YouGov Poll - 33 Point lead!

"People can't get a doctor's appointment as the doctors are over-subscribed " but surely the numbers have not massively increased since Covid. I know there are probably less doctors but even before Covid it was almost impossible to actually see a doctor. This is one of the things that need sorting. Get doctors sorted and it would bring down the numbers going to A&E.
The numbers have massively increased because of covid, it caused a massive backlog (which has effected beds, A&E, GP's, Physio's etc, it's all linked) and covid effectively becomes an amplifier for many other issues. The couple that with the issues covid has caused for staff, illnesses etc. The Tories have cocked up massively, up to Covid, but Covid came and bit them (and us) in the ****. It's not all their fault mind, it wouldn't have been easy for any healthcare system to deal with, which is why they're all struggling (to a lesser degree).

The population has only got gradually older in that time of course, but that's a long-term problem which adds up every day, just like the Tory problem adds up every day.
 
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You see, instead of trying to look slightly less bad than the Tories, the Labour Party should be banging on about this. No amount of propaganda by the Tories and their press allies about Labour spending will gain traction when set against this simple, straightforward graphic.

It should be on billboards all over the country.

I might add that those on the left undermining Starmer and complaining Starmer is too much like Blair and Tory lite should look at the graph as well and ask themselves which colour they prefer.
 
Labours record of the NHS compared to the Tories is something I think is absolutely clear and those graphs show it and I think we’ve all probably noticed

Andy, what service do you think should be run by private companies and I’ll explain my view in response

Cameron and the Andrew Lansley health act meant the NHS has to put its services up for tender where the NHS bids to retain the service compared to private companies that bid

So that’s been in place to just under 10 years

Which service providers Andy would you like to use as an example of where it works?
Pretty much any aspect could be run better, just like any area could do with more workers and a better (more standard) ratio of management to workers. It's not necessarily individual areas, it might be the whole thing, and it's all interlinked.

From my experience, private companies tend to run better than public ones as they have to, and tend to have the best people running them, as they pay more money for them. They need to be cost-effective and competitive or they go broke. Then couple that with poor performance leads to the sack or people being moved to less influential/ responsible areas, which happens a lot less in the public sector.

It was the same in the RAF, sure all of us on the ground did a good job, in tough conditions, but it was so badly run, extremely inefficient and extremely wasteful, which everyone could see and agreed on. Our lower management and mid management had their hands tied, loads of the problems were caused by poor regulation, for fear of regulation through lack of understanding, and top level management. The top level management never got to see how it actually was on the ground, as they were very rarely there, and when they were there our lower management was effectively told to lie, by the middle management, as the lower top management effectively told them they wanted lies, it was mental, it was a pure fugazi. It's even worse now apparently.

Same applies to now for my construction company, when we price work on council jobs. They're so badly ran it's beyond a joke, we have to double our price (or use rates on a job which should be fixed price) due to how many errors we know the client (council) will make, and how much extra time this will cause. We can't risk it running into other work (so price to assume it will take longer), and delaying the next job, and losing long term clients who do know how to plan/ price correctly.

Same applies on HS2, the company is effectively owned/operated by Network Rail/ the government/ people, the designs they have put forward are laughable. Projects which could be done for 50k are costing 250k as they're so badly/ inefficiently designed. It's not the designer's fault or the contractors, it's that the designers are being told to go way OTT by NR/ HS2/ policy/ regulation, and any time they cross NR, Highways or Council land, they have to fight their own NR/ Highways and Council regulation, who are meant to be on the same side. Never mind that of the regulation they put on the utility asset owners, which then comes to bite them back in the ****. It's like a massive feedback loop of inefficiency and increased costs. It's paying a lot of people to run around in circles mind, so I suppose it's good for employment if nothing else.

Like I say though, I definitely don't want the NHS privatised, I don't want it run for profit, but it needs to be looked at like a business, and how efficiency can be improved, what is causing backlogs etc. It needs to do better for the money spent, but this is 110% in no way the fault of those at the lower levels, those actually treating patients etc.

