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?

This winter is dreadful. I wonder if people think that NHS staff are kicking back, taking their time to process patients. We're not. There are simply no beds. Physically. Extra beds are being put in the middle of bays within wards. Therapy areas are being converted to wards. It's still not enough. All routine and planned surgery cancelled. All routine appointments cancelled so staff can join the acute teams instead. Patients being made outliers in other areas because there is a space, but then when a patient who needs that specialty presents, there is no free bed.

Flu A, Flu B, H1N1 (swine flu) are all flooding in, and it's only just started.

Overall the NHS is quite efficient. We get a good standard of care and good life expectancy and we only spend 9.5% to 10.5 % of GDP on it. The Yanks spend 18.5% for worse outcomes.

That said, when you look at the system it is full of little inefficiencies and small-scale waste. Inappropriate prescriptions, bed-blocking, lazy undertrained staff, records still kept on paper, hopeless buildings, vile attitudes to patients from some staff, rigid and bureaucratic procedures, loads of missed appointments.

All this guff about privatization vs national health is missing the bus. It needs better management (not more managers).

Yes I have had flu, proper flu and I know a few other people who have had. Flu seems to be particularly common this year. Unfortunately both myself and DP caught flu from a patient who came to see him and who should have stayed at home.

We are definitely at crisis point in my maternity unit too.

The birthrate has risen beyond anticipated levels, and my unit, despite being a new build only 10 years ago, can no longer accommodate the numbers.

We don't have enough staff - this is not down to a restriction on recruitment at trust level. It is down to not enough midwives being trained.

Not only is the birthrate up, but so are the rate of complex women. Our section rate is now sky high (35-40% most months) and our induction rate is 40%+. This is due to the number of diabetic (sharp rise with obesity), IVF, increased maternal age, etc etc. Also technology is detecting more problems with fetal growth in the same group of women, and also smokers etc. Also sometimes women with no risk factors of course.

Induction and c/s leads to longer hospital stays and increased medical costs.

It also impacts on low risk women as often they are hurried through the system due to lack of staff capacity. Eg instead of waiting longer for a labour to progress, there may be a suggestion of syntocinon or breaking of waters to speed it up - but if baby doesn't like it, it increases the risk of further intervention. Or these women perhaps receive substandard care because their midwife keeps popping out to check on the other patient she has (so much for one to one care in labour...) and this in turn can disrupt a nice normal labour.

There is no easy solution at all. I genuinely have no idea what the solution is. Really we need another maternity unit to open locally but how would they ever pay for a whole new unit and staff it?

Staff shortage
Over worked nurses
Nurses off sick
Not enough nurses on shift, huge demands on staff.
Long hours, no breaks.
Increased demand on services
Everyone under increased stress
Unable to meet patient needs leading to low morale and poor job satisfaction
Staff leaving to work elsewhere.
Wards staffed with junior nurses
Student nurses being put off the career when they see the strain and pressure the nurses work under.

....and back to the start.

It is a constant cycle and until a huge amount of money is thrown into the NHS to meet patient demands and increase staff numbers then things will just get worse and worse.

In terms of a nominal charge having an impact on abuse of services, I know this is the case. But the reality is that I suspect those most likely to abuse, would not pay a charge. Unless you charge everyone it would be a very small proportion who would pay.Most users of the NHS are elderly people, young children and those with chronic health issues. Most NHS funding is in the first few years and last few years of your life.

Crunchy, did you or DH have the flu vaccine? Just curious as the only people I know personally who have had the flu this year DID have it.

Crunchymint other countries manage to charge all users of their health service even if it's just nominal so why can't we? I have family in America/Asia and they budget for healthcare from their salary/benefits/pensions. It's a blind spot in this country that all healthcare should be completely free,which was probably doable in 1949 when the NHS was established, and is one of the biggest obstacle to making the NHS meet the very different health needs of 21st century

Life expectancy is a problem no one dares confront. The problem is that living to 100 invariably includes many years of living a much reduced life. Fil has been in a care home with dementia for nearly ten years - all his assets have gone. Nearly everyone else in his home is being funded by the council. In spite of this home being in an area of high unemployment and offering good terms and conditions, they just cannot get staff. There is no one working there who is under the age of 50 or local.

I think we are going to have to move away from the idea that people get their own individual rooms in care homes and return to dormitory-style accommodation. People will receive good food and care, but nothing fancy.

I also think that care will have to be provided by some sort of national service. As it is, young people would rather be unemployed/have children than work in a care home (actually who can blame them?).

I also agree that what is it with people going to the doctor all the time? With a cold, fgs!!!!! I went to the GP last year (infected gall bladder, so genuine reason!) and he was spitting feathers that the last three patients had all come in with the common cold. Mil used to go to the doctor every week because she was genuinely under the impression that the doctor was interested in her.

crunchy DHs family are Danish. They paid to see the doctor until their income dropped below £15k a year and they had assets under a certain threshold. It's been an issue with us supporting DHs parents because buying them a home also means we have to cover their doctor visits. In the grand scheme of things I have no issues with paying for the visits. We have them a credit card which we pay in full.

If we hadn't purchased a home for them none of this would have been an issue. They would have qualified for a smaller home than they have now and it would have been ground floor. We purchased a 2bed apartment on the top floor of an apartment building with an elevator and parking for them right next to the elevator door in the basement. Doctor visits and the insurance for their prescription charges cost us about £1500 a year.

