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Post by michael on Jan 30, 2018 19:17:17 GMT
The NHS is out of control. They recently opened a gambling centre in Leeds, the first outside London. This kind of reach is absurd. I know there are links to wellbeing and gambling but there are stronger links between employment and wellbeing so the NHS might as well become the job centre.
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Post by Deleted on Jan 31, 2018 3:39:52 GMT
Basically the NHS needs to become a health service and make the fancy stuff private, even if it is part subsidised. Put bluntly, boob jobs for little boys and girls who want to look like their idols is outside the original purview of the original mission. There in not a nation on earth can afford to do what this system is doing without dragging their country down with it. Time to stop living in lala land, smash the rosy glasses and smell the freakin coffee.
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Post by Tim on Jan 31, 2018 9:45:36 GMT
Basically the NHS needs to become a health service and make the fancy stuff private, even if it is part subsidised. Put bluntly, boob jobs for little boys and girls who want to look like their idols is outside the original purview of the original mission. There in not a nation on earth can afford to do what this system is doing without dragging their country down with it. Time to stop living in lala land, smash the rosy glasses and smell the freakin coffee. A return to basics would certainly be welcome.
Mrs Tim has been doing some research on health service funding around the EU and I'm sure she said that we actually spend less per head than a lot of our near neighbours despite them having larger private health care setups.
On another topic has anyone seen that the council that are responsible for Grenfell Tower had recently spent £200k in legal fees to assist a wealthy local family with a noise complaint against a neighbour whose son was learning to play a musical instrument (possibly the piano). Surely this is not something that the council should be paying for on anyone's behalf?
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Post by michael on Jan 31, 2018 10:55:48 GMT
Mrs Tim has been doing some research on health service funding around the EU and I'm sure she said that we actually spend less per head than a lot of our near neighbours despite them having larger private health care setups. We do spend less as a proportion of GBD than a few other countries but obviously that's not the whole story. In the UK around 80% of health expenditure directly government financed compared to around 5% for Germany and France - for those countries a compulsory insurance scheme makes up the difference. The private sector in the UK is about 5% but in France it's more like 20%. Italy has a similar level of direct government health spend to us. I think we need to move to a similar insurance backed scheme and release the NHS funds to the wider benefit of the UK economy. I think it could transform the country and improve the health of the nation in the process by improving the economic situation of each individual. It'll never happen though as the political parties are in a race to the bottom to win of the electorate with free stuff.
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Post by PG on Jan 31, 2018 14:26:11 GMT
We do spend less as a proportion of GBD than a few other countries but obviously that's not the whole story. In the UK around 80% of health expenditure directly government financed compared to around 5% for Germany and France - for those countries a compulsory insurance scheme makes up the difference. The private sector in the UK is about 5% but in France it's more like 20%. Italy has a similar level of direct government health spend to us. I think we need to move to a similar insurance backed scheme and release the NHS funds to the wider benefit of the UK economy. I think it could transform the country and improve the health of the nation in the process by improving the economic situation of each individual. It'll never happen though as the political parties are in a race to the bottom to win of the electorate with free stuff. This is the travesty of the debate on the NHS and health spending in the UK. Basically we can't have one. No political party dare mention private involvement - like private hospitals - as this is political suicide as "privatising our NHS" is right up there with child molestation or being a sexual predator. Even though most countries use this public / private partnership very effectively to get more money into the system. Another factor now also is that after the Carillion debacle, any mention of private people being involved in the NHS will also be attacked from that angle too. So even less likely that we'll have a sensible debate.
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Post by Bob Sacamano v2.0 on Jan 31, 2018 14:44:20 GMT
The NHS is out of control. They recently opened a gambling centre in Leeds, the first outside London. This kind of reach is absurd. I know there are links to wellbeing and gambling but there are stronger links between employment and wellbeing so the NHS might as well become the job centre. This should be paid for by the gambling industry out of their vast profits. Alcohol dependency units should be paid for by the drinks industry. Gender reassignment surgery could be crowd funded by Loose Women viewers.
