Wtf is going on with the nhs, is this the new normal?

[letdownchristmas]

I was in A+E with a relative yesterday with a suspected pulmonary embolism (has a history of this ) although luckily turned out to be all clear. We got there by ambulance at 3pm yesterday and was on a trolley in the corridor until 9pm. There were 15 people in the corridor on trollies with ambulance crews waiting to be handed over. All I could think was how the fuck are there any ambulance crews left on the road when they are all waiting in here to hand patients over. I was told that that this is a fairly normal day now. On the electronic board I could see that there was a 42 hour wait for an inpatient bed and only 56% of people met the four hour target. A 7 hour wait to be seen for walk ins. It honestly frightened me as to how the nhs is going to survive another winter.

We spend so much less than comparable countries on our healthcare and the tories are privatiseing what's been run into the grounds. Three NHS staff in my household and our income has fallen a lot relatively

NC for this.

I agree that this is terrifying - I am in Wales and it is awful here. There are a myriad range of factors, but here my thoughts. (I work in Social Care)

Aging population with complex health needs. Beginning to deal with the generation of older people who did not look after their health to be frank - I think the pre baby boomer generation did so more. So we are seeing huge implications from obesity, drinking, smoking, inactivity and so on. And continuing to neglect health even after diagnosis’s for diabetes for instance.

Social care deficits - lack of suitable care homes. Individuals and families not prepared to pay for care homes. Waits for care home placements. Social work shortages. Lack of home care and carers. Poor quality home care. Limitations in what home care can provide - for example - in Wales, the Government pay for the bulk of home care costs. But they will not do cleaning, shopping, laundry and so on. We have so many people with no additional support and no capacity to make necessary arrangements. There are no meals on wheels any more. Home carers do the bare minimum.

Lack of funding for voluntary sector organisations means that support groups, befriending groups, practical help in homes for older adults, volunteer drivers and shoppers etc have gone.

very little rehab beds /convalescence anymore. All care homes and home care commissioned privately. No day centres.

Complex needs - we cannot get support to older adults with complex needs - mental health including advanced or challenging dementia, substance misuse, aggressive behaviour, chaotic home conditions, homelessness and so on. This means that we can see people living in squalor, unable to feed themsleleves of look after ghemselvs in any way that we cannot access care and support, or care home placements for. All care homes can now cherry pick and opt for the more straightforward residents. So these people bounce between home (or being homeless) and hospital.

Mental health services and Capacity - massive issues due to lack of resources. Not enough EMI nursing home placements. No MH hospital provision. No emergency MH intervention for people. People with dementia being violent to vulnerable family members and no help from MH services, and no SC home carers of care homes prepared to work with them.

All of these people end up in the revolving door of A and E.

Keeping people alive with antibiotics etc. No assisted dying laws. Going back 20 years ago, some doctors could and would quietly ( and with family or individual agreement) increase morphine to enable someone to quietly slip away. You can’t do that now. So I see people in nursing homes who, for 5 or more years, have been bed bound, turned every two hours, no capacity, no speech or apparent awareness or what is happening to them, no family visits, spoon fed soft food, given drinks and so on - and still on meds for diabetes, heart conditions etc. And then when they get UTIs and pneumonia, treated with antibiotics and get better and so it goes on. Many of these are over 100.

Social care have the same issues with too many managers in teams meeting spouting coporate rubbish!

What needs to change:

The million dollar question. But I would start with:

Get the tories out.
Stop employing managers who don’t come from health or social care backgrounds.
Stop outsourcing everything (home care, care homes, day centres etc)
As soon as someone is stabilised, move to community provision.
Bring back community hospitals
bring back district nurses in much higher numbers.
increase palliative care options - hospices and community teams.
Pay family carers decently
Change assisted dying laws and give us dignitas! Stop trying to keep people alive at all cost, consider quality of life.
encourage everyone to complete advanced health directives and register them, so that unnecessary medical intervention can be stopped.
People have to start taking responsibility for their own health!! And thinking NOW about how their decisions now will impact their old age. And I will sound totally preachy but those people who are eating huge amounts of UPF, not exercising, drinking too much etc etc - are the NHS problems of the future, and it is getting worse.
By the same token, there needs to be restrictions on advertising and sales for the crap. Why are our supermarkets 40% UPF and then with shit quality fresh food - look at the difference in an average French supermarket? Why is it seen OK to sink 2 bottles of fizz and get pissed every 5 minutes?

There are also massive issues with MH services in general and A and E being clogged up with people with MH/drugs etc but I won’t go there for now.

i would also add (and I will be unpopular) that I think that certainly whilst there is such a crisis, that certain NHS services should not be available to people, or at least should be very low priority. I don’t want to say means tested because it goes against my political beliefs but I am uncomfortable with things like plastic surgery, (apart from bariatric because of the implications that obesity has on the NHS), seeing Gp for meds that can be obtained over the counter.

