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

More social care workers, more nursing home placements

Less managers.

More GPs.

Weight loss surgery prevents so many other diseases.
I've had times in my life when I haven't been able to afford a prescription, it's quite dangerous. Eg not being able to get antibiotics , could end up becoming much sicker.

Agree, I’ve worked multiple trusts and used carenote, RiO, System1. Unable to access notes unless on HIE

Investment in earlier mental health support, particularly for minors - this will require major investment
Remove choice, it's inefficient and doesn't make the best use of limited resources
Increase budgets for staff, equipment and digital innovation
Changes to nursing rota's away from 12hr shifts which are difficult to deliver childcare around. I'd consider onsite nursery for staff, covering longer hours that make it challenging for clinical staff to continue working full time
More family friendly options of part-time workforce to retain people in the workforce at different times in their lives
Apprenticeship and trainee routes into as many roles as possible including nursing, pathology and radiology roles.
More GP's and other Primary Care roles to support patients to avoid them getting so ill that they need hospital
I actually don't think there are too many managers, it just appears that way because there are too few staff, the managers that I know do incredibly challenging and important work to keep patients flowing

But none of this will make enough difference unless we sort our the crisis of community care such as respite care, community hospitals and care for patients returning home

Reduction in obesity would help too, perhaps free or subsidised community sports facilities for the lower paid, unemployed etc

Make people pay - then they might use it properly.

How’s that enforced? Talk me through how it works?
what if patients pay and present inappropriately, then what?

I don't agree about health tourism. I have been to a and e twice in the last ten years and been honest, I haven't lived in the UK for years and am not entitled to free NHS as I am not a resident just a citizen but both occasions I have been asked to stick my mums address down. In London, the overseas finance officer was on long term sick leave and in Southampton they didn't have any mechanism for charging. I have global insurance. I don't want or need their charity and as soon as I am stable enough find a proper hospital which is paid for direct by the insurance. They don't care a jot about it, it's so wrong.

Have a proper system whereby every adult pays for health insurance and so thinks twice before wasting the time of health professionals. It's done in Australia and most European countries, so I've no idea why we can't do it here.

The NHS staff think they are above mundane details, such as payment and eligibility.

They know that they can cry about underfunding and all will be fine, more money will be poured dean the bottomless pit that is the health service.

Invest in prevention. Vast majority of diseases and ill health are preventable and linked to poor lifestyle: poor diet, burnout, lack of exercise, loneliness, addictions, chronic stress.

Stop dishing out pointless hospital appointments for the elderly - it was horribly stressful getting my Dad in and out of outpatients for appointments that little changed as a result of. We used to sit for hours in clinics full of elderly patients who'd had to get transport in and out/have relatives take annual leave to get them there for. I feel we've lost sight that aging is a natural process, and beyond 70 people only need to see their GP in the main or a specialist geriatric nurse. All this over prescribing should stop as well - when my Dad went under palliative care, he had a medication review and they found he was on about 7 different meds for reasons that no one knew!

We should invest in IT to allow people to work more efficiently.
I’m an NHs consultant. I like to use Dragon dictate ( AI ) to write letters. My PA is then organising and not typing. I can spend free up my time from admin to patient care.

I am much more efficient at one hospital then the other where the IT and admin support is better.

I would encourage early Treatment escalate planning. We cannot keep elderly people going indefinitely and we need to really consider quality of life . If people has to spend their own money to live into their 90s in a nursing home they wouldn’t do it.

The NHS will never be reformed while it is a political issue. No party will do what needs doing to reform it because it will lose them
an election. If the tories had any conscience they’d start something before losing the next election, but they just want to provide money making opportunities for their ilk.

It’s unfortunately no longer fit for purpose. More funding will not solve all the issues, because so much money is wasted. And because, as has ahead been pointed out - we can keep people living much longer now, and we have a growing population.

i think the biggest difference would be investment at either end, so to speak. So primary care to prevent unnecessary admissions and social care to get admissions out as soon as reasonable - at the moment there’s so many beds taken up by people who don’t need hospital anymore but haven’t got anywhere suitable to step down to.
Staffing is also a major issue, decent pay and conditions would help, and bringing back bursaries for training too.
And making people take responsibility for themselves - which I suppose is the bit the politicians are reluctant to tackle. Small charges for appointments, larger ones for no-shows. Change in attitude so certain types aren’t quite so entitled and learn to appreciate it a bit more.

And for those who can’t or won’t pay the insurance, then what. Do we decline treatment if not insured

In my opinion, things that need to happen are:

• stop investing in initiatives that waste money (PFIs for example)
• better investment in social community care and convalescence & rehab beds (huge amount of bed capacity is occupied with people who don't need acute hospital beds, but there is nowhere for them to go
• reduce management posts in certain areas and some non clinical roles
• invest in the education of clinical students and go back to bursary funding
• change system for booking GP appointments
• NHS being ripped off by suppliers in some cases
• easier for the NHS to discipline or fire incompetent staff

More money is needed, but some of it is clearly being wasted or could be much better used.

