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

There isn't the experienced staff available to mentor them on placement, chicken n egg.

Sickness? they work with infectious people, they will get ill more than your average worker.

Agency staff? we need to match agency pay and flexibility as well.

Last suggestion "could" work, though how would you deal with staff who have been in the NHS for several years and have been paying back loans? might lead to a lot of resentment as new starters come in and have it all for free.

The same way you deal with nursing degrees no longer having full bursary. People get on with it.

Start charging for maternity care after 2/3 children. Reduce population.

Ariela · Today 13:41
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 is happening now in the area I live in.

Recently, I had my first breast screening appointment and was impressed by how efficient the whole process was. It happened in a special breast screening unit and was very well organised. I do think things like this- high volume and relatively easy- are well suited to a kind of "production line" process (for want of a better phrase). I remember reading that there are units for performing hip replacements run in a similar way, just the one type of operation and everything set up for it.

My other thought is that there should be special discharge teams in hospitals, and they should start the discharge planning as soon as someone goes into hospital, not leave it until people are nearly well enough to go home. And step down units, like convalescent wards, for people who don't need to be in hospital but are waiting for whatever support they still need to be set up for them.

I agree
The community teams are the front door and manage a lot of work that doesn’t become inpatient . The complexity of cases has exponentially increased too

YES, GP are private for profit businesses contracted to provide services to NHS , but not actually part of NHS.

You bang in about especially ‘revisiting consultants contracts’ . We’ll listen to that when we get the 40% pay cut reversed and back pay for the last 14 years. And until then, won’t be doing a second more work than currently contracted. And yes, all the consultants I know think the same. Hence the strikes and rejection of government’s pay offer.

@Zone2NorthLondon that's interesting. What do you mean by secondary gain ?

A number of the points that have been mentioned on this thread are already happening (or at least they are in some areas) - apprenticeship programmes to train up more clinical staff, discharge teams & a focus on discharge planning from the moment of hospital admission, investigation of patients who may not be eligible for free treatment etc....
The concern is that this STILL isn't enough (though I can see it is helping).

Take the discharge planning- approx 25% of hospital inpatients are there due to social needs and have no medical need to be there. All the planning in the world isn't going to get these patients discharged to a more appropriate location if there is no social support/ care home/ carer etc available

More long term planning rather than only within this years budget.
This would allow better investment in equipment and buildings.
Would allow for long term workforce planning. It takes many years to train a new HCP, in my discipline minimum 4 years, then another 2 or so before fully functional. There are at least 6 staff members in my dept who are within 6 years of retirement age, or past, and only 5 trainees in the pipeline, which doesn't take account of the need for more staff as the work becomes more complex. There is a national shortage of specialists in my area.
Sort out procurement so that the NHS doesn't pay more for simple items like stationery , keyboards, PPE, than a private purchaser.
sort out IT so systems can talk to each other.

as a nation we need to be far more proactive about preventative health measures. both individually and our Health system.

i could go on, I've worked in the NHS for 26 years.

Thats the attitude that has led to people leaving the NHS in droves... just Get on with it.. but they don't, they feel pissed off, undervalued and leave.

No bursaries, no grants, no staff accomodation and expected to work for peanuts at the end, if there are suitable vacancies

A lot of nurse vacancies, for example are not suitable for newly qualified

They've come through a gruelling conveyor belt of academic and practical, unpaid training, sustained themselves as HCAs or carers, only to be told there are no jobs, either at tbe hospitals they trained at or elsewhere

The drop out rate is dire, current staff are telling people not to go into the professions and the pressure on staff isn't reasonable or sustainable in the mid to long term

I work for the NHS including A&E. There are lots of problems!
A&E should be triaged better. It is ridiculous the trivial complaints that people trot along with. Sore throats, back ache they’ve had for years, lots of drunks.
So much wastage across the NHS in wasting expensive equipment and ridiculous training. Too many layers of ‘management’. So many members of staff who would never get a job outside of the NHS and get away with laziness and so much inefficiency.
I would like to see teams set up to analyse the entire NHS, cross party and also including people who have run their own successful businesses. Just throwing money at it without more analysis is a huge waste of money.

A really good point.

