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

228 replies

DistinguishedSocialCommentator · 29/03/2024 15:29

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

NHS consultants run private firms charging to cut waiting lists at their own hospitals

Calls for a ban as health trusts award ‘insourcing’ contracts worth millions to tackle backlogs

https://www.theguardian.com/society/2023/feb/12/nhs-consultants-run-private-firms-charging-to-cut-waiting-lists-at-their-own-hospitals

OP posts:
MariaVT65 · 30/03/2024 02:02

berksandbeyond · 29/03/2024 21:05

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.

Tbh I agree with this. It could free up alot of extra cash without extra funding.

Prescriptions need a review. Bit harsh for example for my friend who needs constant insulin and pumps etc for type 1 diabetes, but I can certainly afford to pay for my contraceptive pill.

MariaVT65 · 30/03/2024 02:13

Nikee20 · 29/03/2024 23:21

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!

i’m not sure that would help tbh.

We all know what healthy food is. Regardless of cost, i think a huge issue is that people are exhausted and lacking in time, so they opt for convenience food. Pizza much easier then a pepper.

jandalsinsummer · 30/03/2024 03:01

First thing I would do is sort out eligibility and stop treating those from overseas (obviously not those who happen to be from overseas originally but are long term UK residents) I used to work near Heathrow (and Gatwick!) absolutely routine for people to turn up in a and e with suitcases, people used to get a diagnosis of needing dialysis and pop over to the UK so the good old ‘free’ NHS could pick up the bill, HIV, malignancies anything just get the NHS to treat you. I am overseas at the moment It is still routine to tell some people where I am to go to the UK for medical treatment. Yup you read that right.
We also really need to have a conversation about what we are paying for, how much tax we are paying, what the role of a health service is, what we expect from it and a good bit of education around social responsibility thrown in.

totallybonkerswarning · 30/03/2024 03:24

jandalsinsummer · 30/03/2024 03:01

First thing I would do is sort out eligibility and stop treating those from overseas (obviously not those who happen to be from overseas originally but are long term UK residents) I used to work near Heathrow (and Gatwick!) absolutely routine for people to turn up in a and e with suitcases, people used to get a diagnosis of needing dialysis and pop over to the UK so the good old ‘free’ NHS could pick up the bill, HIV, malignancies anything just get the NHS to treat you. I am overseas at the moment It is still routine to tell some people where I am to go to the UK for medical treatment. Yup you read that right.
We also really need to have a conversation about what we are paying for, how much tax we are paying, what the role of a health service is, what we expect from it and a good bit of education around social responsibility thrown in.

I'm overseas at the moment too and pregnant. Although I'm a British citizen I can't return to give birth because the NHS isn't free to ex-pats, it'd be an enormous bill. It's the same for those who turn up at A&E. They get treated but a bill follows shortly

Nikee20 · 30/03/2024 05:58

@MariaVT65 of course it would help! If you don’t have the money eating healthily goes out of the window.

Just think about the cost to make a filling salad verses white, cheap stodgy food. Also, supermarkets are now full of ready meals etc, I know this is what people are buying. Take aways all over the place.

Fruit and Veg tends to be expensive now. Even I have cut down on buying it.

Where I work people can’t afford the healthier food, as a result health is poor!

Nikee20 · 30/03/2024 05:59

@totallybonkerswarning they might get a bill, but lots just leave the country and don’t pay it.

jandalsinsummer · 30/03/2024 06:18

totallybonkerswarning · 30/03/2024 03:24

I'm overseas at the moment too and pregnant. Although I'm a British citizen I can't return to give birth because the NHS isn't free to ex-pats, it'd be an enormous bill. It's the same for those who turn up at A&E. They get treated but a bill follows shortly

You’re right you can’t. Last time I discussed this the overseas billing office told me staff were the most prolific at bringing in relatives for free treatment. Quite a shocking thought!

