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

We need to agree as a society that quality of life is more important than quantity of life. Stop treating a lot of people who don't benefit from the treatment. The number of people who have advanced dementia that I go to on the ambulance and rush to hospital for things like high blood pressure when it would actually be better to let them naturally die.

Improve the discharge processes and the coordination of patients in hospital. My aunt spent 14 unnecessary days in hospital because she was waiting for an x ray and no one bothered to book a porter to take her down one floor to get it for 6 days. When they did, they took 6 days to read it to say she was OK to leave, no one thought to take it to the radiologist 2 floors below, no, they just waited until one came to the ward. Another entire day was wasted because no one could be spared to go get the medication from the pharmacy, so she coudl be discharged. Then it was too late to boom an ambulance which led to another night.

Make people take personal responsibility rather than expecting the NHS to do everything. You don't need a GP to tell you to take paracetamol, stop booking appointments for no reason.

Also stop funding unnecessary things such as transgender services for new boobs because someone feels like they want them, when breast cancer patients aren't being treated.

Yes underfunding and also a huge waste of resources in so many areas. A family member works for the NHS and she is hardworking and above efficient and wants the next case to deal with but her superiors slow it down because they have a designated workload for the day. She has gone to different departments to pro activily seek out ways to help, and they have been so thankful to be dealt with immediately and not the next day, as I'm.sure the patients will be as well. Just my experience, I totally respect NHS workers but believe me backstage some areas could do more.

I'd stop routing everyone through A&E. my dad had cancer and his consultant (in an appointment) said he needed to be admitted. But dad had to then go downstairs in a wheelchair to wait hours in A&E to be then sent back upstairs to a ward. Completely inefficient as surely he could have just been sent to the ward he ended up in? No wonder there are such long waits.

Stop tax avoidance for billionaires and large companies

Get back the money the government gave away to their friends.

Give money to the NHS: they know exactly what to do in order to improve services, they just can't afford to do it.

Make the NHS one single organisation with one computer system, one set of criteria for each referral, one set of staff rather than locums/bank/private GPs. Stop wasting money on funded fertility treatment. Be realistic about treatment options for elderly patients- eg new hips for over 80s.

Much more joined up care. Eg rather than give an elderly with multiple issues 6 separate appointments all needing patient transport give them several back to back appts and tests with all the relevant staff (not “we only have an outpatient clinic on Fridays”). See also people with complex overlapping issues such as autoimmune and mental ill health.

There is nothing that can be done in the current shape or form.
No one is going to commit to funding it adequately.
Assisted dying needs to be brought in, but that's not really relevant to the problems in the NHS.
Probably the NHS (free at the point of delivery) needs to become an emergency only service.
Everything else and I mean everything has to be attract a payment. Certain groups could claim this back. Even so, the NHS should only offer basic care. No, fertility treatment, no breast reconstruction, no speech therapy for 50 year old learning disabled patients, no medications that cost over yada amount per person per year, no weight loss treatment or intervention. Every single treatment should have a measured success rate. None of this 'trying someone on a new treatment that might extend life by a few months '
If you want that sort of thing it's either straight to private via upfront payment or insurance.
I've just come from a ward of six ladies all around 90. Four on IV antibiotics for infection and two COPD management. All have severe dementia. We can't afford (ie society doesn't want to pay for) any of these treatments. None of these ladies should have been brought from their care homes for treatment. All of them should be on palliative care only.

Get rid of the current GP surgery system and have a centralised system where you can book online for a video triage call with a health professional who can offer an ongoing referral to a local health centre with a booked appointment which offer minor diagnostic testing and treatment

Invest in building more care homes and paying care staff a good wage with good benefits to attract and retain staff

Invest in preventative health care, focus on physical and mental health in schools - nutrition, mindful practices, exercise

Reopen the nightingales (okay rebuild) as step down care run by social services to free up beds. Better triage systems at point of presentation with those not in need of A&E care sent home.

