How would you fix the NHS?

Better triage and more solutions for minor issues. So more GP/minor injury/walk in appointments.

All access should be via 111, which books your GP appointment for some time within the next 3 weeks depending on urgency at any practice within 5 miles of your home (closer for those with mobility issues).

They can also refer you to minor injuries/walk in centre who can then start managing their queue while you’re on your way there. You don’t get in without a 111 referral.

Similar for A&E - unless you come in by ambulance or are otherwise incapable of calling ahead (broadly assessed by you arriving walking and talking) you need a 111 referral.

Also, overhaul procurement. DH sells items that the NHS might use (think kitchen fittings). They won’t buy from him because he doesn’t offer a 3 year warranty. He sells to a reseller that does sell to the NHS at 100% mark up because they pretend to offer a three year warranty, but broadly because they’ve doubled the price they can afford to replace 50% of the items within 3 years and still break even. The failure rate isn’t that high. The NHS would be better off buying with a one year warranty at half the price.

Oh god where would I start? the NHS has so many fingers in so many pies and its a never ending circle, one department linked to the other and vice-versa.

GP surgeries are ridiculous which is why A&E is in the state its in.

A&E needs to toughen up on people and tell those who don't need A&E to go to their GP.. but as we all know, seeing an acuall GP now is like winning the lottery!

The Menal Health Service is drowning, another department which is overflowing and time and money is being spent on people who really don't need the service but there's nowhere else for them, and these people are clogging up the service for those who really need help!

Social Services are a joke!

And all of them work lovely monday to friday 9 to 5 jobs! (obvs apart from a&e). Its time to bring them all up to date and with the times. Work 24/7 like a lot of other people have too now! GP's should be available on weekends without having to sit and wait for hours on end, MH services should be available on weekends not just an OOH triage service and Social Workers need to be the same..

Every town should have a small cottage hospital with a minor injuries unit and 24 hour GP cover

🤣 (sarcasm) - our hospital was closed over 30 years ago!
It's still there, but you go for blood tests (8-13:00) X rays (9-15:00), midwife appointments and physio, ... you get the picture. Its for anyone who needs these services and is sent by their GP. Urgent care minor injuries and A&E are located in the next town 10 miles away.

So the solution to lack of care is for overstressed relatives to take over care they aren't capable of doing (try visiting an elderly relative 3 times a day to supervise medicine, provide a meal, and assist to toilet) taking on top of a job and childcare) or discharge the patient into a situation where their health will decline? Mot much point in having treated them in the first place in that case.

Massively fund primary care - there is no need for so many people ending up in A and E because they can’t see a doctor or they have deteriorated because they have been on a referral waiting list for months.

We need more health clinics where people can have stitches, simple tests, IV fluids/antibiotics etc without hospital admission.

The problem with wait lists being so long means it stores up issues that become worse and more costly over time. Tackle this and we may be able to stop “firefighting”.

It would also likely help the mental health of many people who are unwell but cannot get treatment - that would damage anyone’s mental health. Which again costs money to fix and reduces economic activity.

Agree with whoever said GPs on salaries so they have to work weekends.

Have consequences for useless rude medical staff - when a patient is admitted after having seen someone in primary care and not treated properly that cost should come out of the primary care budget. Would soon stop GPs giving the brush off and making it someone else’s problem.

And yes - NHS social care. In fact all NHS and social care budget should be one pot to stop the budget ping pong of making it another depts problem and wasting money to keep your budget active and not caring about the overall service outcome.

It hasn’t been fixable for decades. That’s why it’s never been fixed.

I’m sure there’d be uproar here if that was suggested but if people were at home they’d have to buy their food etc so I’m not sure why it would be so awful. While they're in hospital they'll still have to pay the runnng costs of their home, and they may spend less on food at home than they'll be charged in hospital. Meanwhile they'll not be earning, and their visitors (who are necessary for laundry, maybe helping to feed etc) are paying a fortune in travel costs. Not everyone is able to bear these extra costs of illness.

And a minor injuries.walk in centre next door to every A&E, with A&E staff allowed to redirect people who've come to the wrong place.

