To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

It feels like there are a myriad of problems. But one I never see mentioned is that management don't, as far as my ignorant self knows, have strict (pay linked) targets for preventable deaths, only for waiting lists and spending. Maybe they do and I'm wrong, but if not, then that seems to me a major problem right there. Of course all three need to be carefully balanced.

I'd also introduce uber-style star ratings for staff from patients, also linked to pay. Might improve the appalling attitude from a minority of staff to patients.

I am quite surprised at that. Many OTC medications should not normally be prescibed by the NHS or GP's. If its true that the guidance is being ignored, is there someone you can raise this with? www.england.nhs.uk/long-read/policy-guidance-conditions-for-which-over-the-counter-items-should-not-be-routinely-prescribed-in-primary-care/

Coeliac poverty is a real thing. Should poorer parents (or adults with coeliac disease and not much money) have to choose between damaging their guts or spending money they don't have?

One of the problems sitting behind a lot of health problems is poverty.

thank you for saying this, you said it better than I could.

People seem to think they are entitled to everything on the NHS. Our area spends a fortune on branded medicines, simple vitamins, dry skin lotions, sun screen, GF bread, nutritional supplements, hay-fever meds that can be bought for under a quid in pound shops...

People should expect to manage their own basic needs for food/ toiletries and not expect to get it for free! Patients should have to pay the difference if they insist on a particular brand of a drug. Nothing winds me up more than someone who has the spare cash to smoke/ vape/ have a top of the range iPhone being vile to NHS staff scream that it's their 'right' to get X,Y&Z on the NHS / why should they have to pay?

It’s not the age of the poulation

iys the general health - too much weight and too little exercise - of the population

age is a red herrring

diabetes and it’s complication atakes a huge percentage of the bus budget ans that’s mostly down to weight

but blame the elderly for enjoying their lives , taking your money, your houses , and having the indecency to look old - right old inconvenience

I am so sorry your husband is experiencing that @Badbadbunny. I have a chronically ill friend whose life is similar.

No, the 80 year olds I know don't have "myriad health problems". Of course their bodies are ageing. The diet growing up in the 30s and 40s of the last century was pretty healthy compared to nowadays. They had access to healthcare free at the point of use when they needed it.

The 50 somethings are in a worse state tbh and whatever healthcare we need, we have to pay for or wait and wait and wait.

Ditto. My OH has cancer (non lifestyle related) and has regular awful experiences with utter crap NHS administrators when trying to make appointments, trying to get prescriptions, etc. He's had cancer and been on monthly treatment regimes for 8 years now, but every time he calls to make an appointment or check if his prescription is ready, he's talked to like a child who hasn't a clue. He needs the patient of a saint to have to keep reminding them that he does this every month and knows the date of start of treatment, knows when he needs the blood tests, knows when and where to pick up the prescriptions, when they try to tell him a load of bollocks that he knows is wrong. He always jokes he'd not be alive today if he relied on the NHS to "organise" things for him as nearly all the pre-made appointments are wrong and have to be changed, including stupidity like a blood test appointment AFTER the date of the chemo infusion whereas he knows it has to be 3 days BEFORE - yet the NHS administrators just make up random appointments with no regard whatsoever to the pre-ordained series of events that they have to be in. Not to mention turning up for infusions only to find that they've not been authorised, so left languishing around in the treatment room for hours until the bag finally appears and then the nurse can't start it because she's going off shift or the dept closes at 5 or whatever! They couldn't run a piss up in a brewery.

Apart from the usual A&E issues, the NHS appears to be working very well where I live (semi rural, near a small city), and I and family members and friends of all ages have accessed a range of services over the last few years. Each time I have gone in with low expectations and been pleasantly surprised at the speed and quality of service. So it can work.
The A&E issues seem to be a knock on effect of discharge issues, and that’s the elephant in the room - it’s social care that needs reform.

Actually if we could solve elderly care and obesity, we’d be in a much stronger position!

Bit of both, if an organization is failing then it permeates the culture of the organization. A bad organization attracts bad staff or at best encourages bad habits and discourages good ones. This of course makes the organization worse and the pattern amplifies.

A failing NHS means staff are fed up and not able to do their best. Managers are fed up and know that even if they do their best it will be nowhere near good enough.

The answer is not just throw more money at the NHS, it needs a complete rebuild from the ground up and an acceptance that things need to get worse before they get better. (As opposed to things getting worse then continuing to get worse). A bit like an old building that's no longer fit to live in, sometimes no amount of remedial work will solve the problem, the building needs pulling down and a new one erected.

I’d go with both. DM and DMil are in and out like a fiddler’s elbow with one complaint or another.

At 85 and 81 they are doing really well and are unreasonable to expect to have the body of a 50yr old!

The 85 yr old keeps going but refuses the offered treatment. She probably needed anxiety meds decades ago, truth be told. The 81yr old has had decades of severe health issues and dementia, but somehow keeps pottering along complaining at everyone’s inability to keep up with her or indeed the limits on her own energy levels.

To be honest I get very frustrated with them asking for support that I haven't got the capacity to offer. I wish they’d slow down a bit!

People often do have health problems in their 80s due to their ageing body. My dad has and he's lived a healthy life. Never smoked, slim etc.

Ive worked in the NHS most of my adult life. The aging population is the biggest issue within the NHS. A&E is the vast majority elderly, urine infections/urosepsis, pneumonias, chest infections, hip fractures, falls with a long lie, and unexplained new confusion generally from an infection yet to be idetified, care homes sending in patients that they cannot care for and now require nursing, they will send them in and refuse them back etc etc etc, account for well over 50% of admissions.