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Post by michael on Jan 31, 2018 15:14:59 GMT
This is the travesty of the debate on the NHS and health spending in the UK. Basically we can't have one. No political party dare mention private involvement - like private hospitals - as this is political suicide as "privatising our NHS" is right up there with child molestation or being a sexual predator. Even though most countries use this public / private partnership very effectively to get more money into the system. Another factor now also is that after the Carillion debacle, any mention of private people being involved in the NHS will also be attacked from that angle too. So even less likely that we'll have a sensible debate. It's not even that private companies are delivering the services in many cases, it's just with insurance the government has means to recover costs. As anyone who has ever invoiced as a consultant will know, the more you charge the more people value your time. It's the same with the NHS, as long as it's free people don't value it, they have no stake in it and so abuse the system. The cases of boob jobs on the NHS are low but people attending A+E, GPs and other services with trivial complaints are high. I like the idea insurance being weighted based on lifestyle. Type 2 diabetes is largely avoidable with weight loss but the cost of treating type 2 diabetes is estimated to be in the region of £14billion a year. We can't afford this and why should we? Insurance might encourage to become more responsible for the lifestyle and health decisions they can control.
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Post by Big Blue on Jan 31, 2018 15:49:35 GMT
This is the travesty of the debate on the NHS and health spending in the UK. Basically we can't have one. No political party dare mention private involvement - like private hospitals - as this is political suicide as "privatising our NHS" is right up there with child molestation or being a sexual predator. Even though most countries use this public / private partnership very effectively to get more money into the system. Another factor now also is that after the Carillion debacle, any mention of private people being involved in the NHS will also be attacked from that angle too. So even less likely that we'll have a sensible debate. +1 million. The Slovaks have an insurance based medical system and they're not the richest nation in the EU. Same for my Ma in France: she gets whatever done within a reasonable time and just flashes her insurance details. I'd have no issues with private medical insurance provided it meant I was being given treatment that was necessary, and this is the other big issue with the UK system. If I'm taken to hospital and am in need of treatment in the UK and am left on a trolley in corridor bleeding profusely, it's NHS funding that's to blame. If I'm insured by a huge private medical insurance fund and I'm left on the same trolley in the same corridor bleeding profusely my insurance company is going to want a refund from the hospital thus putting additional pressure on. What I'm saying is the NHS and UK medical care is now so far down a certain route that there is no guarantee that whether billions are injected by the public purse or by private insurance payments that there will be a sea change. What there needs to be is a sea change in policy and regulation so that medical insurance for defined ailments / conditions etc. is tax deductible and can be spent at private hospitals and that there is a regulated fee structure in the private medical care sector so that the insurance is actually effective competition for NHS care. Of course this is easy for me to say, coming with a family history of reasonable good health with a mother living in a foreign country with a good health service provision and a partner that pays health insurance in her home country so when we go there she sees the gynaecologist, dentist, any GP issues etc. in clinical surroundings I can only describe as palatial when I compare them to my experiences with no money exchanging hands.....
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Post by Deleted on Jan 31, 2018 16:34:38 GMT
Interesting thought that but I disagree. The over prescription of antibiotics is hyped by doctors as an expectation by parents that every snot nosed child will get them but who started this? Doctors. Perception by some people that the service is not regarded well because it is free has no basis in fact. From my own experience on both sides of the divide, there are practitioners who are demotivated from not only pay issues but also poor management. Poor budgeting and lack of joined up thinking on budgets with the conduct of a lot of staff towards patients being borderline nihilistic and anti social. You mention type 2 diabetes and attribute it to life style choices, ok, look into the chemicals that get into our water table and in particular since the contraceptive pill has been widely available. There many factors that contribute to our genome being less than optimum but in areas such as diet we could do with kids being taught more about this and while I am on the subject of education, how many leave school knowing how to manage money? A bank account? Credit? Loans? Stress? Stress in its more severe forms presents the same as severe mental illness and can have just as severe consequences. Expecting more direct expense to have a beneficial results on health is akin to expecting direct and close exposure to radiation poisoning to have the same result. Measured doses in an x-ray perhaps but not otherwise.
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Post by Tim on Jan 31, 2018 16:45:52 GMT
You're not entirely correct there Mike. For example, my brother in law thinks the NHS is totally shite, mainly because his Czech partner has told him that. Obviously the fact that both her parents are doctors and that she still has private healthcare back in Czechland have no bearing on her views However, neither of them have been prepared to pay for private cover over here so when they have had to use the NHS they already have the thought that its going to be sub-standard but clearly they're not comparing like for like. I have no issues with the NHS but am in the fortunate position that I've clearly had some good GPs over the years. As with every other service you can be unlucky in that respect too.