I'm not against tendering, if it's linked to targets and there are penalties, it works better than just having free reign to the chequebook. Competition should be a good thing if things are not corrupt, even if the tendering is only used as a feasibility/ confidence check on the cost. There has to be some accountability though, maybe big bonuses for those who control various sectors of the NHS, if they do a good job, on budget etc. I've no doubt some aspects could be tendered out for less cost, and hit better performance targets, but this could only be done if the client manages it correctly which effectively the Tories as a client of the NHS will not do. Labour could do better if they recruited the right people to run this (not a politician who has zero expertise on this), but it would cost a lot to get them, and press would have a field day with that. The later issue though is when Labour lose power it's back to the tories being the client again. It could still work, but there would need to be some extreme controls, which cannot be altered to suit people getting backhanders.
 
Sunak must be doomed

Teachers striking now
Write out one hundred lines...

You must provide a minimum service level or you will be sacked
You must provide a minimum service level or you will be sacked
You must provide a minimum service level or you will be sacked
You must provide a minimum service level or you will be sacked
You must provide a minimum service level or you will be sacked
You must provide a minimum service level or you will be sacked
 
Andy, keep it short you prefer private NHS service to public so which companies or service are you referring to? 🤷🏻‍♂️
Can't keep it short and be thorough, it's an extremely complex topic.

When/ where did I ever say that I wanted a private NHS? Although saying that, I just want it ran the best way possible. It doesn't mean it couldn't be better than it is now, if they could hit better targets for less money (tendering) then it would make sense. Why wouldn't it? I wouldn't want it making obscene profits, but massive contracts like that are usually priced on 1-2% profit, or cost plus 1% etc. I'd rather have a company running it and hitting targets for less money, making 1% themselves, than spending more and not hitting targets.

Public-owned with heavy oversight by qualified people (not a politician), but privately ran or running it like a private company maybe, for some aspects, depends who the government is and who is running it. Absolutely must have minimum standards better than now, say to meet 2010 levels (which will also need a lot more funding and staff), and offer better value though, otherwise, it's pointless. Wouldn't trust the Tories to do it this way though, which is a problem when they're in power 2/3rds of the time. It would need to be locked out, so Tories could not funnel money into their mates (or own) private companies, and so we don't have companies/ people with zero skillset for what is required, like they did with PPE etc.

I don't think I've seen any good examples of something which is publicly owned and publicly ran, which is efficient and modernised, not in the UK anyway. It would be good if anyone had some good UK examples? I've got examples which are horrendous: rail, councils, construction (of public projects, private works fine/ very well), highways, utilities etc, and I expect the same continues with the NHS, seeing as anyone working in the NHS I speak to says it's so badly run.

Specific people or companies, for health? Which ones do you think work well, or are efficient? Which aspects have adequate management ratios and would hit budgets and performance targets, even if we did have more doctors and nurses? I've no idea, largely not my sector other than some utilities and construction on NHS sites, which they **** up as the client and as selecting or controlling main contractors. But the people will be out there, even if it meant recruiting from countries that were more efficient than us, which is not hard to find nowadays. Other countries just run public services better than we do, and that's not often due to more funding or people, whether that's health, energy, rail, highways etc. Hard to pinpoint that problem from our end/ level, so get someone top-level from places where their systems work.

Like I keep saying though, the NHS does need more funding and more nurses/ doctors etc, a lot more of both, everyone in the world knows this, but these are a million miles from being the only problems. Any company, service or workforce should embrace change if it could lead to better efficiency, and maybe even less cost, through modernisation. Every other industry can do it, if it has the right people running it, the right high and medium level management, right controls, right contracts etc.
 
Can't keep it short and be thorough, it's an extremely complex topic.

When/ where did I ever say that I wanted a private NHS? Although saying that, I just want it ran the best way possible. It doesn't mean it couldn't be better than it is now, if they could hit better targets for less money (tendering) then it would make sense. Why wouldn't it? I wouldn't want it making obscene profits, but massive contracts like that are usually priced on 1-2% profit, or cost plus 1% etc. I'd rather have a company running it and hitting targets for less money, making 1% themselves, than spending more and not hitting targets.

Public-owned with heavy oversight by qualified people (not a politician), but privately ran or running it like a private company maybe, for some aspects, depends who the government is and who is running it. Absolutely must have minimum standards better than now, say to meet 2010 levels (which will also need a lot more funding and staff), and offer better value though, otherwise, it's pointless. Wouldn't trust the Tories to do it this way though, which is a problem when they're in power 2/3rds of the time. It would need to be locked out, so Tories could not funnel money into their mates (or own) private companies, and so we don't have companies/ people with zero skillset for what is required, like they did with PPE etc.

