How would you fix the NHS?

@taxguru the funding models now gives ARSE cash which can specifically not be used to hire doctors 🤷‍♀️. Wes has lifted this restriction very recently but it will take time to filter through.

We gave enough doctors and nurses. We need to employ them. This would offer up more appts, cut waiting lists and help get the NHS back on its feet.

Well said. And I hate this patronising/high-handed assumption that no one over 80 can possibly still have quality of life, it's such bollocks. My dad had great quality of life despite multiple conditions, right up until his final illness. And my MIL is 84 and freakishly healthy, much healthier than I am in my fifties. I don't think she's been ill in over a decade. According to pp, though, presumably any time after next year if she has the misfortune to get ill, regardless if she's still healthy overall/has a treatable condition, it'll be 'Now don't be selfish, dear, shuffle along and let the young take precedence.' What a way to treat people who have worked and paid into the system for many years.

We seem to be moving towards a society like those in the kind of dystopian novels that used to seem impossibly far-fetched. If all this writing-off of older people is really indicative of the collective ethic of this country, then as a society I think we really need to have a good hard look at ourselves.

What really worries me, given the levels of ageism I see on MN and in society generally, is that inevitably at least some of the policymakers and decision makers within the NHS will be of the same mind. Oh well, at least the funeral industry will boom and it'll provide extra job opportunities for the young, eh?

Disgusting.

If a supermarket gets loads of waste, the store manager gets investigated. As the supermarket my friend was working at ten years ago there was a fridge failure and the store managers ignored it and all the food has to be disposed.

NHS managers get no investigated if they waste the same value as the food in the above

My nan used to be given paracetamol and vitamin d every month for no reason at all

A friend of mine is a 'part time' GP. She's on 60% of fth, she works 40 hours a week, misses loads of evening and weekend social events because she's at work.

Not too sure if this is a problem with the chemist. During my late DGF’s last illness and other health issues which was about 2 years. My late DGM ticked what repeat prescriptions that DGF needed. Every single time they got a box of 100 soluble paracetamols in his box of prescriptions. Even though my DGM didn’t order them. There was no issues with other medication that wasn’t selected as wasn’t delivered,

The cost of these paracetamol is (today’s prices) £20 a box. That is 26 boxes of them in two years and about £450-470 in prices when my DGF was alive. These weren’t wasted, They were distributed in the family and DM took a box to her work with a note “help yourself”

Heard of other pharmacies just reissuing the patients’ entire prescription list. So that costs go to the NHS.

The GP funding model certainly needs to change. With them getting a fixed fee per patient, there's no incentive for them to offer more appointments etc as they get paid regardless. It needs to move to a "pay per consultation/treatment" model, so the GP practice gets paid for what they actually do, like virtually every other business model, such as NHS opticians, NHS dentists, etc etc. The idea of the "fixed fee" was to encourage GPs to provide preventative/proactive services, but it's failed, so time for a change. If they got paid for what they do, you can bet your bottom dollar, they'd make more appointments/services available. Time for change. Even if it costs more short term, it would probably save the NHS money in the long term by getting a grip on problems before they develop into more expensive/complicated treatments needed.

Or do we expect GPs to work for free ? And a 5 day week from them is usually 60+ hours. So not like the rest of us.

@Ladyof2024 one word. Cash. They won't be getting enough money to afford the GPs working more days.

Also @Alexandra2001 at my GP practice there are 6 GPs and they all work part time. One only does one day a week and another 2 days, the others only do 3 days. WHY?????

If they would just work a normal 5 day week like the rest of us have to, and like the GPs used to when I was a child, it would no longer be impossible to get an appointment without phoning every day for a week.

Alexandra, who said they should work weekends AS WELL AS weekdays?

The railways, the buses and the tube lines run and are manned 7 days a week.
Cinemas, theatres, restaurants are open 7 days a week.
Gas, electric, internet, water board staff work 7 days a week.

But the staff only work a 5 day, 37 to 40 hours week. Can you work out for yourself how that can be done or do I have to explain it to you?