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Post by michael on Jan 31, 2018 16:48:51 GMT
I didn't mention perception of how well the service is regarded, I said that if you don't pay for it you're more likely to abuse it. There is plenty of evidence to support this, from people calling 999 for a plaster to those who take a prescription for paracetamol rather than buying their own. As for information there is plenty out there. Their can't be many smokers who aren't aware of the risks but they choose to do so, education alone is pretty futile, you ultimately need the stick as well as the carrot. I'm not sure where you're going with chemicals in the water table but if you're arguing that they cause a similarly avoidable £14billion cost to the tax payer then you'll need to explain how. If you're trying to say obesity isn't an individuals fault that's fine, I well aware of the Foresight systems mapping project into determinants of obesity, 127 I think, but the fact remains that although individuals might gain weight for a variety of reasons we loose it in the same way - eat less and move more. Failing that bariatric surgery which is a further cost to the NHS albeit cheaper than diabetes.
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Post by Deleted on Jan 31, 2018 17:30:34 GMT
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Post by Deleted on Jan 31, 2018 17:33:17 GMT
The point I was making about perception is that there is no one source for it but an amalgam of experiences and origins.
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Post by PG on Jan 31, 2018 17:39:39 GMT
...Failing that bariatric surgery which is a further cost to the NHS albeit cheaper than diabetes. Over the last few weeks the BBC has been running its annual "the NHDS is in crisis give it more money" nightly bulletins. The only thing wrong is that there is not enough money. On Midlands today last night, there was a news item on the number of people having bariatric surgery on the NHS in the midlands region in the past year and that the figure was up some large % year over year. I'm sorry but I can't remember the numbers but it was quite a few hundred people having the surgery. Some of whom were over 75 years old. But of course what they totally failed to give was the view that this costs the NHS money and that this is money that could otherwise be spent on A&E or social care for the elderly. After all, that would be fattist which seems to be another thing we are not allowed to talk about...
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Post by michael on Jan 31, 2018 17:50:40 GMT
Bariatric surgery is cheaper than the costs for diabetes but it’s still expensive and requires lifelong medication for vitamins. There have been a number of cases repeat surgeries now from when people put the weight back on. Another massive cost is when excess skin removal surgery is paid for by the nhs. It’s not always offfered as it is effectively cosmetic surgery but some get it on grounds of mental health. As Mike says there are lots of things that make us ill, or at least as less well we think we need to be, but there needs to be a line where we say the nhs doesn’t pay for this.
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Post by Deleted on Jan 31, 2018 18:15:10 GMT
Agreed, there is a lot of money in the nhs and the waste of it that goes on is something I cannot even name. The nhs needs and a primary consideration to re examine its core mission. The nhs was after all, primarily brought into being to return people to fitness for work. I have mentioned this before but short sighted costing does nothing but waste money. One example is the cystoscopy which has been found to be around 20% effective versus mri which is in excess of 80%. Short termism means cystoscopy is the preferred option so false positives occur more regularly than need be and more procedures are carried out. turp is the cheapest procedure for dealing with prostate cancer and yet it has one guarantee, repeat turp. Each procedure carries high risk of nasty and debilitating 'problems' It is however, cheap when considering it as a one shot deal, which it is not. Using the abdominal route means there is less chance of leaving prostate remains which will regrow and has fewer contra indications. It is more expensive but has less chance of repeat procedure. What does the nhs do? Really? The cheaper one shot deal which is like saying, if I smack my hand with a hammer it will hurt less should I do it again. How do they get around this? Simples, they do not give correct information and fail in their duty of care and to the letter of the law which requires fully informed consent. ALL the plus and minus points of the procedure suggested but consultants and their teams will never give that information. All this costs money which is wasted when we should be making the most use of every penny in the nhs. Unit managers save up their budget and towards the end of the financial year, to make sure they get the biggest budget they can, spend the rest on anything. I am not the only one who knows this. Did you see the report on prescription costs demonstrating the pharma companies driving the costs of medication in the hundreds of percent? The nhs allowed through incompetence, for this to happen. Was there collusion? Quite possibly. I hope consultants are no longer 'borrowing' surgical sets and trays for use in their private work as they did in the past, often these tool sets which cost in the hundreds of thousands of pounds, ended up in india and pakistan etc.