MariaVT65 · 30/03/2024 06:22

Nikee20 · 30/03/2024 05:58

@MariaVT65 of course it would help! If you don’t have the money eating healthily goes out of the window.

Just think about the cost to make a filling salad verses white, cheap stodgy food. Also, supermarkets are now full of ready meals etc, I know this is what people are buying. Take aways all over the place.

Fruit and Veg tends to be expensive now. Even I have cut down on buying it.

Where I work people can’t afford the healthier food, as a result health is poor!

The original post referred to an education about healthy food. I don’t believe people don’t know that a pizza isn’t good and a pepper is.

For some people, prices may be a factor yes. But the healthier food also comes with a lot of added cooking and prep time that many people don’t have time or energy for. We buy ready meals because they are quick, not because we think they are healthy.

Nikee20 · 30/03/2024 06:27

@MariaVT65 I said that a pepper is 55p and you can get a pizza for that…

I’d say that’s talking about price.

If fresh food was somehow cheaper people wouldn’t buy so many ready meals. Some people have to buy what’s cheap. You can get 10 freezer filler for £10 at the moment, that’s the price of 1, maybe 2 freshly cooked meals. It’s depressing.

MariaVT65 · 30/03/2024 06:29

Nikee20 · 30/03/2024 06:27

@MariaVT65 I said that a pepper is 55p and you can get a pizza for that…

I’d say that’s talking about price.

If fresh food was somehow cheaper people wouldn’t buy so many ready meals. Some people have to buy what’s cheap. You can get 10 freezer filler for £10 at the moment, that’s the price of 1, maybe 2 freshly cooked meals. It’s depressing.

Edited

Your post mentioned government investment about educating people around food. That’s not the same as reducing food prices is it. That’s what I was referring to. I don’t think the government spending shit loads of money educating people about healthy food is a good use of money.

Maybe review what school kids are taught to cook in food tech.

MrsPatrickDempsey · 30/03/2024 06:31

Public education and self care is a huge factor, coupled with better primary care.
People seem to jump at needing instant reassurance with any little thing and this can clog up the system. In my area (like many I'm sure) people have to then access A&E or Urgent Treatment as there is no other option for them.

Nikee20 · 30/03/2024 06:34

@MariaVT65

We do need education about ultra processed food and its impact on health. I don’t believe that’s as well known as you seem to believe.

We also need to reduce the price of healthy food. As I have said 1 pepper is 55p…

I no longer want to be involved in this conversation.

JLT24 · 30/03/2024 06:43

@MrsAmaretto so true about GP’s doing form filling

Need a disabled bus pass as DVLA says I can’t drive - need a GP letter to confirm why even though driving licence has been revoked by DVLA for medical reasons

Need to claim benefits - need a GP letter to confirm illness even though DWP then do their own doctor led assessments

It’s beyond ridiculous

Midnightrunners · 30/03/2024 06:51

How much more would you add to the Healthcare budget and exactly how would you pay for it ?.

Sunnnybunny72 · 30/03/2024 07:01

Legalise assisted dying.
Massively reduce the thresholds at which people are eligible from the state/ie other people for financial assistance with care costs.
Means test all currently non means tested benefits, ie, those just dished out virtue of age and not need. They do it for child benefit.
Everyone to pay National Insurance.
A more realistic thinking about prolonging life at all costs.

Whycantiwinmillionsandsquillions · 30/03/2024 07:02

So much to unpick.
Common themes seem to the:
Babies being kept alive whereby in the past they would not have been viable. They grow int

VerityUnreasonble · 30/03/2024 07:08

Fix primary care. Including out of hours GP appointments / walk in centers.

Improve health promotion and disease prevention. Including teaching basic health awareness and first aid in schools.

Sort out social care so that people can actually be discharged safely.

Improve community provision- Urgent response teams / virtual wards to avoid unnecessary admissions.

Improve carer support. This could be done through VCSE sector supported by councils as well as through NHS policy. Carer's are one of our biggest resources.