*Windchimesandsong *
I think each department thinks of itself as a separate entity and if they save money then that is all that matters. No one looks at the bigger picture

Everything is to be passed on to become someone else’s problem and the more it is passed on, the more costly it becomes

I agree @Yalta

The false economy approach is a problem

I think there would be a lot more beds available in hospitals and less overall cost to the NHS and the country if GPs would not try to save money by putting off and putting off patients from getting tested for anything and then only sending the patient for a blood test or test to test for 1 condition at a time

I have seen a ward of women who had different illnesses. If they had been sent for all the tests for things involving their symptoms at the same time then it would have come back within a couple of weeks exactly what they had wrong with them and they could have all been treated with prescriptions/outpatients or at worse 1 or 2 days in hospital. Instead by the time they were tested for their illness, months of
going to the GP,

getting a piece of paper to go have blood tested etc

Making an appointment to see the GP a couple of weeks later (if they were lucky).

Going to the GP

Getting a piece of paper to go have blood tested etc etc

By the time the doctor had the test results which indicated a problem, the problem had grown to needing much more invasive treatment and a much longer hospital stay

Whilst the GPs surgery is congratulating itself on being frugal with how much money they have saved by not sending people for tests it fails to realise that the overall knock on effect has cost the NHS millions and the country overall millions more.

I was denied an MRI (£300) on the NHS for what I thought was a hip problem

7 years out of work in constant pain and claiming sickness benefits plus the consultants appointments for 7 years. The 7 years of fortnightly physio appointments
The cost to the NHS and the country was probably around £300,000

So to save £300 they spent £300,000

I went to see an osteopath privately

After taking my details and exactly how I came about to be in so much pain, 15 minutes into the appointment I was told that hip pain was sometimes deferred pain from the back. She asked me to show her my back

Apparently I had bones sticking out where bones shouldn’t be sticking out.

I was referred for an MRI and to the Bupa hospital as she recognised it was more than she could deal with.

Apparently I had been walking around with a slipped disc for 7 years

Probably not a popular opinion but we should stop treating people over 85. No more operations, no drugs, no more extending existence at the detriment of wider society

Some absolutely disgusting ageist bigotry on this thread. And goodness what a slippery slope. Start at 85, then slide down to 70, then 60, then before you know it 50.
And younger long-term ill or disabled people - including children, and sick babies.
What a horrible dystopia!

Re
I agree - and I've lost many lovely elderly relatives and friends. Many hated the near-torture of constant hospital visits, scans, investigations, treatments etc etc and just wanted to be left in peace! Some said 'You've got to go some time!' and others 'I just want to be left in peace'.

If they hated it, nobody was forcing them to have it. They didn't have to go for hospital visits or have the scans and treatment etc. Others do want the care they're entitled to and deserve - and have benefited from the improved quality of life and cherished extra time with loved ones it's afforded them.

I used to strongly support legalisation of assisted suicide - but recently I'm beginning to rethink that because of the increased amount of bigotry towards older people. Worrying signs it won't be a free choice. And assisted suicide is something that should never be a coerced one (including coercion by neglect).

I think it depends on the fitness of the person concerned, clearly some 80 somethings are very fit and may live another 20 years with treatment. But I don't actually think medical staff are stupid, they won't operate on someone who's frail for no good reason.

Yes this is the case - for all ages.

@itwasnevermine actually you don't. You sign up for a 40 hour week. But because of under staffing you are required to do 78.

Facts are important. Not 'well you signed up to be treated like crap so you deserve it'. That attitude is why Australia's biggest medical school is the NHS. That and we don't employ our own doctors so it's down under or drive an Uber.

I agree with all that. Far too much of the attitude of "it's a drop in the ocean" when it comes to unnecessary waste and inefficiency. Far too many staff just don't care about waste - it's endemic - they see no one else around them cares, so they don't care either.

The waste I have seen and the response from drs and nurses is always “It’s the way it has always been done”
There isn’t even acknowledgement that what they are doing is wasteful

I have watched as patients are told they are going home today

They then get up and dressed and 2 nurses arrive to strip the bed, clean the bed and make the bed up

Patient and family then sit on the bed waiting to be discharged. Patient is then discharged. Then 2 nurses arrive to strip the bed, clean the bed and make the bed up. The bed they only made up a few hours before.
Not one nurse understood how much of a waste of time and money what they had done was as “It’s what we have always done”

Exh went to have chemo, the practices in place made so little sense given the NHS is always bleating about the amount of money it needs.
Before patients would arrive in the morning nurses would set out trays and label them with the patients name. On each tray would be placed a bag of the chemo needed, a new box of gloves, new box of antiseptic wipes and any other things they needed.

