Do non NHS people realise how bad it is at the moment?

[DoyouknowJo]

I had to justify to my managers manager why I needed to spend £7 on stationery. Stationery. Some biros, some staples and a box of envelopes.

One of my colleagues chairs broke and she was told to apply to charitable funds to get a new one.

Everything is held together with sticky tape and blu tac (literally and figuratively)

We have four members of admin staff bunched into a desk meant for two, because there is no money to pay IT to put a new port in on their desks.

Waste toner cartridges are on lockdown. If yours is full you should take a scalpel, cut the seal open, empty it and then stick it back together and put it back in the printer. Don't worry about all your printing then being covered in smudgy ink. We're broke ya know.

And some fucking idiot turned up to A&E today...because their arm has been hurting for two months and they are off on holiday tomorrow and could we sort it please.

I'm thinking of starting an anonymous instagram account to get all this crap out.

@oliversmumsarmy - I think you and I may well have discussed before the wastage incurred as a result of hcps plain NOT LISTENING to patients! If gp's had listened to me - and if referrals weren't financially disincentivised - my endo would have likely been DX within 2-3 years rather than 14! This would not only have saved money on at least 8-10 primary care appointments per year for treatment of symptoms and me trying to get a DX, but despite me asking hcps directly on here and trying to find out myself also the cost of treating the 2 mc and twisted ovary that were likely due to the condition. The twisted ovary and 2nd mc both required surgery and the mc a lengthy hospital stay!

Ditto dds disability which we didn't get a DX for 12 years despite 3 clear and unusual symptoms/indicators at birth, repeated visits to gp surgery and a&e for further multiple symptoms (I swear we were on first name terms with X-Ray dept at one point!).

Even now she has her DX the GP surgery STILL don't listen when either her or I say "yes she's prone to X condition/infection because of her disability so we've been TOLD by the consultant at the first hint of Y symptoms she's supposed to see a GP NOT a nurse as she'll more than likely need z prescriptions ASAP to treat and your practice nurse can't prescribe that" we get "told off" for seeing GP rather than nurse (unless it's one particular GP who DOES listen and understands the condition, but is unfortunately part time), denied the treatment - only to have to use up ANOTHER appointment days later as the issues HAS AS WE PREDICTED worsened and requires more aggressive treatment. This can and does include stronger prescriptions, longer prescriptions and additional prescriptions - which MUST be more expensive than if they had LISTENED in the first place!

"There are forever clear advice posters/notes on social media about what to do and where is appropriate to go with a problem" that's all well and good IF patients can access the primary care practitioners in a reasonable time frame, but that is becoming increasingly more difficult!!

Education/public info is definitely one factor, I'm in Scotland where our local tv and radio seems to do this loads! Plus there are posters in pharmacies, dentists and opticians saying basically "did you know we can deal with X y z health issues?" In very clear easy to understand language.

But where certain services are cut to the bone and hard to access, knowing you SHOULD be seeing a dentist/GP but you can't get an appointment - perhaps can't even get registered! Then desperate, anxious and in pain patients will end up in places like a&e.

One county I lived in there were for several years NO dentists taking on Nhs patients, this was quite a while ago now, when a new dentist opened a surgery and was willing to take on Nhs patients people were queuing for over 24 hours to get registered - it was on the news!

And that was over 10 years ago and I hear the situation is now much worse - but it's so common now it's no longer newsworthy!

The procurement function needs centralising and upskilling, there is also an element of patients needing educating on what is the most appropriate service to utilise; this would probably require extra investment in GPs etc, but honestly, sorting out the procurement function could save a lot. Stationary should be a lot cheaper on a framework than available on Amazon etc, but they seem to run on ineffective ones which are too skewed to the suppliers benefit.

@HerRoyalNotness I'm all for spending to save in the long run, but I don't think many people would be a fan of the NHS spending £250 million for a company to come in and try and make efficiencies. Some of the improvements are glaringly obvious, and there are other public sector departments who could help. Even the learning from that exercise could be applied, there seems to be a real taste for private companies getting paid ridiculous amounts which could be invested in staff training, more staff or retaining highly skilled staff who leave to become contractors.

Honestly I think that kinda thing is largely down to corruption!

Too many backhanders and similar going on! Contracts being awarded due to nepotistic type practices, or in order to get preferential treatment for another contract.

