How would you improve the NHS/ - A&E, appointments, waiting times etc

[DistinguishedSocialCommentator]

Please dont bang on about throwing more money at it

If you are a NHS staff - what would you do.

I'm sure different hospitals, groups of hospitals work differently, so are there any good ideas about?

IWe are too old and many medicals to get medical insurance but our children and their children all pay into private care plans but we are all aware we need a good NHS

So, is there something that apworks at your place and not others, what is it

I've noted that the gov has over the last couple of years set up many new CT/MRI sites and recently heard from a friend that people from abroad were running mobile units and weekend ct/mri's units in hospitals etc and waiting times were going down - that is good.

I've noted and was pleasantly surprised I had an ultrasound and then a camera investigation same appointment. In the past it was go for an ultrasound, then a camera if required.

I've also experienced Sat and Sunday scan appointments, last 2 years - so there is good news

However, A& E is a shambles, and worst of all, I've read re seriously ill people going to A&E having to wait hours at times

Should we get rid of more management?
Should we proparely look/investigate procurement?
Should we revisit all nHS staff's contracts especially consultants' contracts so the NHS could be more effective?
Should we seek a mandatory working period for mandatory hours by newly qualified NHS where the majority of the money towards their learning is from taxpayers?

Could we adopt a great system from another country and if so, where from?

the link below - I don't blame the consultants but the gov for not changing rules re payments for contracts - not sure what difference it makes if the doc was working at the hospital or not?
https://www.theguardian.com/society/2023/feb/12/nhs-consultants-run-private-firms-charging-to-cut-waiting-lists-at-their-own-hospitals

Your pitch is some what lacking. Don’t bang on about money? oh ok, so just ask people to make suggestions that don’t require any funding

worst of all, I've read re seriously ill people going to A&E having to wait hours at times ➡️ Seriously, where have you been past 15 year?

It's ALL about money!! There are literally no other solutions.

I’d free up some cash in the following ways :

• no more NHS fertility treatment, you don’t have the right to reproduce, sorry
• no more NHS weight loss surgery
• cut down on the huge volume of middle management positions within the nhs
• no more free prescriptions

then you need to find some way of appealing to clinicians to stay in this country when they get treated like shit and can get far better paid elsewhere… not quite sure what the answer is there but isn’t it clapping on the doorstep at 8pm

The NHS is a huge employer and it needs to be treated as such, rather than the state religion status it has now where you’re a terrible person for criticising it. It doesn’t actually need more money, it’s funded massively, it needs to be run more efficiently with the huge amounts of funding that it does receive.

I personally think that we need to spend billions:

-building new hosptials (an extra 2 for every existing one)
-increasing the number of GP surgeries by a factor of 5
-having clinics where you can go without referral (eg you have a problem with your ear, you go to an ear clinic and they deal with it).
-and most critically we need to pay ££££££££ to get doctors/nurses/HCPs to immigrate here to staff the above facilities.

But we will pretend that my solution is outlandish and instead people can continue to die from not getting medical treatment, as though we are a third world country.

Please dont bang on about throwing more money at it

Over the last 14 years NHS funding has not kept up with the ageing population. I'd invest.

Yup. Underinvestment is why we are in this mess

Lack of step down reablement beds adds to the DTOC. Underfunded local authority impacts as medically stable pts can’t be discharged, because there is inadequate provision

unsuitable buildings & poorly maintained estate
vacant posts
retention issues. Staff looking to work elsewhere eg NZ, Australia for better wlb and manageable work duties

creation of trusts has created a competitive internal market which is counter intuitive. It’s supposed be national health. We have regional health and different clinical services in each region. I would abolish foundation trusts/trusts

Make assisted dying available.
Stop treating drunk regulars.
Teach people how to take responsibility for their health, I'm astonished at some of the reasons people go to accident and emergency.
No free prescriptions for rich old people.
A means tested charge for every GP/A&E visit.

We just need some staff. We are so so short staffed. Staff are leaving continually. We have no time to support the staff who have just qualified.

Patients are living longer. Babies are being saved earlier and earlier. Patients are sicker. Our acuity is higher.

Every day we escalate our staffing. Every day we’re told the risk is ‘mitigated’ by management so it doesn’t show as being unsafe. Matrons appear in our clinical areas and tell us we have to get on with it before running back to their offices. There is rarely any help. There is little support.

I would like to work a shift where I don’t leave late. I don’t know what the answer is.

Get rid of tourist treatment. IE people coming here for treatment and then doing a runner.

Pay nurses better
pay HCA better
Generally better working conditions
train more belts professionals- make it an appealing carer
money money money

This virtually never happens, because you need an NHS number for treatment other than emergency.

Weight loss surgery ultimately saves money.
What happens to people with alcoholic liver disease, copd or other ‘self inflicted’ medical conditions. Seems a bit mean to deny bariatric surgery and and continue to treat other folk who can’t control their addictions like alcoholics and smokers.
Most middle managers are clinicians also. Band 7 and 8 nurses can be ward managers, modern matrons.
’No more free prescriptions’ - hopefully means tested.