I don't think I've seen any good examples of something which is publicly owned and publicly ran, which is efficient and modernised, not in the UK anyway. It would be good if anyone had some good UK examples? I've got examples which are horrendous: rail, councils, construction (of public projects, private works fine/ very well), highways, utilities etc, and I expect the same continues with the NHS, seeing as anyone working in the NHS I speak to says it's so badly run.

Specific people or companies, for health? Which ones do you think work well, or are efficient? Which aspects have adequate management ratios and would hit budgets and performance targets, even if we did have more doctors and nurses? I've no idea, largely not my sector other than some utilities and construction on NHS sites, which they **** up as the client and as selecting or controlling main contractors. But the people will be out there, even if it meant recruiting from countries that were more efficient than us, which is not hard to find nowadays. Other countries just run public services better than we do, and that's not often due to more funding or people, whether that's health, energy, rail, highways etc. Hard to pinpoint that problem from our end/ level, so get someone top-level from places where their systems work.

Like I keep saying though, the NHS does need more funding and more nurses/ doctors etc, a lot more of both, everyone in the world knows this, but these are a million miles from being the only problems. Any company, service or workforce should embrace change if it could lead to better efficiency, and maybe even less cost, through modernisation. Every other industry can do it, if it has the right people running it, the right high and medium level management, right controls, right contracts etc.
I’ve worked in private companies for about 40 years.

They have been far from efficient or well run although you get pockets of things being done properly for period. The only difference is the money runs out after a while if they are not making a profit.

Look at Carrilleon, a private company spending public money, went down for billions and billions, I don’t think they’ve even got to the bottom of it.

Private or public, it’s the British way to run things chaotically, politically and inefficiently by often putting the wrong type of people in key positions.

Anybody thinking privatisation will somehow transform our health service into a panacea of efficiency is just wishful thinking, the Tories only want it for ideological reasons rather than making it better.
 
I’ve worked in private companies for about 40 years.

They have been far from efficient or well run although you get pockets of things being done properly for period. The only difference is the money runs out after a while if they are not making a profit.

Look at Carrilleon, a private company spending public money, went down for billions and billions, I don’t think they’ve even got to the bottom of it.

Private or public, it’s the British way to run things chaotically, politically and inefficiently by often putting the wrong type of people in key positions.

Anybody thinking privatisation will somehow transform our health service into a panacea of efficiency is just wishful thinking, the Tories only want it for ideological reasons rather than making it better.
Just to row in with something I don't know much about. THe idea that private is bad and public is good isn't necessarily true. There are some private companies that are run excellently but their goal is a little bit different, both tactically and strategically.

Public owned companies, I suspect, will only be run if the folks at the top can learn to think in a different strategic way. Given the goal isn't profit but levels of service within a budget the thinking is clearly different.

A CEO of a privately owned organization has to think what the market will be like in 5, 10 years and how do you make a profit and stay competitive as the world market and your customer base changes. Someone running the nhs has to think strategically too, but their strategy should be very different. How do we ramp up for different health care needs in 5, 10 years, what assets do we need in place and how much will that cost over the short, medium and long term,. what are staffing needs and how can we best support an aging population.

The questions and solutions are different and just employing a commercially successful ceo into public owned companies, won't necessarily work. Publicly owned companies have, if I recall, been run quite poorly and perhaps that is the reason why. or of course, it could be poor government setting that agenda. Public services should be taken out of parliamentary remit, ringfenced and run themselves with the best people available with the previously alluded to ring-fencing in place.
 
I’ve worked in private companies for about 40 years.

They have been far from efficient or well run although you get pockets of things being done properly for period. The only difference is the money runs out after a while if they are not making a profit.

Look at Carrilleon, a private company spending public money, went down for billions and billions, I don’t think they’ve even got to the bottom of it.

Private or public, it’s the British way to run things chaotically, politically and inefficiently by often putting the wrong type of people in key positions.

Anybody thinking privatisation will somehow transform our health service into a panacea of efficiency is just wishful thinking, the Tories only want it for ideological reasons rather than making it better.
Carillion wasn't well run, they cooked the books and hid their debt, which loads of people apparently realised before they went into liquidation, they were broke long before this. They also had the wrong business model which was inevitably going to come back and bite them, which it did. They're similar to Interserve, those two are probably the worst "large" construction companies I've come up against as a sub-contractor. I mean against too, as when working for them, you have to actually cover/ remind yourself that they're working against you, as your PC, when they should be working with you.