Unfortunately, even if all of the above happened, we have a massive problem coming, a culmination of:

• an older generation living longer and with it the issues associated with older age (dementia, strokes, falls etc)
• a mental health crisis (I am not sure where to start here, as the bottom line is a total lack of staff across all mental health specialities and not enough uptake of training places
• increasing obesity levels causing ill health at younger ages- diabetes, heart disease etc

More widely, our government needs to do a lot more to tackle obesity as pitting the emphasis on the general public to maintain their own health and eat well clearly isn't working (for a various reasons, but in my opinion the systemic issues are the most pressing)

Tax free or low tax salaries after 5 years service to retain experienced staff .
Ditch the internal market .

@HesterPrincess I agree . We need to accept that we should not try to live forever

For a start of, I would have a much more robust filtering system - if you're simply not unwell enough to be there and you CAN and SHOULD wait to see a GP, you should be sent away. You should also be billed if you've called an ambulance thinking that will get you seen quicker. No one should be in A&E with a minor cut to the hand that could be plastered in the meantime before being seen at a Dr's the following morning. No child with a simple virus should be made to wait 12+ hours in a waiting room - have more doctors working antisocial 'normal' lifestyle hours. Utterly ridiculous you can only see a dr between 9 and 5 Mon- Fri. Introduce a paid 'private' system to deal with this.

For people in my situation (serious illness condition which does require immediate attention at times and obviously this always bloody happens at an antisocial hour) there should be pathways/clinics that don't involve attending A&E. I should never have to wait 36 hrs in a corridor waiting for a CT scan to clear me. A CT scan should be bookable so I can wait safely at home.

Agree with the poster above about cutting down on free treatments and surgeries.

Charge patients for not turning up.

It's no so much the money - it's about how it's worked with.

In some clinical roles, such as nursing, the apprenticeship route started about 3 years ago (it is essentially a modern rebranding of the old registered vs enrolled nurse system)

It’s all about money. I also think pointing the finger at managers and procurement is lazy. All the managers I know do an exceptional job. Then our procurement process is insane and very demanding on the other companies time.

My number 1 suggestion would be to tackle poverty. Poverty is associated with poorer health outcomes, alcoholism, smoking, obesity and countless chronic conditions. A reduction in poverty would in the long term benefit to the population and NHS.

Next, I’d improve adult social care. Often our patients are waiting days for beds in care homes or care packages to be organised. The major problem with this industry can’t recruit staff. If you’ve ever worked in care you’d know it’s an incredibly hard job, with low status, for fuck all money. They need to be well compensated for what they do.

Third, there needs to be more walk in centres. Often people who come to A&E want to see a doctor urgently but can’t get in to see their GP. So understandably they come to A&E. It’d be great to have more services to bridge this gap.

Last, similar to point 2 I’d invest more in staff and trainees. Lots of lower band staff would love the opportunity to upskill but can’t afford uni or further training. Doing so will create more staff in the middle bands, attract people to apply to lower bands and improve morale. Also, most of the doctors I know are struggling to get on to training programmes! Furthermore, the number of medical school applicants far exceeds places. Talk about shooting ourselves in the feet. The accessibility to doctors in the upcoming years will only get worse. As such, this urgently needs addressing.

Last but not least gives us all a fucking pay rise!! No explanation needed.

No, I’m not. I work full time and earn £24k a year. Less than that when we lived for a few years in Oz and had to pay to see a GP.

Education. About lifestyle, money, food, health. If we had better educated people with better financial skills, able to cook and who understood how to look after themselves (from basics of a cut or graze to staying healthy to prevent heart disease) we would see the benefits down the line with less need for the NHS.
And definitely do the rolling age limit for smoking

I'd like to see lots of testing, use and development of Artificial Intelligence in healthcare. Small, pilot studies, lead by innovative professionals, tailored to their expertise and the unique demands of their area.

Cut out all the beuricratic bullshit and invest.

Im a surgeon, I trained for twenty years to get here. And now i am, guess how much time I spend operating on a 12PA job plan? (120% full tine equivalent)

46 days per year. That's it. And that's before annual leaving, study leave etc.

I do roughly 35 days of clinic per year.

All the rest is admin, and I still have over 1200 unanswered emails. That needs to go. Over half of my working life is paperwork, admin, letters, revalidation, micromanagement that someone far less expensive should be doing. You could almost effectively double the number of doctors by taking this work off them, but you'd still have to build more theatres and staff them.

Kerching! Address the poverty as that drives the health inequalities. Cannot Separate social issues and poverty from health. When we do prebirth assessment we consider the social,the poverty,the environment as it all impact upon health. Poor people are institutionally disadvantaged and that is evident in health outcomes

casual pejorative terms like frequent drunks, these are people who have trauma , mental health and social issues . Still need treatment. In health care, veterans,care leaver and individual who’ve experienced trauma are over represented . It’s all inextricably linked