A question for NHS staff

[Glowinginthedark]

AIBU to think that no amount of money throw at the NHS in it current state will fix the issues? What is the real problem? Lack of funds or people completely abusing and misusing A&E or both?

You’re right. The whole thing is broken. Public expectation of what the NHS is for/should treat, extended life expectancy, chronic underfunding in training and shitty pay and conditions/treatment for those that are in the system means medics and nurses leaving in droves for greener grass. Constant media berating. And the cherry on the top is Brexit. It’s made us completely unwelcoming and even doctors from developing countries don’t want to come here now.

A whole host of things but specifically in my area, it's shortage of current workforce and a serious decline in future supply. So even if they did throw more money at it, we still can't magic up the staff from nowhere.

This problem has been seriously exacerbated by, removing nursing bursaries, the junior doctor contract, and Brexit. Applications for nursing training from EU countries has fallen by 99%!

I honestly think that in 10'years time, 50% of the population will be over 80 and the remaining 50% will be having to care for them. Slight exaggeration but hopefully you get my point.

Advances in science and technology allowing people to live with diseases and conditions and after major accidents that thirty years ago would have almost certainly have been fatal - but the infrastructure or the support for individuals to care for these people doesn't exist, so they remain in hospitals or expensive private clinics. Some of these people require constant medical and nursing care and expensive drugs and treatments eg home ventilation. Money too for research, staff, support for carers etc. But it isn't wrong that more people are made better at all.

We also expect more care , rightly, for conditions that previously were accepted as a part of normal life or treated very differently. I'm thinking mental health, childbirth injuries , childbirth in hospital as opposed to home, contraceptive and family planning and sexual health, and incontinence and non life threatening stuff such as port wine stains etc. It is right that our attitudes and expectations change but with this comes cost and lots of it.

I think theres a bit of an attitude too with some people that the doctor or nurse will patch you up and that makes it OK to behave in certain ways eg binge drinking etc. Don't think that's very prevalent though.

Older people attending ED with conditions that would have killed them a couple of decades ago, then having nowhere to move onto into the community so 'bed blocking'. There are no beds available for routine surgery as they are full of medical patients with nowhere to go. The Trust I work for is in the SW with a high aged population and it has been crises management all year, way before 'Winter pressures' started.

I had to go to A&E recently, it was absolutely rammed with patients on trolleys in halls etc. And I was the youngest patient in there by about 40 years. My husband’s grandfather has been to A&E three times in the last month for falls, and an infection.

Just to be clear I am NOT blaming the individuals, I am glad they got the help they needed! But it’s the natural consequence of an aging population. And there just isn’t the care available to help many people in their own homes any more, so many have no choice but to go to A&E.

I think it's hugely complicated, but IMO some factors include:

• rapidly increasing population, spread disproportionately across the country
• inefficient middle management
• people living longer
• cuts to bursaries etc
• increasing cost and complexity of modern treatments
• closure of hospitals and a&e departments
• "health tourism"
• large negligence claims

What we have today is so much bigger and more sprawling than what was envisaged after ww2. It needs a huge overhaul and probably some unpopular measures to radicalise it. For example, what about an incentive for more employers to offer private healthcare, or a specific 1% increase on NI or income tax to be dedicated to the NHS - that sort of thing.

Healthcare should not be about profit. The NHS is precious and some truly amazing people work there. It needs an overhaul so it can survive for future generations.

Available workforce definitely a huge issue, especially in nursing. Who would want to be a nurse? Who would encourage their child to be a nurse? Funding no use if there’s no one to pay.

Selfish and demanding society.

Yeah I agree it needs a complete overhaul Rebecca and these issues are not a new thing they may have been exacerbated by cuts etc but the problems have been going on for years at present you could throw all the money in the world at it but I don't think it will help.

The NHS needs someone brave enough to take it apart and start again, as it is a model no longer fit for the purpose for which it was designed. It is abused by the public, who quite rightly have very high expectations of the service provided. I have recently retired after many years of service, and felt at the end that I was just firefighting, ticking boxes and patching up problems which would almost certainly reoccur. Morale was very low, and I felt so sorry for newly qualified practitioners coming in with such enthusiasm. My job was amazing when I was allowed to
do it properly. It can’t carry on as it is, and all the money in the world isn’t going to fix it.

Does anyone have any statistics on health tourism?

If not, what makes you feel comfortable citing it as a key factor?

The fundamental problem is that the government don't want the NHS to succeed. They want it to fail so they can bring in reforms that allow greater privatisation.

Lack of proper management is a huge issue

Health Tourism is NOT a key factor, it's about 0.3% of total health spending.

However, it's dangerous (where people are using fake IDs) and needs to be stopped for those reasons, or at least, we need to work out a way where people don't use others identities putting themselves and their children at risk.