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Post by PG on Feb 1, 2018 11:19:02 GMT
I don't get involved in political debate on facebook - too messy. But I think I might have to make an exception for this post I saw this morning. It is this sort of utter misunderstanding / pig headed ignorance that is why we can't have a proper debate. Firstly, if a maintenance man (well two as we can't have one bloke up a ladder due to H&S can we?) can get from his base, to the stores, pick up said light bulb, ladder (or scaffold if working at height), get them to light bulb position, erect, change, take down and get back to his base in 5 minutes, then he ought to be at the Olympics beating Usain Bolt and not working in an NHS hospital. Then there is the fact that to the hourly rate of pay you have to add employers NI, pension, health, cover for sick and holidays, and of course nobody works 24/7 so you need probably three teams of people to cover the required hours. Then they'll need the tools, a base, stores building, some admin, management and HR time (like being paid for example, or tracking their sick, holiday etc). Based on all that, £70 for the light bulb is probably quite good value. The hand dispensers argument has all the above elements and their maths assumes that all of them have to be changed at the same time. Hardly likely? And if you use the argument that people could change their own light bulbs or hand dispensers, my life experience tells me that is a shit argument. Running offices as part of my remit for most of my career, in companies employing quite clever people, if I counted and got paid per time based on the the number of times I had to change the hand towel in the kitchen, or fill up the water dispenser in the coffee machine or even change a fuse in a desk power socket as nobody else could be bothered, I'd have retired years ago. And finally if a hospital manager really made that argument, then that tells me all I need to know about how shit most NHS management clearly is. img photos
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Post by Bob Sacamano v2.0 on Feb 1, 2018 11:27:02 GMT
You're not entirely correct there Mike. For example, my brother in law thinks the NHS is totally shite, mainly because his Czech partner has told him that. It's always interesting that the perception of the NHS by people who have had actual cause to use the NHS is far higher, when polled, than those that have only had their information on it second or third hand - or worse by the news. Speaking of which; there was a lot of headlines on the BBC and other news outlets about the strain the NHS has been under this winter, with patients waiting in corridors etc due to the flu epidemic. What they don't tell you is that this has been a worldwide problem, with health services, public and private, struggling to cope. We're lucky in the North East in as much as we have excellent health services, with new or recently refurbished hospitals and doctor's surgery, and it's where I started my journey towards my new hip, via referral from my GP to a consultant at the Freeman Hospital and then onto the waiting list. As it happened, as I was flexible on dates, I could have had the hip done within 4 weeks but I chose to defer until January. They operate two lists, a list for the NHS Freeman Hospital, and a list for the local private Nuffield Hospital. As I was younger and there wasn't expected to be any complications, I was moved onto the Nuffield list. From there on I was basically a private patient, paid for by the NHS. They bought a full package from the Nuffield that included all pre-operative assessments, surgery and hospital stay, all medications and living aids (crutches, grippers, sock-putter-oners etc), follow up physio and six week final follow up with surgeon. I had a quiet private room, with en-suite and the food was first class. All the paperwork I've had has been from the Nuffield, not the NHS, and my going home pack even included extra bandages and the tool for removing the staples next week. There were lots of younger people like me there, having hips and knees done and it seems very sensible that this sort of elective, routine surgery be subcontracted out. No-one is getting rich from the NHS by this practice as Nuffield Hospitals are non-profit and have no shareholders.