The Carillion example is a good one though, they relied heavily on government/public sector contracts, which was a bit nieve during a recession recovery, headed by a Tory government known for shafting the public sector. They also took on all the risk, which is extremely naive when working for a client who does not know what they're doing. This coupled with their model of ******* off (bankrupting/ shafting) subcontractors, effectively left them with crap work, for a crap client, with a subcontractor base (nearly all of their work was sub-contracted) who either massively overcharged (insurance against Carillion) or would not work for them.

They Carillion/ Interserve had all risk contracts, yet took on subcontractors who would not/ cannot do all risk, it's not how construction works. You cant price low, take all the risk, assume subbies will absorb those risks (which they're contractually not obliged to do) and then shaft the same subby with under and late payment. Word gets around, and inevitably a company which 100% relies on subcontractors has nobody who will work for them for a fair price, with a fair contract. Towards the end, when they asked us to price work for them I would always stipulate settlement of the outstanding debt, before I even sent any e-mails related to the job they wanted us to tender for, then any new jobs our terms were payment up front. This partially worked and we were getting our outstanding debt back, at a low trickle, it was the only way to trickle that money back.

In the end Carillion went down owing me about 50k I think (better than the 80k it was), and Interserve still owe about 30k which has been going on about 7 years, although they're still sort of going somehow. I won't price Interserve work "normally" now though, last job for them was at James Cook, the new secure treatment section, the whole job was a joke, and took about 6 months to get paid all of it.

Everyone knew what Carillion were all about or, or learned this between 2008 and 2015, the only ones who didn't were new sub-contractors, new to the industry or those scrapping for any sort of work after the recession (this was plenty of companies mind, we were the same in 2010/11).

Oh I didn't say it would work (running it all private, but as a publicly owned company), as it relies on a competent client/government, which we currently don't have (we've had 13 years of bad, who dug a big hole), and won't have for 2/3rds of the time (going historically). It could work under Labour, if they got competent people in, to look after it, but I'm not sure I would even want to take that risk, as it's coupled with the risk of losing to the Tories. It could (and should) really work, but I'm not really saying it would.
It doesn't mean the private aspect is wrong, it means we have a control problem. I think some smaller sections of it (to start) could maybe run private but mainly needs to be on the low-risk, easier areas (not construction), and areas where budgets can be forecast more easily. It's certainly not easy, but controlling that sort of budget never is. It also doesn't mean we can't make big changes, to streamline things, pre A&E/ GP Triage, bring back walk in centres for minor injuries, not suitable for A&E, pharmacies taking on more responsibility etc. I imagine some things need breaking down, to take the load away, dealing with smaller, should make it easier, but some areas need better integration, like between the NHS and social care, as they're so reliant on each other, and one can sink the other.
 
Just to row in with something I don't know much about. THe idea that private is bad and public is good isn't necessarily true. There are some private companies that are run excellently but their goal is a little bit different, both tactically and strategically.

I'd say probably 80% or more are extremely well ran, in my sectors anyway, but they pay a high price for the best people. This pays back by many orders of magnitude though.

Public services should be taken out of parliamentary remit, ringfenced and run themselves with the best people available with the previously alluded to ring-fencing in place.

200% this!
 
Carillion wasn't well run, they cooked the books and hid their debt, which loads of people apparently realised before they went into liquidation, they were broke long before this. They also had the wrong business model which was inevitably going to come back and bite them, which it did. They're similar to Interserve, those two are probably the worst "large" construction companies I've come up against as a sub-contractor. I mean against too, as when working for them, you have to actually cover/ remind yourself that they're working against you, as your PC, when they should be working with you.

The Carillion example is a good one though, they relied heavily on government/public sector contracts, which was a bit nieve during a recession recovery, headed by a Tory government known for shafting the public sector. They also took on all the risk, which is extremely naive when working for a client who does not know what they're doing. This coupled with their model of ******* off (bankrupting/ shafting) subcontractors, effectively left them with crap work, for a crap client, with a subcontractor base (nearly all of their work was sub-contracted) who either massively overcharged (insurance against Carillion) or would not work for them.

