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

I sort of agree with some of the principles of your post but I think it can be really easy to be short sighted on this.

No fertility treatment = higher mental health costs

no weight loss surgery = more diabetes and heart disease cost for those individuals or even fixing botched surgery from abroad

no more free prescriptions = lots don’t take their meds so we instead treat them at crisis point which is much more £££

Don’t we already pay for it?
I think better triage at a&e and direction to an accessible GP would be good.
I know people who go for the littlest thing and aren’t sent away…

Thanks to @ChardonnaysBeastlyCat for supporting my tourism treatment claim!

All trusts will have day hospitals for the elderly / falls clinics to allow them to have multiple tests in one place. It's not possible / feasible ti have every single speciality present, though.

One set of referral criteria to cover all services is ridiculous.

Bank / locum staff - you realise we have to have them because we don't have enough of the permanent staff that you want to replace them with?

Joined up IT system - people have been trying for years.

Fertility treatment - I'm going to assume you didn't need NHS funded fertility services to help you have a child if indeed you've chosen to become a parent?

I think a massive government investment into educating about processed food.

Also, 1 pepper is 55p in Tesco. You can get a
frozen pizza for that….

I’d say that sums some of the issues up!

locum and bank staff fill the vacancies, we simply can’t get by without them.
IT multiple systems across multiple trust. It’s a Gordian knot
Joined up care, that requires money & a whole system approach

I never understand why medicine is such a highly competitive academic field. Lots of people are disappointed to not get places and yet we are crying out for doctors and nurses. We should be training twice as many - and free if they stay in the NHS for say 10 years.

Allow NHS procurement to shop around and get rid of preferred suppliers or at least nominate more of them to encourage lower prices.
Accountability within departments for wastage.
I work in NHS dentistry, we don’t have to use preferred suppliers and if we waste materials it comes out of our own pocket. The dental suppliers are much more competitive as a result. We probably pay half the price that hospitals do for PPE because we actually look for the best deal.

Controversial, stop the 6mnths sick pay. The private sector are no where near as generous. Most staff would thank you since when someone is off for six months due to stress the remaining staff need stress leave on their return after struggling to cope. Most depts have significant numbers off on long term leave at anyone time. People have learned to use the sick leave because it is there, it’s endemic. It should be there if you need it but it’s so easy to abuse.
Bank staff often cost over twice that of the regular staff. The NHS as a whole would be less stressful if the workforce were not under pressure due to chronic sick leave.
The NHS would also be able to afford more staff with money saved from not using bank staff.

Agreed. Restricting treatment is never going to save money and will always ending up cost the NHS more. That’s part of the problem now as some people aren’t getting the treatment in a timely manner making them sicker and more difficult and expensive to treat.

I’d like to see more screening programmes, better public health information and schemes to support those on low incomes. PP poster mentioned quite a lot of this stuff. It needs to be done.

Settle the pay disputes so doctors stop leaving the country.

70! I’m sorry but this is nonsense. You’d be causing more issues if you did that and consign a lot of elderly people to poor eyesight, easily treated diseases, deafness, broken bones, osteoporosis, etc. etc. I could go on ad infinitum. Are you planning to leave everyone over 70 to deteriorate, lie rotting in bed, putting more pressure on social care, families, council resources. Honestly, think things through.

Mixed thread,some very compelling posts and some absolute knee jerk nonsense

No appointments for the elderly! Fascism practically. Tell you what-you sign up for that, for yourself obviously, and leave the rest of us alone.

Train more Doctors nurses and dentists.

I have seen 102 year old in better health than most 60 year old, an age should never be the cause of not treating someone, but potential outcomes should be.

Also agree with procurement. I have to use a supplier with a huge contract to book train tickets at work, if I buy them myself they are at least 50% cheaper, but nope, got to use the preferred provider who is supposed to save us money!!

I addition any time you see a private provider such as Virgin Care or serco or G4S running a hospital, you probably don't realise that they have a minimum 10% profit margin on every contract! They pocket £100k for every million they are paid. If that was an NHS trust that money could be spent on staff. Wtf are we forced into doing this.... Anyone hazard a guess as to who might hold shares in these companies?

Training is always oversubscribed.It’s the retention that’s the issue
I have worked with F2 to consultant who have all relocated to Aus and NZ
Worked with nurses who’ve left ,relocated or do bank only.

I’ve worked for the nhs twice.
manage people properly; make sure they are supported and trained, but that they also pull their weight and don’t waste resources.
have an online booking system which penalised people for not showing up, but also remind them.
Don’t allow people who don’t need to come to A&E to attend (same for ambulances), refer back to GPs.

Make being drunk as socially unacceptable as drink driving is now. Anyone coming to A&E drunk is automatically lowest triage case and has to pay a burden tax just to be seen at A&E. If they can afford to get legless, they can afford the tax.