I am not sure what to say about fertility / trans NHS care - both very complex - but conversations need to be had.

I could keep going for hours but I will spare you! 😂😂

Yep, I had to have a suppository inserted into my anus, in the corridor, on a trolley.

To be fair, they gave me the choice - on trolley or wait another 6 hours for a room to receive it (pain relief) … and an orderly did hold up a blanket as a kind of make shift curtain. 🤷🏻‍♀️

There needs to be far more investment in prevention - getting more people to old age in good health. We need holistic long term planning - but that’s hard when politics works to a 5-year cycle.

No point just blaming the Tories. Labour are in charge in Wales and SNP in Scotland. NHS is just as bad there.

The current set up no longer works. Pouring money at it isnt going to work and without fundamental change it is going to collapse.

It's no good claiming everything would just automatically be better under Labour. You'd think so due to the ideology of the party, but in the past they've not been financially competent enough to be able to maintain their improvements. Like the police in the early 2000s: mass recruitment and investment, everything looks great for while, and then the whole thing turns out to be unsustainable and it falls apart.

I was in a&e recently and there was a 10 hr wait. There only seemed to be 2 drs working. I was hoping that was just circumstance and not the normal.

MIL was rushed to hospital after a suspected heart attack last week and it took 11 hours to get her a bed.

She's now on a ward where, in fairness, she's being incredibly well taken care of but the state of A&E was shocking and this was just a random weekday.

Funding is an issue, as people expect more expensive and more complex treatment these days… whilst only ever voting for lower tax. Some people will vote for higher tax, but often only if “they” pay it eg “they should pay more tax”.

The 5 year elections produce short termism. Sorting out the health system is a political football, where parties (both) throw some money in the pot (for votes) and kick change down the road.

i do wish parties would form a cross party group on this issue, come up with 4-5 different, fully costed models and then put it to a separate vote as a referendum.

Yes sadly this is the “new normal “ my 79 year old father had just spent three weeks in hospital with double pneumonia , he also has terminal cancer .. was discharged and ended up being taken back in again a day later .. he spent 36 hours on a trolley in a and e have iv antibiotics as the pneumonia hadn’t quite cleared up .. then was discharged last night in a terrible state with antibiotics because there were no beds ..

I'd say you were lucky. In my city it is frequently a 72 hour wait. That's 3 days on a trolley in a corridor for many patients. We are seeing more complications of this in ICU - pulmonary embolisms and advanced pneumonia.

I had to go to urgent care recently as my GP would not see me for an ear infection. He sent me to my pharmacy who said they didn't have nhs funding to see adults only children.

2 mins for antibiotics but I clogged up the system because I couldn't see my GP.

Some of it is just that an and E /urgent care is the only place to go when the gp won't see you.

Tbh it’s not even 5 years anymore. ICBs & local councils get the budgets in 12 month cycles. The planning guidance for the NHS for 24/25 was released on 27th March fgs. Where I work budget allocations have not been done beyond headline figures so I’m working with people who have no idea if there is still funding for their job from next month. Proper prevention activities take 5-10 years to show impact. With 12 month budget cycles we’re screwed before we even start

err of course it was sustainable, the Tories though, chose Austerity & cut 21k Police, closed down all the Police stations and made it almost impossible to visit a Police station.

Same with NHS, other countries simply do not have the issues with 72hr AE waits, 8m on waiting lists and millions on long term sick... yet we have all gone through a pandemic etc

Why are we so much more worse off?

The analogy would be keeping your house well maintained, if you don't, it costs more in the long run and thats where we are now.

A lot of it is also to do with poor social care - too many bed blockers.

Costs hundreds for someone to be in an NHS bed for one night, even more so when they don't need to be in hospital.

Also lots of people doing agency work at a much higher cost to the NHS even though they're still working in the same places for the same patients, or doing private work as well as NHS.

And lots of small cuts that make a huge difference over time, e.g. getting rid of subsidised/free nursing training for low rung staff where they could work in their current social care/care worker NHS job while training to be an NHS nurse and progress their career with no loss to worked hours or income.

Get private health insurance as a priority

Social care needs to come down to families taking more responsibility for their "elders" as happens in many other countries or investment in more care homes/facilities. Tereasa Mays proposal was politicised by Labour as a "dementia tax" now no-one has any proposals.

Part of The problem is that demographics and society have shifted massively. 20% of people over 50 don’t have any children which bluntly is where the main source of unpaid care for older people comes from, 50% of people over 75 live alone, families stretch over several generations but generations are now much smaller so there are fewer nieces and nephews. People move about more, there’s more family estrangement & I can’t see society changing on that.

we have to have some adult conversations in this country about how we care for our older people but successive governments have just whanged on about how to save the family home if people go into residential care - but the vast majority of older people don’t go into care homes, it’s support to stay at home that they need but governments don’t want to talk about that

I think some of it is luck, and also where you live if I'm honest. I'm not for a moment denying the awful waits that people have described happened, and I know relatives who have been treated appallingly.