Improve employer occupational health schemes and ensure these offer access to MSK and mental health support. Possibly mandate this.

Stop cutting mental health inpatient beds.

Sort out the disaster that is NHS IT. Have a centralised system, which would reduce repetition of work by multiple services. Reduce the overall amount of paperwork and allow use of technology to support efficiency.

I know people think the NHS is over managed but the research says it actually has a low % of managers for an organisation of it's size. And many managers are still also clinical. There are always some "interesting" roles which could probably go and the Trust / ICB / NHSE system might or might not be worth reviewing.

Whycantiwinmillionsandsquillions · 30/03/2024 07:11

Posted too soon.
They grow into adults with complex needs, this costs money.
Older generation living longer. Require umpteen free prescriptions every month. Plus all the doctors appointments and hospital visits.
Bed blocking- lack of social care to help them so they stay in hospital.
Tourists getting free treatment.
Fat people.
Drunks.
Time wasters.
Genuine folk who cannot get a GP appointment. Often due to all of the above, so they have to go to A& E.
Useless IT- definitely a major pain.
Lack of staff retention. Hardly surprising if they have to deal with all of the above.
Bullying. I know NHS staff who have left due to this. The bullies tend to get promoted upwards rather than dealt with.
Government which wastes tax payers money and gave away millions to their mates instead of using as it should have been.

Lizzypet · 30/03/2024 07:14

We were in New Zealand a few years ago (we are Australian citizens) & my son because ill. We were given a number of criteria that he would have to meet (in terms of signs/symptoms) in order to qualify for free assessment & treatment in A&E. We took him in & he was seen for free as his illnesses warranted it. If it has been something a GP could have managed we would have been charged. But for this to work here in UK GPs would need to stop turning away patients.

PrimalLass · 30/03/2024 07:17

Bed blocking - we need to bring back convalescence homes and proper nursing homes for the elderly

Whycantiwinmillionsandsquillions · 30/03/2024 07:32

The trouble is nobody wants to pay for it do they?
The ‘working poor’ certainly don’t.
There seems to be less and less people paying into the system and quite frankly these are the people who often cannot access GP appointments.
The very rich can get away without paying and the non working don’t pay.
Yes the elderly might have paid ( if they worked and paid tax) but the present working generation have been told they will carry on working until they are almost dead.
I absolutely cannot get a GP appt because I work. All appointments have to be booked at 8am on the day. I can never get through. The lunchtime appts are saved for home visits 🤨. After 5pm appointments mysteriously not available even though I had received emails boasting about how they run late night surgeries. And most stupidly of all the few Saturday morning appointments were used for- wait for it- booking covid and flu vaccines for the over 75s!!!!
You could not make this bollocks up.
I only know about the Saturdays because an elderly relative told me it’s when they were invited in to the surgery.
No wonder people present at A& E if this is what they have to go through.
I should have had several check ups but haven’t. I don’t get time off for medical appointments either.
Yet another way the those working are punished but that’s another thread.

PrimalLass · 30/03/2024 07:35

Also, bring back the improvements that were there before Covid and still haven't restarted. My GP practice is only just about to allow a small amount of online booking again. It worked really well before 2020! They've sent me letters about things like a smear test but I can't get through to book one. Ridiculous.

IloveAslan · 30/03/2024 07:37

NC03 · 30/03/2024 00:48

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

Exactly this. One of my friends is 71 and will need a new hip, should she just be left to deteriorate, despite being very fit and active, and spending a lot of time looking after her teen grandchildren when their parents are away? My boss recently retired in his mid-70s, people of that age are not all sitting at home waiting to die.