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Post by Tim on Feb 1, 2018 11:35:31 GMT
I don't get involved in political debate on facebook - too messy. But I think I might have to make an exception for this post I saw this morning. It is this sort of utter misunderstanding / pig headed ignorance that is why we can't have a proper debate. Firstly, if a maintenance man (well two as we can't have one bloke up a ladder due to H&S can we?) can get from his base, to the stores, pick up said light bulb, ladder (or scaffold if working at height), get them to light bulb position, erect, change, take down and get back to his base in 5 minutes, then he ought to be at the Olympics beating Usain Bolt and not working in an NHS hospital. Then there is the fact that to the hourly rate of pay you have to add employers NI, pension, health, cover for sick and holidays, and of course nobody works 24/7 so you need probably three teams of people to cover the required hours. Then they'll need the tools, a base, stores building, some admin, management and HR time (like being paid for example, or tracking their sick, holiday etc). Based on all that, £70 for the light bulb is probably quite good value. The hand dispensers argument has all the above elements and their maths assumes that all of them have to be changed at the same time. Hardly likely? And if you use the argument that people could change their own light bulbs or hand dispensers, my life experience tells me that is a shit argument. Running offices as part of my remit for most of my career, in companies employing quite clever people, if I counted and got paid per time based on the the number of times I had to change the hand towel in the kitchen, or fill up the water dispenser in the coffee machine or even change a fuse in a desk power socket as nobody else could be bothered, I'd have retired years ago. And finally if a hospital manager really made that argument, then that tells me all I need to know about how shit most NHS management clearly is. img photos
I don't think £70 is good value for money. You're right about having 3 teams, etc but they won't be there just to change bulbs, it'll be part of their ongoing maintenance so the cost of changing the bulb should be, say, £20-30 based on them knowing that they have to change a bulb and turning up ready to do the work (by turning up I mean going to the place in the building they need to be, they'll already be on site) and perhaps allowing 15-20 minutes to do it including 'travel' time.
If you think about it they should only be charging a %age of an hour's time, possibly for 2 people, one of whom should be a trainee/apprentice.
If it's still £70 then the NHS are being charged Mercedes levels of hourly rate for the work!!
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Post by johnc on Feb 1, 2018 11:38:10 GMT
Surely someone just needs to do the maths on whether it is cheaper to employ people to do those jobs and other maintenance items instead of outsourcing? It's not rocket science. Half the reason many of these jobs were outsourced was that the "handyman" department weren't authorised to touch electrics or plumbing or to work above 3 inches off the ground and you therefore had an army sitting about doing f all for most of the day, making the cost of the light bulb change even more than the £70, as PG said.
Some of the rules and regulations are necessary and many are not but the PC softies got us in this mess in the first place and now they are moaning.
In the first office I worked in there was an older gent (an ex regimental Sergeant Major) who basically did anything that needed done - he would change light bulbs and fuses, he would go out and deliver documents, fix dripping taps, take the partner's car for a service, sort squeaky hinges or wobbly desks or clear a blocked drain. Demarcation and regulation now mean this kind of indispensable character is outlawed. If we want to be cheaper we need to be more efficient and efficiency means using a resource as close to 100% of the time doing what they are trained to do.
Bring back the multi talented individual!
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Post by Tim on Feb 1, 2018 11:43:03 GMT
You're not entirely correct there Mike. For example, my brother in law thinks the NHS is totally shite, mainly because his Czech partner has told him that. It's always interesting that the perception of the NHS by people who have had actual cause to use the NHS is far higher, when polled, than those that have only had their information on it second or third hand - or worse by the news.
My bro-in-law HAS used the NHS (for example he had an op to his cruciate ligament after a mishap on an oil rig*) but while the work done has been reasonable, perhaps not excellent, he has been exposed to 10 years of his Czech partner telling him how shit it is and he just trots it out now. The irony of this particular situation is that she has Chrones disease and the NHS consultant suggested a course of treatment that she absolutely refused to follow. Cue a trip back to Czech for private healthcare and guess what? Yup, they gave her EXACTLY the same treatment as she refused here but because it was across there it has been the greatest thing since sliced bread, etc. Mrs Tim - who works in the NHS - is extremely close to punching her brother and his stupid Czech partner!!
*He came under pressure from colleagues not to report this mishap as it would've screwed up their 'no accident' bonus. If he had reported it, the correct thing to do for him, then his care would've been covered by the oil company, instead he has used the NHS (and cost it several £000) and is now complaining, 5 years later, because his knee is giving him problems.
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Post by PG on Feb 1, 2018 11:50:12 GMT
...In the first office I worked in there was an older gent (an ex regimental Sergeant Major) who basically did anything that needed done - he would change light bulbs and fuses, he would go out and deliver documents, fix dripping taps, take the partner's car for a service, sort squeaky hinges or wobbly desks or clear a blocked drain. Demarcation and regulation now mean this kind of indispensable character is outlawed. If we want to be cheaper we need to be more efficient and efficiency means using a resource as close to 100% of the time doing what they are trained to do.