I would bring money into the NHS by offering add ons so you want a 6am GP appointment not a problem it will be X. Jump a month/year on the routine waiting list not a problem it will be Y. Offer private rooms with a couch bed for X etc.

Invest in and make online differential software part of the consultation (incentive to use it) with appropriate streaming to Pharmacy, Practice nurse, PA, GP etc. You could also look at centralised services our local trust is building a diagnostics hub for example.

Did you know that every person with Learning Disabilities who does has to be investigated by the NHS, in case something was missed in their care that meant they died earlier than a patient without one? Even if no doubts that they had amazing care, even if they were killed by a truck hitting them whilst sitting in their garden.

This is one example of how things that seem good ideas end up costing millions.

Also the PP who said that we should go back to one NHS, no procurements which waste time and millions of pounds a year (most of it going into private pockets). At the moment there are too many levels of management due to the multiple structure. Primary care networks, then NHS trusts, then Integrated Care Systems and Integrated care boards, then regional NHS England teams then National NHS England teams. There should be one NHS organisation and it should cover it all. That way there would be less duplication.

More data analysts, more workforce planners, more admin staff. Why the fuck are clinical staff spending hours inputting into shitty payroll etc systems? So much time is spent on what used to be an admins role because successive useless governments have cut admin staff - clinical staff need to focus on patients and need admin support.

Next stop asking for everything to need a GP report or signature e.g. housing, education, workplaces. Hours upon hours of fucking form filling for other government departments.

And finally the Scottish government can just do one with their endless fucking quarterly and annual returns. You have fucking National systems, pull the data yourself. Stop asking for information all the time purely so you can score a political point. Constantly micromanaging. And as for the wankers that are political researchers, stop putting in FOIs. Fucking hundreds of FOIs from the Scottish Liberal Democrat political researchers alone. Fuck the fuck off and let me do my job.

If you think that is going to help the financial crisis many trusts/hospitals are in you’re either financially illiterate or delusional. It costs approximately £185 million a day to run the NHS stopping fertility treatment and weight loss surgery (obesity is costing the NHS a fortune by the way), cutting out some middle managers and no more free prescriptions isn’t even going to touch the cost of running the NHS.
Im particularly interested in why you think ending free prescriptions is going to save money, many elderly are on multiple drugs which they currently aren’t pay for, many can’t to pay for them. So for example if they cannot afford their anti hypertensives they could have a stroke and end up as inpatients in an NHS bed requiring very expensive treatment. There is a strong link between deprivation and poor health if those who are living below the poverty line often with multiple health conditions requiring medication can’t afford this medication they will become even sicker than they are now this costing the NHS even more money.

Change the funding structure of GP’s so they are direct NHS employees in NHS clinics, none of this private business malarkey (which dates back to the formation of the NHS and was meant to be a temporary concession as they weren’t happy, not a permanent solution). Have a standardised appointment procedure, no post code lottery. Also, if booking is centralised rather than only seeing ‘your’ practice, appointments are spread more evenly.
Every area should have a minor injury / walk in clinic.
Less disconnect between health and social care.
More funding for mental health services and addiction care (early intervention saves money over all).

Less fucking paperwork.

Start at the end and invest hugely in fixing the crisis in social care. Decent social care will mean a huge number if people can be discharged from hospital, freeing up ward beds, enabling people to be admitted through A&E or for routine procedures, freeing up ambulances etc. Basically unblocking the logjam.

Alongside this, decent social care will mean many more minor complaints do not develop into bigger problems that need GP appointments or hospital admissions. This then means reduced pressure on GPS, so it's easier to get a GP appointment when needed, hence fewer people showing up at A&E

But this will never be the solution chosen becauseits not a vote-winner - any extra money will go into the NHS instead, despite the fact that they can never fix the problem alone.

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

This is not how Australia works. Adults over a certain income are slugged by a tax if they don't have private health insurance. There's still bulk billing but less of it as government funding doesn't cover it, so fewer practises do it. You have to pay for ambulance cover unless a pensioner, a category that is not universal by age.