I really think some posters don't know many people in their 70s 😅

Alfreddoeblin · 30/03/2024 07:42

Whycantiwinmillionsandsquillions · 30/03/2024 07:11

Posted too soon.
They grow into adults with complex needs, this costs money.
Older generation living longer. Require umpteen free prescriptions every month. Plus all the doctors appointments and hospital visits.
Bed blocking- lack of social care to help them so they stay in hospital.
Tourists getting free treatment.
Fat people.
Drunks.
Time wasters.
Genuine folk who cannot get a GP appointment. Often due to all of the above, so they have to go to A& E.
Useless IT- definitely a major pain.
Lack of staff retention. Hardly surprising if they have to deal with all of the above.
Bullying. I know NHS staff who have left due to this. The bullies tend to get promoted upwards rather than dealt with.
Government which wastes tax payers money and gave away millions to their mates instead of using as it should have been.

Obese people ultimately require medical treatment. Treat the obesity early whether through counselling or medication or bariatric surgery or all three and you save millions. Is this supposed to be some kind of punishment for being fat and are you going to implement the same policy to people playing risky sports ? We treat a fair number of overdose patients in critical care costing probably hundreds of thousands of pounds a year. Are they time wasters ? Do we leave them to die because it’s self inflicted ?
Poor staff retention is mainly due to poor working conditions, inadequate staffing and laughable remuneration. Sort that out out and retention will improve. Ultimately it costs money.

CentrifugalBumblePuppy · 30/03/2024 07:42

Ultimately, it all comes down to money.

Make the NHS an employer that medical staff want to stay & build a career in.

Build primary care into multi service providers (like our surgery here) where we have pharmacists, physiotherapists, district nurses, nurse practitioners (all with their own specialism) & HCAs for support services like diabetic foot checks, which can be signposted to by receptionists so everyone is not jostling to see a GP who may not be the best first line for depending on your needs.

Poverty is inextricably linked to poor health. Cheap foods are not healthy foods. Stress and depression linked to smoking, alcohol and drug use.

Invest in the old style convalescent homes & better social care, where people (predominantly elderly in my own experience) can rehabilitate and regain function before discharge, helping to regain use of their surgical or medical bed in hospital. Or have a major investment in social health care which (again, anecdotally with my own parental experience) for faster discharge from hospital.

We need public awareness campaigns to educate people when A&E is appropriate to use. Yes, we have this today to some extent, but let’s start teaching the public about first aid, what can be treated at home, what needs immediate treatment.

Unfortunately I’ve been watching ITV daytime guff lately as I’m a carer for my Mum; instead of another phone in about pet psychics (what the duck This Morning?) what about a daily first aid segment? They do a great job with their medical team educating about basic illnesses and signpost viewers to use pharmacists/treat from home rather than go to a GP, so let’s take the next step & teach the public how to treat cuts, sprains etc. at home, and when to seek more advanced care.

Being back the old Green Goddess and Mr Motivator style keep fit/healthy living segments on daytime TV rather than another bloody orange faced host helping greedy family sell their granny’s silver for the highest profit.

And let’s all be brutally honest for a moment.

Governments have known there is a large bulge population group approaching 75+ since 1946. Have we modified our NHS with this advancing age group in mind, building elderly care provision?

Have we bollocks.

Instead we have reduced hospital beds (our Trust has lost 500+ plus after closing 2 inpatient hospitals to be replaced with 2 spanking new outpatient hospitals). Austerity measures (read, save money to give Tory donors kickbacks) have systematically defunded social care.

This puts families (mostly women) in a position where they’re squeezed looking after children on one hand, and aging parents on the other, putting families under more stress and less time, that brings less time to make good food so rely on fast, UPF crap, or having to sacrifice working hours & pay because they have this extra care to provide. And that’s without elderly hospital or doctor appointments you have to juggle with work or childcare commitments.

And since we can’t expand the number of hours in a day, some may cope with alcohol or nicotine (paradoxically further increasing stressors as we know). Which leads to poor health, more stress, more reliance on poor food choices.

But this will all cost money. And this govt. has just given us back tuppence in the pound for NI as an election sweetener.

I’d rather have a 2p increase towards social care, NHS & health and well-being education.

What ever you do, don’t vote Tory at the next election.

Even if you are GC, remember this;

the only cnuts the Tories care about is themselves.