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

Well let's train more.

What's the sickness rate in NHS workers currently.can we reduce that and reduce reliance on agency staff.

Offer them training in exchange for years of service. Stay and don't pay for the education.

There are WAY too many directors of , deputy directors of etc who literally make work for themselves. It needs simplifying, get rid of multiple layers of managers that do fuck all and invest in staff, add extra clinics and see more patients

To improve the NHS
Funding for more training, more preventative care initiatives, more GP surgery’s (one’s that offer a number of services) more minor injury units for a start

To improve heathcare in the UK
look at funding heathcare through insurance as do France and Germany as regardless of how much money of added to the NHS funds it simply can’t manage the complexities of a population that is living much longer

do you have any evidence of this still going on? The hospitals I've been to ask for your details and cross ref them

Stupid idea as there is no way that would work other than those that have saved money via working hard as always pay.
Pointless ad one of the worst ideas I've seen on this thread

This is what I want but NHS is too fragmented but credit to them, now where we live, the local grouples/trusts are communicating better. Just a few years ago it was, "sorry, we cant see your records."

Along with other good points by other FM's

Health education inc eating and keeping weight low
Excercise regimes are available for all older people at low cost or free of charge
when is hospital for initial appointments - before seeing a consultant, they should decide if scans/xrays/blood/unrine tests required get these done same day and see doc a few days later.

Cut down management
Sort out prcurment
More mobile scan units and were are seeing these run by docs from india/south africa/new Zealand etc - these run at times 7 days a week and late into the evening

@mumda well yes that's the point I was making. More investment in training staff. Better promotion prospects. Better working conditions. Higher pay. But it needs extra funding and some would rather take perfectly legitimate things off others they think less deserving….

Don't bang on about money?

You pose a thoughtful and well phrased point, don't you?

It is about money.

And GPs. And Care homes. And district nurses. It goes on and on.

But it's rooted in money.

If people were paid well and hospital trusts and primary care networks had the funding, there would be fewer issues

@mumda yes thats a good idea but I think space will be a problem for some hospitals bursting at the seams.

Would it help to have a GP based at a&e for those gp related things? I know records are not easily available which would be problematic.

Some EDs do have a GP service. So patients will get triaged and sent to the GP.

Its all very well saying we need to train more nurses etc, we can’t retain staff! People don’t want to stay on the wards.

I know a few people that have left to do aesthetics as it pays well.

My dad called an ambulance for my mum this morning. They arrived quickly, spent nearly 40 minutes doing tests then took her to hospital. She’s been seen by multiple people and had numerous tests all very quickly. Nurses keep offering dad coffee and we can’t fault the care other than she’s on a mixed ward (but that’s not a big issue in the context of everything).

I’m not saying the system isn’t broken (I work in a hospital that’s different to where dm is) but there’s hope. Ime when it’s life threatening, the care is there. Minor and chronic issues are where things fail.

Try funding it.

Yes let’s not have the staff banging on. They’re noisy enough with all the demands and strikes. Can’t have them banging too

Can we try have a discussion without pejorative terms such as
drunks
bed blockers
time wasters
I will say it again, think beyond the superficial. Ask the why question . Examine and address the systemic failings elsewhere that cause patients to present ED. I’ve had patients who’ll present ED because for them it’s quicker to be seen than wait days/week for GP appts.

DTOC is a step down issue, inadequate care to discharge to and that block the discharge. It’s the system that is the block not the individual

we are supposed to be holistically trained, generalist training with specialist post grad training

the drunk,the time waster, the bed blocker…ask why?keep asking why

There have been interventions to address the high ED attendees , aka frequent flyers . Staff were assigned to work intensively with the individuals and reduce the ED presentation , it worked and uncovered v interesting reasons why some clients present habitually to ED

24 hours in A&E has also attracted fans , folks who attend in basis saw it on tv

I absolutely addressed the why when using the term.

@Zone2NorthLondon is this some sort of high impact user service that are working with the frequent ED attenders? Can I ask what common underlying themes were behind these frequent attendances? (Edited for spelling)

@Gingernaut I wish it were simply this. The NHS defintely needs more money, but that is far from the only problem. Bill Gates could pitch up tomorrow and donate £50 billion, and there would still be issues (though certainly less than we see now)

Kind of.

Except a new hip can keep people at work, or prevent them needing a carer. In terms of value, its the second most cost effective procedure available on the nhs, the first is cataract surgery (but only for the first eye) the second isnt as good vakue as the patient woukdnt be totally blind if you didnt do it.

@Saintmariesleuth
social issues
No gp or poor relationship with Gp surgery
familiarity with ED
impulse attendance when GP closed
good rapport or good ED experience
didn’t understand issue could be addressed elsewhere
didnt want to wait days/weeks for GP appt
secondary gain
seeking multiple prescriptions

Standardise a system that automatically emails and text reminders - with a default for those without texts/emails to be called by an auto reminder call to remind them the week before the appointment as well as the day before the appointment.
This would get round the issue of missed appointments /missed pseudo appointments (DH arranged an appointment with his GP and wrote it on the calendar. He arrived to be told his appointment was the PREVIOUS day, a day he wouldn't have picked when looking at the calendar because he wasn't here! )

That would save the NHS over 200 million I reckon (based on 2019 figures of 7.2 million GP appointments missed and allowing a buffer for some still being missed)

Would phase this in through ALL appointments ALL departments.

Should speed things up a bit!

More proactive measures - school nurses, workplace nurses and health monitoring much earlier on to stop issues in their tracks and not have to deal with something too far progressed to deal with, honest conversations about weight, lifestyle and not be afraid of telling someone the truth, alongside hard decisions about not funding some interventions, that are elective. Private isn't the way and I work for an employer that's funded it partially for one year, but in year two has reduced the cover (as they don't want to pay the premium and isn't that like employers) and year three will not cover the tax implications, so it will be unaffordable. Also my colleagues have found there just isn't the availability to be able to book or react for many conditions and one found they can't afford the private prescriptions. We need to train more practitioners across the board, support those in post and pay everyone, everywhere a living wage that allows them to have a quality of life, build in resilience from day one into our children to stop the issues that are to come and start thinking about the fact we can't afford not to fund health, or to train or provide a health service, as the UK plc depends on being able to function and a country of sick people will not do anyone any good. Money now, good management now, will, in the long run, save the UK a great deal!

@Zone2NorthLondon
That's interesting, though mostly what I expected. I think GP and community services is certainly where sorting our health service out should start. Though I am not sure how much the government can exert it's influence here as a lot of it is not actually NHS

I agree with most of this.

I would also stop striving to keep everyone alive as long as possible no matter how old or sick they are: sometimes interventions such as surgery are cruel, really.

I don’t think more money is need but a fundamental overhaul. Procurement for example, needs to be properly managed and responsibility taken.

I would also scrap the current GP system and set up a new form of primary care more suited to the demands and needs of the modern age. Good primary care would have a knock on effect on other services. Not being able to see a GP means delayed diagnoses, more emergencies, and thus pressure up the line.

I don’t think we should rule out some sort of insurance based system for primary care either, such as is in place in much of Europe.

By telling people who want cosmetic surgery on the NHS because they have "mental health issues" to f off.