They Carillion/ Interserve had all risk contracts, yet took on subcontractors who would not/ cannot do all risk, it's not how construction works. You cant price low, take all the risk, assume subbies will absorb those risks (which they're contractually not obliged to do) and then shaft the same subby with under and late payment. Word gets around, and inevitably a company which 100% relies on subcontractors has nobody who will work for them for a fair price, with a fair contract. Towards the end, when they asked us to price work for them I would always stipulate settlement of the outstanding debt, before I even sent any e-mails related to the job they wanted us to tender for, then any new jobs our terms were payment up front. This partially worked and we were getting our outstanding debt back, at a low trickle, it was the only way to trickle that money back.

In the end Carillion went down owing me about 50k I think (better than the 80k it was), and Interserve still owe about 30k which has been going on about 7 years, although they're still sort of going somehow. I won't price Interserve work "normally" now though, last job for them was at James Cook, the new secure treatment section, the whole job was a joke, and took about 6 months to get paid all of it.

Everyone knew what Carillion were all about or, or learned this between 2008 and 2015, the only ones who didn't were new sub-contractors, new to the industry or those scrapping for any sort of work after the recession (this was plenty of companies mind, we were the same in 2010/11).

Oh I didn't say it would work (running it all private, but as a publicly owned company), as it relies on a competent client/government, which we currently don't have (we've had 13 years of bad, who dug a big hole), and won't have for 2/3rds of the time (going historically). It could work under Labour, if they got competent people in, to look after it, but I'm not sure I would even want to take that risk, as it's coupled with the risk of losing to the Tories. It could (and should) really work, but I'm not really saying it would.
It doesn't mean the private aspect is wrong, it means we have a control problem. I think some smaller sections of it (to start) could maybe run private but mainly needs to be on the low-risk, easier areas (not construction), and areas where budgets can be forecast more easily. It's certainly not easy, but controlling that sort of budget never is. It also doesn't mean we can't make big changes, to streamline things, pre A&E/ GP Triage, bring back walk in centres for minor injuries, not suitable for A&E, pharmacies taking on more responsibility etc. I imagine some things need breaking down, to take the load away, dealing with smaller, should make it easier, but some areas need better integration, like between the NHS and social care, as they're so reliant on each other, and one can sink the other.
Sorry to hear you lost money with Carrilion, I was just using them as an example but there are plenty more examples of badly run big private companies. As you allude to above many of the problems are rooted in the system we have put in place in this country which is largely a no trust, exploit weaknesses in the contract or claim your way out of trouble culture. And that’s without looking at the ‘human capital’ shambles currently being masqueraded as good people management. The likes of PWC are in the middle of it all and they are clueless but listened to because they are accountants and our system is run on shareholding and finance.
Like I said, the British way, chaos but ok if somebody can make a quick buck here and there.
 
I’ve worked in private companies for about 40 years.

They have been far from efficient or well run although you get pockets of things being done properly for period. The only difference is the money runs out after a while if they are not making a profit.

Look at Carrilleon, a private company spending public money, went down for billions and billions, I don’t think they’ve even got to the bottom of it.

Private or public, it’s the British way to run things chaotically, politically and inefficiently by often putting the wrong type of people in key positions.

Anybody thinking privatisation will somehow transform our health service into a panacea of efficiency is just wishful thinking, the Tories only want it for ideological reasons rather than making it better.
It’s not just the British way. I’ve done business pretty much all over the world (apart from Sub-Saharan Africa), I have met incompetence from public and private entities everywhere I have traded. Oddly, given their reputation efficiency, the worst was probably Japan, with a ridiculously ossified hierarchical structure. The one common theme was the smaller the company, the more efficient is was.
 
Sorry to hear you lost money with Carrilion, I was just using them as an example but there are plenty more examples of badly run big private companies. As you allude to above many of the problems are rooted in the system we have put in place in this country which is largely a no trust, exploit weaknesses in the contract or claim your way out of trouble culture. And that’s without looking at the ‘human capital’ shambles currently being masqueraded as good people management. The likes of PWC are in the middle of it all and they are clueless but listened to because they are accountants and our system is run on shareholding and finance.
Like I said, the British way, chaos but ok if somebody can make a quick buck here and there.
Ah it's not a big problem, that's construction, it's ruthless, they were not the first by a long shot, and won't be the last. We know it's going to happen, so make allowances for it.