I think we have to accept that some symptoms may be trivial but worrying to the layman, and so may end up unnecessarily at A&E through no real fault of the patient.

Yep and the NHS of 14 years ago, is nothing like the one we have now...

Its a 5min survey & about "buy in" for staff patients etc to have their say, i doubt it will have much impact on what they'll actually do.

Good to hear that Tory backers don't think its fixable.... what a good they ve done!!

Privatise it. Or at least set up a proper insurance system.

I would invest in more respite care as at the community hospital I work at it is very clear that many people are in because family need a break. It also puts people off caring for loved ones or taking them home to await care as they know there will be no break so the person just becomes a delayed discharge in hospital waiting for care.
One of my colleagues is from New Zealand and apparently if you are in hospital there over a certain amount of days they have to pay a small amount per day to cover the cost off their meals, electricity etc. I’m sure there’d be uproar here if that was suggested but if people were at home they’d have to buy their food etc so I’m not sure why it would be so awful.

I would also like there to be some sort of forum within each health board where ward managers could put up anything they didn’t need any more and others could take. It’s been mentioned before but wards could make their money go further if they had a bit more control over their money instead of having to use suppliers who charge double the price of Argos for the same item.

Unfortunately though a whole culture change is needed as people expect the NHS to sort all their problems and don’t want to take any responsibility for themselves.

Labour have had 14 years to come up with a plan. Streeting is extremely well paid and has a huge team of well paid staff working for him. To beg the general public for ideas is desperate and incompetent. Either do the job you're paid for or resign. If they don't, they'll be castigated for not asking the users of the service.

I agree. It’s a gimmick.

There will be yet more failure and disappointment in the NHS’s performance whatever the government does, because as a nation we’re too scared to admit that healthcare FATPOU has run out of road.

‘Lifestyle’ therapy will just make things worse.

I don't think the NHS can be "fixed" until adult social care is sorted out.

But I don't think she necessarily does. An elderly person is likely to need more support getting to the loo, for example, possibly encouragement with eating and drinking, smaller more nutritionally dense meals. An elderly person is more likely to have other medical needs and therefor drug interactions, more likely to be deaf and need staff who realise that they're deaf not stupid. "Hospital aquired delirium" is a real thing in older people. A lot of these are not purely nursing needs, and are porrly catered for in hospital, but are vital to return a person to the best health they are capable of.

I had to provide proof of address because of the catchment area. Although when I moved, (there's 6 surgeries within the surgery group. Registered at one, moved and am now closer to another) I was told to just change my address. No proof needed

Millions of people with no access to public funding register and use the system. That's a bit of an overstatement! Hansard 11 May 2023 says according to House of Commons Library, 1.6m people are given leave to remain wiithout recourse to public funds. So less than 2 million rather than"millions".

I don't think that's feasible or can always work. There was an ex teacher in the Education role in 2001 and she couldn't perform as she was far too close to it. She resigned. Starmer has doctors he could call on but presumably they don't have the skill set.

This is badly designed questionnaire. No surprise there! It’s very prescriptive and you can clearly see what they already plan to do.

I answered it but it’s just a paper exercise.

I might be in cloud cuckoo land, but...

-A better focus on preventative medicine/health.
-Law put in place for minimum safe staffing levels (and this increases as acuity/dependency levels increase).
-Stricter rules to protect staff against aggressive and abusive patients/relatives. Over the years, I've been physically and verbally abused. I've been groped by patients, and had threats made against me, colleagues and even my family. Often from serial offenders, who we have to keep admitting and trying to treat.
-Software systems that are universal (across all Trusts and in community etc), which mean if a patient is out of area/repatriated from a different hospital etc, their records/results are easily accessed by the staff who need them.
-Better investment in community care (and make it a more appealing job for people!!), be that more beds in cottage hospitals or nursing/residential homes and better staffing/working conditions. I'm a ward nurse - things are hard for us, but God knows I know how hard it is for my colleagues in community (be they, nurse or carer).
-More OOH/minor injury places.
-More GPs, so that there are enough to staff GP surgeries for evenings and weekends.
-have things like hospital transport made in-house. In my Trust, there are two different transport providers (depending on which county you live in) - each having different rules and regs.
-Have a look at the NHS suppliers. They often charge way over the odds for items that could be sourced a lot more cheaply elsewhere.