Make it compulsory for people who practise sports with high injuries to take out private insurance in case of accidents - skiing; rugby, horse-riding etc.

That should ease pressure on A&E.

Encourage self-funded NHS - people pay cost-to-NHS price not private price for non-critical treatments. We did this for IVF. There was no free IVF when DC were born.

Posted this on another thread
Surely this costs a fortune and affects waiting lists?

But as one example
My dad is 73, fit and looks a decade younger
He's recently had treatment for
Glaucoma - so do they not treat that? He needed to go to the eye hospital which doesn't fall under geriatric care or a GP
A detached bicep - if he hasn't had that treated he wouldn't have been able to care for himself
Carpal tunnel - from pulling pints for 40 years - better quality of life and able to write again and do DIY which he loves

Outrageous and pejorative views. I trained to work with all clients,intoxicated or not. That includes the drunk too

Drunk individual often have high physical need that cannot be ignored or triaged to low as a punishment for being intoxicated

Alcohol intoxication and frequent ED presentation is indicative of trauma . multiple ED attendance and substance misuse alcohol is associated with increased link of suicide and DSH. 3 or more intoxicated ED presentation in a year increase risk of suicide or accidents eg skip trip,fall

More preventative stuff. Information and regular checks could lessen the burden in certain areas.

More healthy living emphasis

More staff

It’s really dispiriting to see the casual prejudice towards Alcohol & substance misuse. Really try think beyond superficial. Ask why do some individual habitually get drunk and present to ED

• trauma
• social issues
• inadequate support
• Co-occurring mental health and substance use
• undiagnosed untreated illness

binge drinking, why?
problematic drinking? Why

I don't work in the nhs, I just use it a lot. But here are my suggestions anyway.

sort out social care and stop bed blockers.
Teach basic first aid and self care in school as part of pshe, including the appropriate times to call an ambulance and when to visit the pharmacy rather than the gp.
teach child health and first aid, how to treat mild croup etc to pregnant women and their partners.
Encourage drs to become GP's to increase available GP appointments and relieve the pressure on a and e.
Encourage nurses to train as HV's and encourage parents to see their health visitor first if they are worried about their child, rather than a and e.
Encourage everyone to see their gp rather than a and e unless it's something that only a and e can do. For example my then one year old was wheezing so I phoned the gp who said to bring him in. Saw the gp, then had some time on the nebulizer, prescribed an inhaler and then home. Total time less than an hour including waiting for the prescription. Many people in the same situation would have gone to a and e and waited hours to be seen. So maybe an advertising campaign saying what the gp can do and also what a pharmacy can do. Also saying the purpose of a and e and that you can't use it to jump the referral queue for tests, scans etc. I'm sure a lot of people underestimate both g p and pharmacies.

Also there must be something that can be done to stop people going to a and e for sympathy/likes on Instagram. I see it all the time with people saying things like "dd was rushed to hospital in an ambulance, been diagnosed with tonsilitus/ear infection but it was touch and go for a while" on facebook. Or people on mumsnet posting asking if they should go to a and e. Then pages and pages of replies saying definitely go, it could be sepsis. Then if they get discharged there are more replies encouraging them to go and try a different hospital or saying "my mum's cousin's friend had the exact same symptoms and he died". I'm not sure how to stop that happening though.

Give tax relief or reduced NI for anyone who pays private health insurance. Improve amount of social housing, in particular housing suitable for someone who has mobility problems, cuts down bed blocking by patients who can't be discharged because no suitable housing available. Get rid of NHS regions, bring it all under GB NHS, cut executives & anyone who in reality doesn't contribute to improving patient outcomes, use the money saved on more doctors, nurses, HCA, porters etc.

@Bluewallss Im glad you dont know any lazy managers- thats not been my experience.

My brother is a GP and he works in an out of hours clinic. If you cant get a GP appointment you get referred there. It takes the pressure off the A&E dept. My brother turned up for a shift at the clinic to find that due to an error, no patients were booked in. So he and the 2 receptionists had nothing to do but were paid for their shift. Ofcourse he called but was told that by error all the excess patients were sent to A&E....when they easily could have been treated by him! This has happened so many times.

Also he has been told off by seeing patients too quickly. He personally feels bad when he works as a locum to see the waiting room full of ppl and tries to see them all quickly. If its a straightforward case why does he need to linger?

When I gave birth, I had to wait for 8 hours to bd discharged. Straightforward delivery, no meds, nothing wrong with my baby. Im sure someone needed my bed but there I was waiting for my discharge papers, red book and eager to get home.

NHS managers need to listen to the staff about how to make the NHS more efficent.

Triage to avoid time wasters (at all levels)
Fund mental health
Fund children's services
Fund preventative campaigns
Fund preventative medicine

That alone would slash costs.