Totally agree with what you're saying, we have many broken systems, we need a reset and to start to think outside of our box (or just like successful services/ countries do). The fight was hard before (comparing ourselves to other countries), but it's going to be even harder now, as we're going to struggle to compete outside of the EU.

We absolutely have to be as efficient as we can be, in everything we do, throwing resources at problems won't fix problems, picking the right thing to fix the problem will (will also likely need more resources).
 
Seriously 🤨

And we have a pharmacist shortage believe it or not 🤷🏻‍♂️

Why couldn't pharmacies/ pharmacists sort out some (even 20%) of the potential GP appointments, if they were given more power? Especially in winter when flu/ colds absolutely pummel GP's? The load imbalance from summer to winter is a problem, which needs assistance, and the method of treating the load needs to be flexible, to be efficient.

I'm not talking life or death, or anything close to that, which certainly needs a GP, or even to be able to bypass that to more specialisation. The majority of younger/ 9-5 working folk would likely get 90% of their needs met, by a basic/ quick 5 minute online triage by a doctor (I would absolutely love something like this, for my family). This triage would take less time than it does to try and get through to the GP, and they could then be directed to the Pharmacy/ GP/ A&E/ Minor injuries/ X-Ray dept/ physio etc. I'm not saying send old people with chest pains to the pharmacy, I'm saying not cram up GP appointments with those who won't need them, if there were alternatives, so those with bigger problems can actually get an appointment. The triage system could even allocate drugs out from central hubs, and courier them around, to save people who may not need physical appointments/ contact from taking up time from those who do need the contact. Could also stop viruses etc spreading around, reducing the load. The system of people sick with flu, chest infections or whatever, going to the same places/ waiting rooms as vulnerable people with bigger issues is absolute madness.

I'm not surprised there's a shortage or pharmacists, just like there is with everything, maybe we need some sort of fast track/ leaner qualification, which is more specific, and less padding, and which can be later built on with more experience. Same with GP's, maybe less General, and more targeted to specific areas, and then people get sent to specific GP's which cover that band of issues. This cold work in towns and cities, but would be more difficult in smaller places, but there's no reason why it has to be the same everywhere.

I think most Pharmacies are private too, which I don't like and wouldn't want, if they were given more of the load, I'd rather this was in public ownership and may help with the ludicrous prices the people and the NHS are paying for drugs/prescriptions etc. Any drug which can be bought by the public, should not have to go via NHS prescription (or even a private pharmacy), which adds on massive cost, and wastes the trained medical staff's time.

Like I say though, I'm very much not a specialist in medicine, but I'm good at making things efficient and problem solving/ spotting, so just putting ideas out there. I'm certain there are plenty of people good at this sort of thing with much more expertise in the field, we just need to be open to changes and embrace the technology we now have. Ultimately the idea is that people with less risk, and lower level problems do not need to be taking up time/ space/ cost/ resources, which causes those with bigger problems delays and further decline of health, which ultimately requires more time, space, cost and resources to treat them.
 
So we have a pharmacist shortage and you still want them to take on referrals?

Do you know how many serious issues I can think of alone with the that suggestion? Probably at least 20
It's one of those solution that seems to have some merit but only until you start to look into how it might work. I didn't know there was a shortage of pharmacists, for example so it sounded like an idea worth exploring. It maybe still is, I don't know, but until you do feasibility studies, you dont know.
 
So we have a pharmacist shortage and you still want them to take on referrals?

Do you know how many serious issues I can think of alone with the that suggestion? Probably at least 20

My local pharmacy takes on referrals and it seems to work okay.

I understand that getting every pharmacy to be forced to take on referrals wouldn't be suitable but if it can be utilised well I don't see a problem.
 
So we have a pharmacist shortage and you still want them to take on referrals?

Do you know how many serious issues I can think of alone with the that suggestion? Probably at least 20
Of course, the idea would be to increase the number of pharmacists, which I expect is easier than adding more GP's, and still crippling them with issues which could be solved with much simpler care/ treatment.

There are issues with everything, the NHS has thousands, if this adds 20 issues and saves 100 then that's a positive.

You have to be open to change, we're using a similar system to what we always have, and it's not really modernised, where there's clearly the ability to do that for some appintments.
 
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