Bring back the multi talented individual! I quite agree. We used to have a young lad who did all of that in the company I worked for about 20 years ago. He also did driving of people to and from airports and so on too. When we got taken over by a large US multinational, and everybody had to save x% of their labour budget in some inevitable re-org carry on, nobody would have him on their budget and the global facilities manager refused to pay for him. Result - he got made redundant. The reality is of course always somewhere in the middle on stuff. Like Tim says, maybe an internal team could do a lot of the jobs cheaper. So what really needs to happen is that the jobs are categorised as to who could do them internally and which require specialist skills or equipment that need external people to do it. Like we can all change a tyre, but new suspension is probably a garage job. But that would require grown up and sensible thinking, which seems to be lacking and is the root cause of so many of these sort of debates.
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Post by michael on Feb 1, 2018 11:58:03 GMT
A few tabloid headlines to imagine: "Outrage as nurses expected to change lightbulbs" "Outrage as NHS has nobody to change lightbulbs" "Nurse sues NHS for falling off a ladder trying to change a lightbulb - outrage ensues" "Outraged as nurse claims lightbulb changing not in job description" etcetera.
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Post by Tim on Feb 1, 2018 12:12:24 GMT
A few tabloid headlines to imagine: "Outrage as nurses expected to change lightbulbs" "Outrage as NHS has nobody to change lightbulbs" "Nurse sues NHS for falling off a ladder trying to change a lightbulb - outrage ensues" "Outraged as nurse claims lightbulb changing not in job description" etcetera. I'm sure they would at least employ a janitor to do these tasks.
Actually our privately owned office building has a janitor/maintenance guy and apart from some hoovering, emptying bins and refilling hand towels he appears to spend a lot of time supervising various contractors while they do maintenance work.
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Post by Deleted on Feb 1, 2018 12:16:22 GMT
I'll do the lightbulbs for £35 a go. I need a job and they need to save money!
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Post by michael on Feb 1, 2018 12:27:47 GMT
I'm sure they would at least employ a janitor to do these tasks.
Actually our privately owned office building has a janitor/maintenance guy and apart from some hoovering, emptying bins and refilling hand towels he appears to spend a lot of time supervising various contractors while they do maintenance work.
They outsource the janitorial services to PHS or whoever as it's more efficient. I think that takes us back to the original post!
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Post by Deleted on Feb 1, 2018 13:32:54 GMT
My sisters first serious boyfriend worked in St Mary's Roehampton when janitorial and repair services were in house. The scam they were allowed to get away with was to do jobs for the week quickly and poorly and then do two days on ivertime. They made a mint but then again the nhs has rarely done anything the smart way.
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Post by Big Blue on Feb 1, 2018 13:33:32 GMT
A few tabloid headlines to imagine: "Outrage as nurses expected to change lightbulbs" "Outrage as NHS has nobody to change lightbulbs" "Nurse sues NHS for falling off a ladder trying to change a lightbulb - outrage ensues" "Outraged as nurse claims lightbulb changing not in job description" etcetera. this.
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Post by Tim on Feb 1, 2018 14:11:00 GMT
My sisters first serious boyfriend worked in St Mary's Roehampton when janitorial and repair services were in house. The scam they were allowed to get away with was to do jobs for the week quickly and poorly and then do two days on ivertime. They made a mint but then again the nhs has rarely done anything the smart way.
Isn't that just a big firm sort of mentality, nobody is really that interested as long as they get paid?
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Post by Martin on Feb 1, 2018 14:21:45 GMT
My sisters first serious boyfriend worked in St Mary's Roehampton when janitorial and repair services were in house. The scam they were allowed to get away with was to do jobs for the week quickly and poorly and then do two days on ivertime. They made a mint but then again the nhs has rarely done anything the smart way.
Isn't that just a big firm sort of mentality, nobody is really that interested as long as they get paid?
No, it’s poor management. I have 2 permanent ‘FM’ guys in my largest site, who do all the regular tasks (from changing light bulbs to unblocking toilets) plus they have a schedule of preventative maintenance to make sure we get the most from them. That’s supplemented by contractors for larger jobs, but our guys will support that work if possible and it’s all managed by our H&S / Facilities manager who know exactly how long jobs should take.
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