District nurses do house visits for patients who are housebound.

They keep missing some patients as they are out shopping.

If you can go shopping, you can visit the practice nurse to get your dressings changed.

You don't need to see a doctor for that and calling out the out of hours GP, because you've neglected yourself for nearly two weeks isn't a good use of NHS resources either.

I wonder if some regions are worse than others? My mum works for the nhs and doesn’t have any problem getting stationery etc - she works in the cardio dept of a hospital.
That sounds truly awful.
I have to agree it’s not just cuts and funding that are the problem, the nhs seems to be severely mismanaged all the way down - in our experience we’ve been given appointments that were a total waste of time (to where the consultant has SAID basically why are you here? And it’s because a box needs to be ticked so we can get onto the next stage, this has happened many times and it’s an utterly ridiculous waste of time and resources).
I also have to agree with previous posters about people wanting to get things like kids head injuries checked - half the time if you can’t get a gp appointment, you phone 111 and they tell you to go to A&E immediately - you’re not going to ignore this advice when your kids health could be at stake, and you’re definitely not going to be thinking about post it’s and staplers/printer cartridges either unfortunately.

It must be such a frustrating environment to work in.

We’ve recently looked at a private healthcare plan because we just don’t believe that if one of us got sick the nhs could offer us the adequate care within a speedy timeframe if needed (despite the pathways that have been brought it).

Ok - health tourism is a very small proportion of nhs budget. I would guess people would tend to be younger and require shorter hospital stays. Money spent chasing this money would also eat into the money recovered (some people would not be able to pay etc).

MRI after head injury is unlikely to be because of suspected acute bleeding. CTs can be done at any time of day if that is suspected but have the drawback of higher radiation (not a problem for a one-off scan but enough to make you do risk/benefit calculation), and being less detailed for certain things. Sometimes if people do not know the alternative diagnoses being considered and the relative probabilities of these, treatment and investigation can seem baffling. I’m very sorry for people who have had wrong diagnoses. Sometimes symptom progression helps give important clues - diagnosis is much more like trial and error rather than House.

For wastage cutting: STOP PFI.
Basically it is where a private company injects some capital cash into building a new hospital and then gets to charge £20 for changing a lightbulb and maintaining a hospital for years afterwards. Contracting for cleaning, maintenance has to go through them and they make oodles in profit. Basically govt shove the cost onto future Better to wait while govt builds up funds or takes on some debt (interest would probably be less than pfi).

I see that the NHS is struggling, when you have 3/4 staff on a ward of 40+ patients. It can take just 1 patient having an issue, staff running around, then 1 person is left to look after the other patients with varying needs.

A&E though is tricky, as I have chronic issues, one time they said this really isn't for A&E, I spent a couple of hours really struggling, till a Dr saw me and admitted me, for what ended up being a 6 week stay. It's not always black and white.

A bit like when you're at the Dr's and you see kids tearing around, they're the patient. Something made a parent want to see a GP it's not for me to judge.

Two years ago whilst in Spain my leg started to swell up and I couldn't walk on it so paid to see a private GP who wanted to rule out DVT so referred me to the nearest hospital (state run.) I had to take my passport and EHIC card in order to be seen. Luckily it wasn't a DVT and I was in and out within an hour, this included triage, seeing an A&E doctor, leg scan, and being prescribed tablets and discharged.

If other countries can do this, why can't we?
Agree with others comments re health tourism, it's not that time consuming to check if someone's entitled to free treatment.

"Sometimes if people do not know the alternative diagnoses being considered and the relative probabilities of these, treatment and investigation can seem baffling. I’m very sorry for people who have had wrong diagnoses. Sometimes symptom progression helps give important clues - diagnosis is much more like trial and error rather than House."

Patronising much?

I for one am not talking about just misdx, I'm talking about NO "alternative DX being considered" NO investigations NO diagnostic testing NO appreciation of the pain Abc suffering caused - not only physical but mental also, sometimes even being denied pain relief!

"Symptom progression helps give important clues" - well yea IF hcps actually bloody listened! I've a ton of scar tissue I didn't need to develop which cause me ongoing issues, dd has very reduced sight as a result of treatment being delayed. She also has joint erosion AT THE AGE OF 18 because of the delay in accessing a DX and treatment - that's the consultants assessment not mine!

Textbook symptoms of endo which were COMPLETELY dismissed as me "overreacting" and "exaggerating" for 14 years.