Yes we both had the flu vaccine. Myself because I am in a vulnerable group, and my DP because he works for a contracted out firm for the NHS.

£1,500 a year is nearly a months wages for me. That is a lot of money. And because of my illness I am sure mine would be higher.
If people paid directly they would demand more. It would have an impact as it has in higher education. I would not pay £15 for a quick 3 minute GP visit, which is sometimes all I need. Literally I just go in and ask for regular hospital test results, told them and how to adjust meds. It is so routine for me that it takes minutes. But I confess I would save up things to ask and have a longer appointment.

I have had several patients mention to me that they would like to give a small donation to the ward and have asked if we have a donation box which we don't and i dont know any wards that do. A lot of families have asked to donate money that has been collected instead of flowers at a funeral but are put of as they are told it will not be guaranteed to be used on the ward they were treated on but will end up in the central pot so they give it to a charity instead. I do wonder if having small donation boxes in wards that the ward manager could use the money from as they saw fit would help.
I think a lot of people would be against this though as the mentality is almost as if there should be no suggestion whatsoever that you could contribute something extra.

I would support donation boxes as long as people did not feel pressured to donate.

crunchy That cost is charged because they own their home free and clear. If we hadn't have purchased their home they would not have to pay anything.

Also that is the cost for two elderly people, one of whom has complex healthcare needs (bladder issues which included the removal of a kidney, their bladder and now maintaining a urine colostomy bag, arthritis/bad back, obesity related issues such as early onset diabetes, high blood pressure and high cholesterol). The other parent has elevated PSA levels. They have annual check ups and my FIL had his in late October. Already his elevated PSA has resulted in him having an MRI of his prostate in November and he had a template biopsy performed in mid December.

People need to see past US healthcare, of which about 5% of the spend of GDP is on profits for the insurance companies. I personally believe the French, German and Scandinavian systems is what we should be looking to move towards in terms of funding.

In terms of management I have been some brilliant working practices here in North America. The NHS could learn a lot about how the Canadians and Americans manage their workforce. They should also look to the aforementioned European countries too.

This, from Frumpety:

I do wonder whether encouraging people to be healthier is actually a good idea ?

The pil ate five a day, mainlined Benecol etc etc but both lived (and one is still living) with dementia for years. In fact fil has been retired for 35 years on public sector pension (all of which is flowing into nursing home's owner's pockets).

Someone I know blackly joked that her dh, who died speedily of cancer at 60 six months after retiring, should have been awarded a posthumous CBE or somesuch for saving the country a fortune in pension payments.

I think we are going to have to move away from the idea that people get their own individual rooms in care homes and return to dormitory-style accommodation. People will receive good food and care, but nothing fancy. I think it is awful to think of your FIL being in that sort of care for ten years, we shouldn't accept going back to that. It will be the workhouse next.

I have had several patients mention to me that they would like to give a small donation to the ward and have asked if we have a donation box which we don't and i dont know any wards that do.

Every ward I have worked on has had a donation box. It’s a good idea.

Many older people own their own home but have a small pension. £1500 a year is a lot of money for 2 elderly people.
My FIL healthcare bill would have been unaffordable if we had to co pay. He has a small house, but costs would have been much more than the estate. His health needs are much more complex. I guess we would have just had to let him die? To be honest the healthcare you outline for them both is nowhere near as much as I had when very ill.

Ward specific donations are regularly recieved (theres a process they have to go through but they do end up back on the named ward) but unfortunately they are more frequently given on the wards that arent in most dire need (i.e. they go to the longer stay "final destination" ward not the assessment and short stay wards)

If the donation is for specific equipment it cant be guarenteed to only be used for a named ward. But if it is for a named wards general use it will be spent on something for the patients on that ward.

There is also a staff fund (hospital wide and ward specific) and a hospital charity.

Its already a thing. But on wards that dont get regular donations (such as assesment units) staff may not know how to go about recieving it.

crunchymint Then the costs are applied against their home and after they pass the claim is made against the estate.

I see a problem of negative thought over people paying more. This is what they do in Denmark which is a socialist (emphasis on collective) society. If this is what we want then we need to collectively pay for healthcare and that does unfortunately mean that certain people aren't going to get the inheritance they were expecting. However their family member will be getting much better quality healthcare.

Americans manage their workforce.

I admit I have almost zilch knowledge how Americans manage their workforce. The only thing is do know is how little annual leave the American workforce get and also poor matnernity pay. Neither sounds looking after their workforce well.

The NHS is not free, people pay for it collectively from tax and national insurance. Most of the German workforce have it deducted from their salary, no co pay. Only top 11 % of earners opt out of state scheme and pay for private insurance.

I am only getting this info from Wikipedia but apparently Danish healthcare is mainly funded via income tax and "Those who have the insurance provided by group 2 may visit any GP or medical specialist they wish, but may be subjected to copayments at their visit. Citizens with this type of insurance make up less than 1% of the population."

*All this guff about privatization vs national health is missing the bus. It needs better management (not more managers).

I have no idea how the NHS is managed not working in it, so can offer no opinion. It may well need improvement, although I know reports say overall the NHS fares well on efficiency in relation to other countries. I am sure there are areas that could be improved, like any huge system.

However, the issue of whether the NHS is being slowly privatised is not in my view 'guff'. People need to be aware if this is happening and do they want a profit based healthcare model? There should be more transparency and discussion.

Missing which bus? The £350m a week for the NHS bus?!