They the go to wards, often not fit to meet their needs due to staffing, and are unable to be safely discharged. This then backs up the entire process, right down to ambulance wait times as they are all holding outside of A&Es, as theres no beds to offload into, as A&E is full, because they cant transfer to wards, because patients cant be discharged. Wait times at the front are the same, cubicles filled with patients waiting for beds, no theres no where to see a relatively minor patient from the front.

Wait times for referrals, again, because so many people are waiting. because the amount of adults has increased. wait times for surgeries constntly delayed due to bed shortages.

GP's surgeries, becase more and more people are in areas needing to see GPs. hospital admissions go up as people attend A&E, or they have waited longer to be seen and then require inpatient care as a result.

We have too many people and not enough rescources to go round. So we need more resources.

Now the first issue is solvable, with better social care, and reopen cottage hospitals, nurse led units for patients not well enough to go home, but not requiring Dr led care. These hospitals were great for recovery, with communal dining and social areas if the patient wished. But they have al but closed down now. Its would relieve the pressure on acute inpatient care massively. The cost of them may be massive,but its vital to healthcare of all. In turn we would see waitlist for surgeries reduce, as beds would be available. GP visits reduced as on going health conditions would be seen too quicker. Less failed discharges and ultimately re-infections and falls would all reduce.

But it would have to be funded. Which seems like in impossibility at the minute.

But I bet those fun loving 80 year olds have myriad health problems.

I agree. The NHS is no longer fit for purpose and has to be changed. Lots of European countries have far better health systems.

It can be both.

when I worked in the nhs it was top heavy. Lots of non-medical management making decisions with little clinical knowledge.

Blair’s labour threw millions into an IT system that was never fit for purpose.

my own department saved millions in preventative and effective care, but as it didn’t “make” money, it was dismantled.

costs are saved on clinical staff. Which is counter productive. The above non clinical management see the dept working with one less staff member, because everyone else steps in to provide cover. So they don’t replace that member of staff. Money saved, but now that dept is running on empty, staff are burning out and no one has the time to do a proper job.

imo the nhs needs staff. Lots more staff. From admin and HCA up. Start employing medical and nursing students- we had a particularly good manager once with the foresight to employ 3 students. They covered staff holiday at peak times, and got through a shit ton of admin backlog, without needing to employ full time staff. After a couple of years other depts would borrow them to get on top of their admin too. But then he left and it never happened again.

sod all the high tech computing and shit that is supposed to make staff more efficient. Just employ more staff.

I have extensive experience of the NHS both as a retired nurse having worked in a variety of roles from student nurse right up to senior management and more recently as a patient because I now have cancer and chronic pain/ disability.

I am constantly appalled by the judgement made by uninformed and smug people about others so called “lifestyle choices” draining the NHS.

The vast majority of patients I have seen who are overweight or smoke do so in large part because of enormous stresses and disadvantages in their lives.

Food or cigarettes are a (just about) affordable comfort when you are, for example, looking after your severely disabled child or elderly parent who has dementia. Or you have lost your job in your fifties and can’t find another one despite your best efforts. Or your husband has buggered off and left you with nothing. Or your childhood was an endurance test of abuse which left you chronic trauma and because therapy is unavailable you have to make do with chocolate.

It’s all very well for too many mumsnetters sitting a lovely home in a leafy idyll congratulating themselves on sensible choices and accountability after their latest gym session over a bowl of quinoa but don’t make the mistake of thinking life is equal.
It isn’t.

This. And a European model. If we want world class services, we have to be prepared to pay more tax.

There absolutely is a management problem within the NHS. I have had wonderful NHS care, but have also come across really poor attitudes. Primarily from admin staff.

The ageing population is also an issue, there are a variety of others which are also putting a strain on the NHS. They are separate issues to the management problem and don’t make it less of an issue though.

The NHS is a victim of its own success. My dad was cured of cancer in his 60s and also had heart valves replaced. His normal life span would have been 60s but he's now late 80s and a heavy user of the NHS. He has lots of friends and neighbours with a similar story. Generally the older you get, the more heavily you use the NHS and we are living long lives now (generally)

It’s really easy to blame people for getting ill. Until you get ill yourself…. And honestly it’s not a road that leads anywhere good. Added to that, in my experience the specialisms, once enrolled in the treatment, are very good- it’s the general wards, GP services and Emergency that are failing.
I don’t know if it’s the individual managers of departments that’s the issue. But the overall high up management, at the point where processes could be joined up and change managed properly, then yabu.
The fish rots from the head.

Demographics is certainly an issue. There's a lot of magical thinking about dependency ratios and a naivety about what an ageing society looks like.

I think part of the problem is that the NHS is reactive because it is resource constrained. My endometriosis was diagnosed privately after years of back and forth with the GP that just gave me strong painkillers (which may well have contributed to my developing a form of IBD).

A family member has just been diagnosed with advanced prostate cancer in his late 50s, regular screening may have picked it up at a much more treatable stage.
Things that could be spotted and treated earlier are left until they reach crisis point when the treatment is more extensive and the outcome less certain.

You hear plenty of stories of people struggling to get referrals and then waiting ages when they do get them for an appointment. By the time they are seen some of them will have deteriorated and require more time and money to treat.

The big issues for me are underfunded social care and a lack of effective public health initiatives.