Yeah I get that but say I manage an obs and gynae service and I get 1 pregnant mum who flies in from Nigeria and has twins with complex needs; that's my budget fucked for the month and I'm beepaten up about it by the FD.

I think it's a real lack of staff, coupled with the general public's refusal to take ownership of their own health.

My trust is completely dependant on agency staff, which cost at least 3 times more than permenant staff, nearly 1/2 of my 'team ' is agency at the moment. And I don't blame the agency staff as they get paid so much more for doing exactly the same job. The trust has to pay agency as the bank rates are so low, and the alternative would be to cancel operations and that is obviously not going to happen. The long days, rubbish pay and many managers refusal to be family friendly have sent staff away in droves.

There is a real culture of it being your 'right' to access free healthcare even if it is not in your best interests. Plus so many health problems can be reduced, if not resolved by being a healthily weight, being active and stopping smoking. For e.g. knee replacements, the vast majority of those who have knee replacements, losing weight would solve their problems, but when the NHS tried to ration them, there was a revolt and the trust involved was accused of being discriminatary.

I honestly think the NHS is unsalvagable and will not be around in it's current state for much longer. It was never meant to last long term and was introduced to bring the nation back to heath after the war. It makes me sad as I love everything it stands for but I think it is on its last legs.

Mary - there are plenty of stories in the papers. Just to give one example, there were 2 Nigerian women who came here to have premature multiple babies, costing hundreds of thousands of pounds each (per mother, not per baby). That's just 2 cases - and yet each would have paid the annual salary of several nurses. I also know a family where the father married a lady from the Philippines. They lived there happily for many years, until she sadly developed cancer, at which point they promptly relocated to the UK so that she could be treated by the NHS. You cannot blame the individuals, of course you can't, but at the same time we can't offer free treatment to the whole world and expect the NHS to cope, sadly.

I don't think it's the biggest problem the NHS has by any means, in fact I think it is a drop in the bucket compared to other things on the list, but it's still a substantial sum. I was asked for my passport and proof of address when booking in with my second child, so some trusts do appear to be trying to address the issue.

In the mental health trust I worked for there was so much money wasted and no one was ever held accountable one example they merged two wards into one gave it a complete refurb (only five years after the last one) at the cost of something like £900,0000 and then closed the ward down permanently less then 12 months later this was going on all over the trust and then they complained about cuts.

Again SW location - current issues include:

• Lack of current staff (local hospitals with many many vacancies, and local big city with huge gaps in GP recruitment)
• Lack of doctors filling training places so no improvement in availability on the horizon
• Lack of carer availability - even if patients and their families want pay for carers it is difficult to get the correct care package.
• Reduced number of care and nursing home places due to a squeeze on council budgets reducing income for homes and thereby their viability.
• Ageing Population living with multiple complex health needs (historically these patients would have passed away)

I think we do need a honest discussion around what the NHS/Councils can provide and what it will cost (I suspect however that voters would not want an increase in income tax to pay for it).

I would imagine health tourism varies hugely depending on your area and how you define it. There are definitely a lot of people using family members addresses to claim residency. I’m front line in an inner city and we have multiple patients who have a foreign dial tone every time you call them, spend large chunks of the year abroad etc. The NHS is also treating diseases the UK eradicated or greatly reduced in the in the resident population years ago. This isn’t a judgement of the patients, I couldn’t do my job if I was prejudiced, but I don’t think it helps to not acknowledge the impact. Hepatitis for example - hugely expensive “miracle” drugs now available. Fantastic for patients but most of the cases treated now were contracted overseas.

Advances in medical science have increased life expectancy by so much.
My dsf, 70, has diabetes and must be costing them an absolute fortune. Weekly doctors, occasionally ambulances, week long stays in hospital, permanent daily medicines. He must be costing far more than he's put in over his lifetime. He would have been dead if it were 1950 and not cost them a penny.
It isn't sustainable.
I think the NHS staff are doing a wonderful job trying their absolute best, but there are just far far too many people like my dsf.
I've no idea what the solution is.

Another thing is the lack of central sourcing of equipment etc. I'm sure I read somewhere that each hospital has their own contracts with various suppliers. Why the hell this isn't all sourced centrally with every hospital having the same supplier, I have no idea. It must cost a fortune.

1 of those Nigerian women didn't come here to give birth; she was refused entry into the US where she planned to give birth and went into labour on the transatlantic flight back.

Also, alcohol is a huge contributing factor to costs.

My DP works in a service that used to be managed by NHS but has been contracted out. Patients still access it through GP. DP says the service has gone downhill although it looks better on paper. The service is focused on the outcomes that make the most money and not what is best for the patient. There is widespread cheating to meet targets, although DP refuses to do this unless a manager puts this in writing - which of course they don't.
DP is planning to leave, as have many experienced staff. The staff are treated very poorly.