Dd with textbook symptoms of her condition ALSO being COMPLETELY dismissed - and in her case that included VISIBLE bruising, extreme swelling, skin discolouration etc

Outright REFUSALS to refer to specialists, which certainly my endo symptoms clearly indicated that a referral to gynae was necessary -

And it's STILL happening to current sufferers which really infuriates me! Not least because it proves GP's are even ignoring NICE guidelines on such matters.

In what way is any of that REMOTELY acceptable? And given the ongoing health issues caused how has it saved money?!

Last time I used A&E, they had a super triage system, run by nurse practitioners, I got told off for leaving it 2 days with a broken foot. Yet most people, well I'd like to this, put off going for as long as they can.

A great example, dearly departed friend, who became ill, it looked like they were drunk in every way. It turned out to be a stroke, as a complication from an undiagnosed brain tumour, they needed an imminent transfer elsewhere.

I won't even mention psychiatric provisions, crisis MH team unavailability, which sees patients in A&E get fed up at how they're treated, as they're deemed to be a risk the police end up escorting them back to hospital, to make sure proper help is instigated.

Some people realise.
A lot of people don't have a clue, and don't want to listen.

They should put boxes for voluntary contributions in all the waiting rooms. My children’s schools ask for voluntary contributions now so why shouldn’t the NHS?

The arm thing, though, has been around since time in memorial. Sadly, always will be as everyone assesses their situation differently. Its wrong and a burden but its not really their fault everything is so bad. It distracts from the true source - the inability of our Government to take action to fund correctly.

I work in the NHS. Everything is in meltdown. The standard wait for a serious but non-life threatening call is 3-4 hours in my experience. A colleagues of mine had an accident a few months ago: tripped and broke her hip. In absolute screaming agony as you can imagine, and needed a specialist team to move her safely as she was completely immobile. 4 hours it took for her to get an ambulance and proper pain relief, because there aren't enough ambulances and they keep getting diverted to life threatening calls meaning that people that need urgent help (but aren't in immediate danger) can wait many hours. This is standard now.

it's not that time consuming to check if someone's entitled to free treatment.

But it is extremely time consuming to then follow up on those who don't seem to be entitled. Should they be treated anyway? What if they are not treated and then get worse/die? What if the NHS is sued for negligence etc etc

The NHS has been chronically underfunded and understaffed under this government so it is not surprising that it is on its knees (and yes, there were problems before but not to this extent). If Brexit goes through there will be even fewer staff, greater staff recruitment problems and less money so expect it to get a lot worse.

Stationary really seems to be the area that's been cut back across the whole NHS, within our department we're having to buy our own elastic bands and poly pockets now, staples are rationed too.

Precisely why I have purchased private health Insurance.

It was a real moral dilemma, but ultimately it was the right decision for my children and I.

I actually went with a company founded by an NHS consultant general surgeon. It’s basic, it’s cheap, and it has been the best purchase I ever made.

The money NHS wastes on procurement. It would save a fortune if we didn't have to buy supplies from one source. Items are double the price that you could buy else where.

Then the cost for maintenance. Put a shelf up we already have £250.

Yes we are on our knees but there are massive savings that could be made. It wouldn't sort the problem out but it would make a difference.

The 2018 inpatient survey showed that
Most respondents (80%) felt they had “always” been treated with dignity and respect during their hospital stay (82% in 2017) and only 2% said they were not given enough privacy when being examined (unchanged since 2017).
Of those who had an operation while in hospital, 80% said that staff answered their questions in a way they could understand “completely”. While this remains high, it has dropped slightly from 81% who said this in 2017.

More than two thirds of those surveyed (69%) said they “always” had confidence in the decisions made about their condition or treatment, a decrease from 71% in 2017.

The proportion of those satisfied with the time they had to wait to get a bed has decreased since last year (63% in 2017, down to 61% in 2018).
Of the 41% of people who said that their discharge from hospital was delayed, over a quarter (26%) said they were delayed for longer than four hours.

It’s not all bad and majority of 750,000 who responded were very positive about their experience. Most people get very good care in very difficult circumstances.

There is chronic underfunding and estates in many area (particularly some of the London teaching trusts) are not fit for purpose with collapsing ceilings and broken lifts as well as potholes in corridors. Trusts have to decide whether to patch up the flooding wall or buy pens.They are overloaded but then fined if they don’t meet targets.