Pejorative. The So called drunk regulars need care too . Frequent ED presentation is a marker of trauma and social issues. More than 3 ED presentations in a year is associated with higher risk of DSH and or suicide. Let’s not create a false hierarchy of need. If we had adequate MH triage and follow up ,the frequency of intoxicated ED presentation would decrease

i trained to work with everyone including the intoxicated

@calligraphee still happens, plus people pretend to be someone else to get treatment.

Invest in triage. Stop the stupid distinction between health and social care and pool budgets. Invest in prevention and supporting in a holistic way those with complex vulnerabilities. Would be a start. Stop internal market and competition. The NHS is no longer one organisation- it’s a system of multiple providers all under resourced with a drive to the bottom. I could go on….

My best friend is an A and E consultant. Having listened to her over the years, charge £50 for every attendance, and have a separate drugs and alcohol service.

A and E would be full of people that actually need it.

@Zone2NorthLondon Agree. Typical pointless thread with mainly random laypeople making ridiculous suggestions. The posts about needing more funding are spot on. More nursing staff, more HCAs, more allied HCPs and docs. Better IT systems and the same one used throughout the NHS rather than for example different EPRs from trust to trust

It happens a lot.

Also, GP surgeries don't check who is eligible or not.

Unfortunately 70% of it comes down to money, as others have said we need more buildings and staff. The other 30% is red tape, out of date systems and bad management.

I'm afraid you won’t like what I say, but we won’t see improvement without investment. The NHS has been systematically underfunded for well over a decade. However, I agree that the money is not reaching the proper areas.

In primary care, money is being made available to employ all manner of health care workers (eg mental health practitioners, pharmacy technicians, social prescribers, nursing associates, physiotherapists) BUT practices and PCNs are absolutely not allowed to use the money to employ more GPs or practice nurses. There are GPs who are looking for work, but practice finances are now so tight due no ongoing reduction in income and increasing inflation costs, that they cannot afford to employ more GPs or even replace leaving GPs. Often services that would have employed doctors are now preferring to save money and employ non doctor colleagues (who often cannot practise the full scope of primary care). Primary care is meant for be the gate keeping service for he rest of the NHS. If we don’t want the rest for the services to be flooded, we need to ensure primary care is funded and staffed appropriately. It needs to be somewhere people want to work, which it increasingly is not in the UK.

Sensible conversations re cost of care and outcomes. At a national rather than individual level. What is actually reasonable to deliver? How much acute healthcare is sensible to provide for over 90s/80s, accepting that no one should suffer in pain.

Increase pay, golden handcuffs arrangements to assist with retention.

Invest ++ in primary and secondary prevention, massive needs in child health and young adult care to reduce costs down the line.

Social care provision.

Tax ++ sugar, cigarettes, alcohol. License fast food outlets and only sell to over 16s.

Flood all of primary care with cash - scrabble around the couches for the last pennies, tax the rich, get rid of the HoC subsidised alcohol and meals - whatever it takes

Throw money at hospital avoidance schemes - virtual wards, district nurses, medically trained carers, home visiting GPs, OTs, mental health practitioners, physiotherapists, social prescribers, day centres and clubs where patients can socialise healthily - you name it, send them out there, pay them premiums to get them recruited and retained and don't pull funding just as we start seeing results

Make the pay rates attractive and people might stay

Sure Start schemes for children and families - targeting those with unhealthy lifestyles, obese family members, 'better dad' schemes, support for mums and subsidised formula, food and clothing

This can support literacy and numeracy, prevention of domestic violence, starting adults into education with short courses and give the children a play space that many lack

Then fling money at training and recruiting GPs and practice nurses, there are so few staff that most people can't get appointments with a nurse or doctor when they need one and patients end up in Urgent treatment centres or A&Es

Expand genetic testing for diseases, to ensure counselling and treatment are targeted at patients early enough to make a difference

More preventative screening - DEXA scans, regular tests for cholesterol, deficiencies, hypertension etc - super surgeries with scanning equipment and easy access to laboratories

Fund and manage nursing, care, hospice, respite and rehabilitation homes centrally but locally in a coordinated manner and stop relying on private companies - profit before people is precisely what got us here in the first place

Stop spending money on Band 7 and 8 managers whose sole responsibility seems to be to make up initiatives for staff and adding yet another badge to staff lanyards

Prevent people having to go to hospital in the first place and then hospitals will function as they should

NHS worker:
More GP availability/more walk in centres
GP ED triage
Charge for patient DNAs
Charge (small but enough to make people pause for a moment) for inappropriate ED attendances - however I appreciate this would take much work about inappropriate/Vs appropriate

However the best way is for the Tories to be removed from power and hope a new government do inject some cash.

We need to pay for it. Just because we don’t at the moment doesn’t mean it should continue that way. How that happens, I don’t know. It may be the Australian way or the US way but it’s clear to me it can’t continue the way it is.

and before people pile on, I know we pay for it through tax but it’s simply not enough.

@moreoutsidespace are you a higher rate tax payer ? Cos I know I wouldn’t be able to afford private insurance as well as NI and I’m not that badly paid.