Agree. Local authority Social care does a huge amount of heavy lifting but is underfunded . Adequately fund local authority and fund preventative interventions such as EIS, and perinatal mental health. Fund reablement to support people on community
Fund virtual wards,
Recruit and train more SLT, OT, Physio

Nhs 20 years and worked in acute and community in variety of roles. Some interesting responses.

Agree with much of it. One thing that sticks out to me though is the arbitrary age cut off some are willing to suggest (I will say I specialise in geriatrics). I whole heartedly agree we need to be more pragmatic and open with our discussions around healthcare for older people, our objectives/wishes/aims/abilities/when to stop etc however we should also respect that they are still a human being! Some 90yr olds have great quality of life with good health and some 50 year olds are in terrible health with multiple health issues yet we go gung ho on younger patients despite evidence that their life expectancy and may be less than that of the 90yr old and risk factors for say stroke higher.

I also think we're all guilty of being apathetic now (because we're all running on empty) we've got so used to providing the bare minimum to keep people safe that we feel people are being 'entitled' when they expect more - that more is infact what we should be giving e.g compassion, care, being helpful and communicative, patient choice etc which isn't asking for much.

In short though issues from my perspective:

Investment.

• staffing, recruitment, retention. Nobody wants to work in a bloody hard job with little thanks, high expectations we can never meet, constant change, red tape, meaningless admin, have to be so educationally qualified but yet in comparison poorly paid, constant moving of goalposts........all for the 'love of the job'.

• social care and mental health, greater integration with health. Investment in mental health and long term workforce planning nationally.

• individuals and communities doing their bit in looking after themselves and each other.

• procurement. The NHS gets absolutely ripped off with a lot of supplies.

• ADMIN. So.much.of.it. to be legally defensible as lots of people want to sue and not for the right reasons. To enable data collection we have to click 50 boxes or use the exact phrase. More investment in AI systems for dictation for instance. One NHS IT system, currently in one job I use 5 different systems that don't speak to each other. Information everywhere, not much joining of the dots - relies on human time to sift through this.

Invest in public health and social care. Get long term workforce planning right so you have the right number of people training to go into the right jobs (HCAs, AHPs, nurses, GPs, consultants etc).We have NEVER achieved that.

Scrap the NHS.

Care to elaborate on the alternative? What provision, what funding?

Agree with most of the above.

Would also like to add - enable self referrals within NHS but at reduced cost for those who don't have private medical, say at 25% of private cost so some money flows into NHS that way.

Invest in primary care. If primary care was efficient and well targeted, things would happen:

1. People wouldn't rock up to A&E with a fungal toenail. Behaviour is driven by results. If it was quicker to see the GP than sitting in A&E, that's what people will go.

1. People will stop booking 'just in case I get ill and can't see the doctor' appointments, because they know they can see a GP at short notice (1-2 days) when they need to.

1. People would trust that if the reception team decided that a nurse was the right person to see them, that's who should see them, because they wouldn't be fobbed off.

1. Doctors would develop a trusting relationship with their patient and they wouldn't spend 5 minutes listening to back stories before actually dealing with the patient.

That would reduce demand in urgent care, meaning that more planned/directed hospital care could be given.

It would also mean that patients are treated more quickly in hospitals, reducing the number of critical care admissions.

Cottage hospitals for rehabilitation would be reinstated so that flow out of acute care could be managed.

@totallybonkerswarning a lot of community services are provided by private companies already- some of these services are rated far worse than the NHS. I am not defending the current model of the NHS, but turning private doesn't automatically equate to improved services.
Additionally, this means that service can be halted if the provider goes bust (which has already happened- https://www.quantuma.com/insights/orla-healthcare-limited. )

I agree that there needs to be a brave review of healthcare and a lot of uncomfortable questions, and a willingness for someone to implement a proper long term strategy that goes beyond the next general election

charge everyone an additional tax alongside council tax that is just for NHS & social care that increases with inflation with a breakdown of cost allocation and make any policy decisions non-political.