When a patient arrived the nurse would take the bag of chemo and because it had been out of the fridge for a while and throw it in the bin
They would then collect a fresh bag of chemo from the fridge.

At the end of the session anything on the tray (I.e box of 50 or 100 pairs of sterile gloves where one or 2 pairs had been used for that patient and the box of antiseptic wipes which are in there own packaging and again only 1 or 2 having been used would be thrown in the bin.

I would say that the NHS doesn’t need more money. It just needs to stop chucking stuff in the bin and doing unnecessary tasks

Good? That's what you sign up for when you become a doctor.

Definitely not like the US.

France is the model to aim for. Those on the lowest incomes including people who are out of work or disabled etc, have their insurance covered - so nobody is left unable to afford healthcare. And French healthcare is better than the UK. Quicker access and more efficient (eg. prompt diagnostic tests).

Re this Turn the heating down. It’s making the patients and the staff sicker, especially on warm sunny days. Yes! It's always too hot in GP surgeries and in hospitals.

Part time GPs will often work 40+ hours a week. Doctors often work 78+ hours a week full time. Not through choice, but because that's what the rota tells them to do.

As an example :

4x13 hour night shift
One day off
2 days 13 hour on calls

Unlikely to get away on time every day as things happen. All for the princely sum of £17 an hour.

We need more doctors and nurses. We have trained more doctors and nurses. Employ them.

Yes I'm a boring stuck record, but it's so simple.

@Alexandra2001

GP locums don't want to work in practice... you cannot make them.

You remove their "comfy" and high earning locum jobs elsewhere. They're only locums and choosing the "easier" and more convenient work because the work is there and they're just cherry picking the jobs they want to do, paying the highest daily rate. It's a bit like the bank and agency work for nurses. Get it sorted, remove the "need" for so many short term locums/temps, so the people having a lucrative easy life would need to find a proper/permanent job instead.

There's only the need for so many temps/locums/bank/agency staff because of poor organisation and management. Of course, there'll always be a need for short term cover, but a lot of the locums/temps etc base their entire career on cherry picking the highly paid, low hassle, roles. It shouldn't be a permanent career choice to not actually have a "proper" long term job and end up earning more, for working fewer hours, by cherry picking the short term roles.

Go back two or three decades, and the "locums" were typically retired GPs who went back to their old surgery to cover holidays, the odd Saturday morning, etc. For some reason, that doesn't happen anymore. Probably because of the pension tax problem and them getting a large pension anyway, they don't need to work.

Now that so many GPs are only working part time (some as little as one day per week), we need to examine why that is, and what we can do to "incentivise" them to work more and cover sickness/holidays of their colleagues. That makes far more sense as they know the practice, know their colleagues, know the patients, rather than bringing in an expensive locum from an hour or two's drive away, who probably doesn't even know the IT system, doesn't know the local Trust procedures for referrals etc (Yes, I've experienced that far too many times - they've not got a clue and basically just fob you off and tell you to make another appointment!).

@Alexandra2001

46m is such a tiny amount in terms of NHS spend that it is trivial

And there in a nutshell is why the NHS is in such a state and soaking up so much money.

That's the attitude of the majority of NHS staff. When they waste, they don't care because it's just a "drop in the ocean". If every NHS employee saved a few pounds per day, it would save billions in a year.

I remember having an ECG. Nurse opened a new packet of those self adhesive clips that stick to your chest and then the wires are clipped on. From memory, there were 8 clips in the pack, she used 4 and threw the other 4 in the bin! Half way through the ECG, a couple of the clips fell off and wouldn't stick on again. So she opened another new packet, used 2 and threw the other 6 in the bin! That packet may "only" have cost a few pounds, but if she's doing that for every ECG patient that day, it will come to maybe a hundred quid. If other nurses in different surgeries/hospitals do the same, then it soon adds up to thousands a day! I fail to understand why she didn't just keep the unused ones for the next patient, or if that's not allowed for H&S, then at least keep them until the ECG is finished in case some don't stick and replacements are needed.

@Yalta my GPs surgery apparently has 14 GPs but they each only work one day a week!!

Except I think if it was going to apply, it should apply to everyone, or I think it should. A line of credit needs to be available for those who just don't have the money there and then though.