Ideally, charge after first child, let's say 5k (stop child benefit for 2nd kid onwards, would assist the hospitals IMO.

@DistinguishedSocialCommentator I agree. Also: No one needs more than two children and if they want to they surely must be in a financial situation where they can afford to, so should foot the bill themselves.

@Vacantstare , @DistinguishedSocialCommentator and the law of unintended consequences means poor women and their babies may die? Or would you force termination upon them?

"may die" - not sure what that has to do with child benefits

I thought you were talking about charging for maternity care.
"Ideally, charge after first child, let's say 5k"

Yes. You dont have to pay it in one go.
It will take time, but we will see the benefits.

Most people, inc us, only had kids we could afford at the time. Why should everyone people not be like that? I get it, you will never get 100% of anything, but you have to start somewhere

NHS, needs improving, many good ideas in the thread, and I have noted scans are being sppeded up but A&E, especially over winter, a lot left to be desired.

To reduce the pop. we could stop migration, which is running at 750k per year.

So what would you if a woman choses to have a 2nd 3rd child but has no means to pay for the £'000s her and the babies on going care might need?

Bit tough if you get pregnant with the means to pay but circumstances change for the worse.

Sounds like just another crazy idea you ve a habit of coming out with & pretty disgraceful on a primarily womens forum.

Maybe you re a man? given you don't propose to charge £5k for the male part of the equation

More efficient ways of being informed of appointments.if it's letter allow time before sending a reminder.if other contact details available use those.the allegedly missed appointments within the NHS how many are down to inefficient admin procedure.

Yes what a fantastic idea. Charge women £5k to have a baby. Cause that definitely won’t lead to awful outcomes such a mothers having a pregnancy without any care leading to babies and mothers suffering or dying. Are you really that dense??

Reducing the need for people to go into A&E is the obvious answer.

Stop the GP surgeries putting up so many barriers to actually dealing with patients.

Get the GP surgeries doing more again like they used to, i.e. minor surgicals, minor injuries, etc. Our surgery doesn't even do blood tests anymore.

A lot of people attending A&E don't actually need to be there. They go because they're desperate and there being no other options, especially evenings and weekends.

Continue to increase the scope of services/advice offered by pharmacists.

Stop the 111 service always defaulting to the "go to A&E" advice for anything other than things that obviously don't require A&E - far too much arse covering and telling people to go to A&E when the call handler isn't trained well enough to do a proper triage (or can't be bothered).

Your last paragraph. Interesting point and one I can relate to as well as reading about this.

Therefore, cancel the 111 service and put the money towards, A&E or more 'Minor Injuries units. I don't have a idea what it costs to rum the 111 service but I guess it could be a few million.

As another FM stated, more education on health. I would target this at different age groups, EG, general health education and education for the older people re being aware of what to do and look out for.

I would also fund exercise classes and people to attend a few times and then a follow up to see if their weight/health had improved and reward them for that, let us say 25 quid, or a voucher I conjunction with major retailers.

Free BP monitoring units for all aged 50+

Mandatory max levels of suguar/carbs/saturated fat and salt per 100grams of food

Some of the above will take time to show outcomes but we need to start somewhere and reducing bad foods, bad practices is IMO a good way to save the NHS costs

@karriecreamer "Continue to increase the scope of services/advice offered by pharmacists."

Unfortunately this is already contributing to pharmacies taking longer to dispense medication. Most have only one pharmacist where the log jam occurs... recruitment and retention of pharmacy staff is just as bad as other medical professionals.

Stop the 111 service always defaulting to the "go to A&E" advice for anything other than things that obviously don't require A&E - far too much arse covering and telling people to go to A&E when the call handler isn't trained well enough to do a proper triage (or can't be bothered)

I ve found the 111 service to be very good.

For example - arranged a GP to prescribe ABs OOH, collected from a closed MIU which he would open..... a first responder to visit my DD, arranged a GP telephone call.

The advice isn't a default go to AE, they can advise on a whole list of things and have qualified staff backing up the call handlers - but if you say your DC is drifting out of conscientious, has a fever and/or rash, what do you expect them to do?

On healthier foods, they cost more, sugar fat salt & carbs are added as v cheap bulking agents...,so how do poorer families afford these?

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