My own experience of the NHS however has been excellent, especially for emergency care in my local area. I've never waited more than 15m to be triaged, and the longest I've waited (for a child) had been 5h, but that included getting x rays done and then treatment. When my mother has been, she's been in and out of A&E within 1-2 hours.

They are also quite good at GPs referring straight to the department at hospital. My children have been sent straight from GP to pediatrics several times, with the department anticipating our arrival.

Equally, only a few days ago, my mother went to a GP with a suspected DVT (had significant history), GP appointment requested and happened that morning, and they arranged for the hospital to do an immediate scan, bloods etc that afternoon, bypassing A&E.

So it can be done. I'm not sure why there is so much variation though.

Yes it is the new norm and yes it has got much worse.

I have friends who are doctors in two different hospitals - practising for over 20 years - the deterioration is horrifying to them.

Yes the population demographic has changed and yes it has grown but any government genuinely interested in a social healthcare system should have planned for that.

The Tory party has never been interested in social welfare - it’s the party of individualism. Lots of voters are also about individualism - until they find themselves ill and dependant on a crumbling NHS.

Lots of voters are more interested in traffic restrictions than the NHS.

As much as I like criticising the Tories, this situation is a product of failures of several governments. I remember being a child in the 80s and discussions on the news about bed shortages. In 1987 there were 300,000 hospital beds in England. In 2019 there were 141,000 beds. Over the same time period the population of England has gone up by almost 10 million. And that population is much older. Is it any surprise that we have patients lining the corridors?

I would start by sorting out social care. An inability to discharge patients into care homes / packages of care is causing massive congestion in the hospital which backs up all the way to the paramedics at the front door. And we need more beds!

I feel so bad for patients and relatives caught up in this. It is scary that these terrible conditions have been accepted as the new norm. No staff member wants to work like this. No staff member would want their family to be treated like this.

There's no evidence that changing the funding model would achieve anything except an enormous increase in meetings.

I agree that the slogans 'bring back matrons!' 'Too many managers' are basically nonsense. There are matrons (your band 8s and 9s). There aren't enough managers if anything. We were made to run our team without a band 8 for 18 months and lost most of the frontline team. I know that people died earlier than they should have done as a result. We got a band 8 at last, things improved, we are providing something timely to people that looks like a service.

Desperate times has brought some good innovation round here - urgent community response is fantastic, hub beds (NHS-funded beds in nursing homes, orders of magnitude cheaper than acute hospital beds), ambulatory care unit (essentially a GP referral unit where people come in to hospital for all the complex investigations that it doesn't make sense to provide at a single practice level) and some truly stellar GPs. It does in the end come down to supporting GP practices and social care.

None of these projects would have happened without managers. Some of whom are clinicians and some aren't. The manager who dismissed the consultant blowing whistles about Lucy Letby was a nurse.

100% agree with the posters saying that people need to take responsibility for their own health. This starts with education though. Schools could help children learn how to feed themselves properly, about their health and exercise and money management. So many people are lacking life skills.
My partner recently had a stay in hospital via A&E for a perforated bowel. A&E were absolutely amazing, he was having a CT with 20 minutes and the surgeon was waiting on his return to review the results.
The ward however was a different story. Completely disorganised. My opinion is they need to bring back Matrons.
Back to looking after your own health there was another patient on the same ward with bowel ulcers. His diet consisted of several 2ltr fizzy drinks, crisps and sweets and cigarettes. Enabled by ward staff. It’s just bonkers.
I could go on and on and on.

I can't even get bloods done
We have blood clinics every day of the week at various doctors/health centres
You used to turn up and you would know which were quieter at a certain time etc, take a ticket and longest I waited would be maybe 30 mins

Now? They open at 8am except they don't because people queue from 6am so by 8am they are full and not accepting any more people. 3-4hr waits are the norm otherwise
I'm meant to have them done every 12 weeks and the hospital are getting shirty with me

Oh and my first gynae appointment for endometriosis that has left me ringing 999 was cancelled 6hrs before I was due in

It's a years wait
That was March and they rebooked me for December. I rang the secretary in the end and cried and they have got me in for April provided it's not cancelled again

But if all the urgent slots have gone and here is no capacity to see you, what else are they supposed to do?
We must get a dozen ear infections a day, multiply that by ten minutes and that's two hours of seeing ear infections alone. What other 'urgent' do we not see to see your ear infection?
Not enough staff. Not enough hours in the day. And if the number of HCP due to retire in the next couple of years at our practice is anything to go by, you ain't seen nothing yet.