There is a discharge lounge where I work. They provide meals and care for patients who are just waiting for meds/discharge paperwork/transport. Patients often refuse to go there, preferring instead to stay in their beds/rooms. We are not allowed to force them to go there. But we get a telling off from senior management when we don't send patients there, and we get complaints from patients and relatives about the lack of beds!!

There are cottage hospitals near where we are, but the powers that be have decreased the number of beds in them. There used to be more minor injury/OOH places, but these were also closed.

We often have patients who are admitted to hospital but then refuse to engage in the treatment or therapies offered. They need it, and understand they need it, but don't want it. There should be a process in place which makes it easier to simply send these people home. I have known of people being in for weeks, refusing physio, OT, medical interventions etc, but then of course not improving....but we can't send them home as it is not safe. They refuse placements and care packages, and stay for weeks in an acute hospital. It's crazy!

So no mention of Dentistry what so ever....

@TheSnootiestFox

i'm afraid you embody all what is wrong with peoples attitudes and why staff are leaving and young people not going into health.

The last time two times I have really lost my sense of humour have been been with so called 'health professionals' and I am also fed up with it. First was with my then 13 year old with a broken foot, sat in minor injuries for 7 hours watching others walk in and be treated, told I couldn't give him pain relief until he was was triaged but they forgot to triage him. Was told just to sit down and shut up. Then got to see the nurse and when I complained was asked why I hadn't just walked down to the garage (leaving him on his own to do so) to get paracetamol. I told her what had happened and demanded to see a manager to make a complaint. Was told there was no manager, nurse refused to treat my child who was in agony because I was 'aggressive' (no, but i bloody could have been!) and porter threatened to call the police on me as I was refusing to leave until I'd made a formal complaint. Second time was arriving to pick mum up after 4 hours during which time I'd assumed she'd had a colonoscopy. Clinic was running late and she'd not even been seen. This was 4pm a few weeks before Xmas. Was again told to sit and wait even though I had to collect kids, take mum home which was an hour away, get her settled (dementia), go home which was 30 mins from mum's, feed kids, get them off to cadets and me to work all before 7pm. Mum had taken piccolax and was refusing to leave until she'd had her procedure, I was refusing to wait any longer and a nurse stood with her hands on her hips and told me not to worry as if I was lucky I wouldn't lose a whole night's wages. No, I'd just have lost my job for not turning up 🙄. Single mum a few weeks before Christmas and they're telling me I can't go to work to earn money for presents.

I am sick to the back sodding teeth of hearing how stressed everyone in the NHS is. We're all stressed and busy. You're not special. In answer to the OP's question, my answer would be get rid of all the people like you who think the patients are the problem. Get rid of all the translators, eleventy billion managers that can't manage and the stupid amount of things treated. Luxuries such as IVF, smoking cessation treatments and weight loss treatments/gym memberships FOR THOSE WHO DO NOT HAVE diseases such as lipoedema or endocrine issues that make losing weight nigh on impossible. Make GPs work weekends like they used to and go back to family Drs who knew their patients and would visit in the dead of night rather than having to trail a sick child to an out of hours centre miles away. I refuse to believe it's cheaper to keep centres open and staffed. First and foremost start remembering that it's a SERVICE, the clue is in the name, and start treating the patients with more respect!

1. Identify a range of metrics by which you can quantify the effectiveness of a public health system
2. Rank all public health systems in the world using these metrics
3. Look at the one that comes out top
4. Do what they're doing

The NHS (in England or elsewhere) can’t be fixed in its present state. It needs to be stripped back and expectations need to change.

Labour have had 14 years to come up with a plan. Streeting is extremely well paid and has a huge team of well paid staff working for him. To beg the general public for ideas is desperate and incompetent. Either do the job you're paid for or resign.

That said, I'll still give an opinion. Do not privatise the NHS. It will finish it. I know the same people scaremongering about the Tories selling it off will clap like performing seal if Labour actually does it, but don't. I'd go as far as saying it would be treasonous.