How would you fix the NHS?

*sensitively

When a condition could be prevented or managed with weight loss, it can be difficult for health care professionals to communicate this to patients. However sensitivity it is communicated, it can cause upset and the health care professional’s integrity is then becomes questionable.

GP surgeries are the only part of the NHS in which there is no insane wastage. This is because we are responsible for our own budgets. Sickness is lower, productivity is higher. If you take away my contract and make me into a salaried part of the NHS ( I only work for the NHS) all my incentive to save money and work efficiently is gone. All the innovative idea that I and my partners have worked up over the years, the staff training we have invested in, the personal care I can offer because I have worked here for 25 years, will all be lost. All the 'good will hours' I and my colleagues put in will stop, Remember the Covid vaccination campaign ? I and my partners worked every single weekend for months vaccinating people, sometimes all day, all essentially out of good will... I'm quite sure this will happen, but it will be a big mistake

Sorry for your loss.
This is exactly the way I would hope to go as well. A long and active life ended by a short illness at a grand old age.
I don't think I've ever heard anyone say they hope to spend their last years in a care home, bedbound, doubly incontinent, in pain and screaming anytime their children come near them because they don't know them anymore. Oh, but make sure they're at the front of the queue for every vaccination going and have the GP on speed dial for the slightest infection in case it kill them.
I think it's very likely the next generation will make sure this doesn't happen to them by having advance instructions in place to refuse life prolonging treatment.

Not all old people are ill and soaking the NHS. DM89 and recently deceased had not visited her GP for nine months, took only one tablet daily for bp, and last spent a night in hospital 44 years ago after surgery for a prolapse. She worked until she was 78, as a MH nurse, because without work she would have had to live hand to mouth in the cold. She managed to buy a 2-up-2-down fixer-upper 30 years ago with a small inheritance and some help from her kids. Dignified, and modest comfort, but lifelong good health was the superpower. And a sudden demise; a long slow decline would have been her idea of hell.

I said living memory, to have been 5 at the outbreak of WW2 you would have to be 90 now. Not that there aren't lots of 90 year olds but it's hardly a huge demographic.

People are entirely right to make complaints to PALS when they get crap treatment. Are you saying they shouldn't be allowed to do that and should put up with whatever crap "treatment" they suffer??

So how do you explain the very different experiences of people using different GP surgeries, some areas offering treatments/services that others don't offer, etc?? Some areas offering "open" MRI scanners, others not, etc etc.

?

Who goes crying to PALS about what?

1234soh , nah they go crying to PALS !!!

Absolutely agree with this, and in the same vein I would say they should focus on early intervention and ensuring patients are well informed.

*

Case in point: I have PCOS and approached my GP in my early 30s, when I was single, to ask for a hormone test to identify any potential fertility issues and ensure I had advance knowledge of any potential fertility issues.

GP refused, saying I should come back when I have a partner and had spent several years trying to conceive.

Several issues with this:

1. Imbalanced hormones are a health issue, not just a fertility issue, and in the case of PCOS are a precursor to T2 diabetes and other health issues. I now know that I handle glucose badly (super common in PCOS) and manage my diet accordingly. Tests would have highlighted this. I’m naturally slim so wouldn’t have been aware otherwise.

2. With early intervention I could have started with a super cheap supplement to regulate periods, then moved up through prescribed medication for ovulation, etc. (again, non-ovulation is also a health issue, not just a fertility issue). As it is I’m now getting IVF via the NHS – potentially about £21K more costly to the system than doing those tests and prescribing some lower order medication all those years ago.

There is a lot of determined short-sightedness

What you’re talking about is everyone basically paying out of pocket for their own medical care and dismantling the NHS.

So your answer is ‘yes’, access to medical care should be determined by financial clout.

So if you’ve worked as a nurse your entire working life, have had several kids, and get cancer, your prognosis is less certain than if you’re a city banker? Or if you’re, you know, disabled – best be a lawyer?

The issue about the NHS wasting money is entirely separate to your suggestion.

We should all know our health risks. For example, weight is as important to know as blood pressure, blood cholesterol levels and might prompt lifestyle changes. Surely it’s cheaper than waiting for cardiac events to happen.

If excess weight is a contributing factor to a health condition, doctors should feel able to discuss this frankly with patients.

Most of us are probably unknowingly vitamin D deficient. Sorting this out could make us all more productive and prevent further problems down the line.

@tataxguru OK, we have gone full circle. Because what you are proposing, is exactly what we have now. NHS England sets a framework, and a budget, and then ICB's fulfil those tasks under a local framework.

No, the services themselves nationally and consistently. Locally, the SCALE of the services, i.e. one clinic per week or one clinic per day according to local demand. A bit like McDonalds. Every franchise is the same in terms of pricing, the menu etc., but different places are different sizes, some have drive throughs, some don't, some towns have one, some have several, different locations to cover different local demographics. But fundamentally, the "same" in terms of the menu and pricing.

Can you remember the exact details of a newspaper article from 15 years ago. The gist of my comments is correct, the exact detail maybe not.

I think the saying was then “if in doubt, pull it out” in the context of teeth.

My DF is same age your DM but his teeth are in an awful mess

You have entirely agreed with my premise then. That services should not be decided nationally, but by local need. Thank you.

You said this there was an article about one particular ward at our local hospital where the staff procured their own non clinical supplies, i.e. sick bowls, loo rolls, soaps, paper towels, pens and paper, etc - so basically just consumables

One ward/staff procured their own supplies... i took it one way, you now say it was meant to mean a 15 nurse committee, working with the trust on seeking out new cheaper suppliers....

That not what you first wrote at all....

I don;t want or need a stupid choice - I need the right medical care, at the right time. Choice is for idiots who need the impression of control. I don't want control. I want the best treatment and give I am not a doctor, I am not best placed to decide anything.

So you think no one in Weybridge has diabetes then? You do realise that T1 isn't linked to lifestyle don't you? It can happen to anyone, anywhere.

What you do in different areas is change the scale of the treatments. So in an area with a lot of diabetes, you put on more diabetes clinics. A GP surgery with few diabetes patients may only need one clinic per week. A surgery with lots may need several clinics per week. But the clinics should all operate the same, do the same tests, offer the same advice, it's just a matter of scale.

Same applies with most other things. You'd need "more" contraception and sexual health clinics in an area where there are more patients using those services, again, larger/small departments, more/less clinics, etc., depending upon the numbers. But again, there won't be any areas where no one needs contraception nor sexual health services!

DM is 76 and had all her teeth removed after getting an access, and has dentures. Seems a bit barbaric now. They said that's what they had to do.

The survey does mention a focus on prevention which is encouraging.

Main thing is a shift to tests and support in the community. Which sort of feels like going round in a circle - we used to have this then funding got cut. So where will the funding come from.
I hope lots of people have filled in the survey.

These are all extenuating circumstances/emergencies, which NHS should absolutely be there for. But because the NHS wastes so much money, it isn't. I don't believe the NHS is underfunded, I just think the money it gets needs to be spent more wisely.

Should poor people get lesser care than the wealthy? In an ideal world, no. But what we currently have is largely a system where the 'wealthy' are paying in money that seems to be readily available to those who aren't.

The only TWO times myself and DH have ever needed hospital care we've had to go private. This can't be right?

The health needs are considerably different due to demographics and population. To say they have the same health needs is simply not true. Obesity and Diabetes is a good example. There's little point in having weight and diabetes services in an area where they don't exist. You'd want those services focused in Bolton, not Weybridge. Different areas of the country have different health needs, and at different stages of life.