.

You think Trump is an advocate of free trade? You seriously think the biggest advocate of protectionism in a generation is a free trader? wow.

As distinct from the external (non EU markets). When there are lots of markets makes more sense to refer to the internal market no?

Only one third of the population growth is due to EU immigration - two thirds is births/ increasing life expectancy and non EU immigration. Why the fixation with it? On average they are better educated, better paid, younger and healthier than resident Brits or non EU immigrants.

Same as every other public infrastructure project - built with either PFI or borrowed money. As the Government can borrow at c1% and every year inflation erodes the debt's value it makes sense (within limits).

Yes. Im surprised you haven't grasped it yet. Successive Governments have failed to deliver real sustainable per capita economic growth so high immigration which boosts the headline rate is the next best thing.

Wrong as ever Wes. EU migrants earn more than the UK national average, pay more tax and have lower unemployment rates. Its immigrants from Pakistan and Bangladesh (note not India) who on average have much lower employment rates and earning levels.