Brexit has seen a huge loss of qualified nurses and fewer recruits.We aren’t training enough to meet demand and many who graduate don’t enter nursing.

People waste what we have and have lost common sense/awareness of how to manage common complaints and don’t respect the experience of the previous generation as they did. Collective wisdom has been loss.

Can you imagine turning up to a GP to ask if it’s OK for your child to do judo and swimming during the school week, or will they be too tired? Or going along because your child has chickenpox?

People call ambulances because they’ve a tiny burn from a kettle or have fainted, having been standing for a long time. We’ve become neurotic and afraid to cope. Far too many wasted trips to GP and hospital.
Far too many drugs given out that can be purchased from Boots. Painkillers to manage side effects of not exercising and loneliness are never going to be effective but cost NHS £445 million annually. That’s about poverty usually, with more affluent areas in the south (Richmond) spending £3.4 per capita compared to say Middlesbrough with £14.8 per capita. We need to address poverty not dump the effects of poverty on the NHS.
Immigration has a net benefit. Hospitals could not run without foreign nationals generously giving us their skills and time.
Health tourism is minimal and costs to recuperate spending high.
We spend much less per person and much less as percentage of GDP than most of the developed world. We have fewer beds per person than most of Europe.

NHS is actually very, efficient and effective but suffers from ridiculously high expectations on ridiculously low funding.

In my hospital, the heating has to stay on all year because the heating system is so old, if they turn it off, it likely won't turn back on for the winter and there isn't funds to fix it.

We have toilet waste coming through the ceiling of our admin teams office from the ward above. Patch up only as there's no funds to fix it. No one to clear up so clinical staff regularly have to stop seeing patients and run round with towels etc.

IT systems are so old and slow that for every 10 mins on the computer, 5 mins is looking at a whirring circle.

We've never had stationary, all has to be purchased ourselves (except photocopier paper and franked envelopes)

No cleaning budget for the clinical areas and patient toilets.

No training budget so all staff gradually becoming deskilled (in my clinical area I mean. I'm not allowed to keep the skills up of nurses in my non nursing specialisms for example which directly affects patient care)

I love my job, my patients and the nhs, I just wish it hadn't got this bad and we could actually do the job properly.

I agree

But then I think we need to look at other parts of Europe and how they manage healthcare

Do you work for the NHS Cherry?

Efficient I fail how to see that at work what it relies on is many of the staff working ridiculously hard to just about hold things together and often that isn’t happening (and sadly a number who don’t but that public sector work culture)

I would agree with that. Every year, we work harder to make up for short staffing and to patch cuts.
The trouble is, that can only go on for so long. Morale is incredibly low.

Senior managers getting involved in biro purchasing are your problem OP. Not patients presenting to be seen. You’re angry at the wrong people.

I know someone who hit their head and had bad headaches for 2 weeks (and counting) that had to wait 6mths for an MRI. They could be dead by then. It’s disgusting what you have to put up with

Maybe let your friend know that they can pay for their MRI privately and then they’ll have their answer. If it was me and i was faced with ‘possible death in 6 months without this scan’ I know I’d be finding the money for it.

Worked in the NHS for 20 years. Frontline. The problems are so many and so complex there is no one fix.
The wastage
The unnecessary management
Poor procurement
The explosion in various patient numbers- mental health and elderly care are the 2 obvious ones.
The ability to treat an ever growing list of ailments......but should we.
The entitlement by patients to their IVF, gastric banding, hospital transport, free car parking (someone has to pay for the upkeep of the car park and if it isn’t outsourced that money comes from the budget to treat your sisters cancer)
Lack of education- whilst on one level I agree with ‘who are you to judge whether I think my child needs to be seen’, but at the same time, what exactly do you think might be wrong with little Jonny who fell over and banged his head 2 hours ago, got straight up carried on playing and aside from the small bump on his forehead, is completely fine? You will wait 6 hours to be told he is fine.

I saw a patient a couple of weeks ago who waited NINE hours to ask for advice on sneezing with his hay fever.

There is no answer, but it will be run into the ground and privatized and then at least some of us will have a better working environment and some patients will get faster treatment.

Those saying ‘get a job somewhere else’. Like where? It’s a monopoly and unless I leave the country or change I have no alternative but to work in the NHS.