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?

To all those who think it's just a matter of more funding, can someone point me at the statistics that show what we need to fund exactly? It seems to me, that we keep throwing money at the problem, but it just keeps getting worse. Everyone seems to have anecdotal examples, but few actual facts. Where does the money go, if it isn't going towards the things we apparently have too little of? How much money does the NHS actually need?

From where I'm sitting, the problem seems to be a combination of:

• more people needing medical help (these figures should be easy enough to get)
• unrealistic expectations of the user i.e. potential and actual patient
• poor co-ordination between clinical and social care
• increasing bureaucracy
• increasing cost for drugs, etc.
• no clear accountability

To answer some of the suggestions

• central sourcing of equipment is great in theory, but in practice leads to using one highly over priced supplier e.g. plugs costing 10/11 times what you or I would pay. Then there's the problem of central storage and getting supplies to hospitals.
• I don't the government (or any government for the past 15/20 years) has a clue what to do. I do think they (all) want the NHS to succeed.
• would paying nurses (and doctors) really make things better? It's obviously a good thing to do, but would it really make a difference?
• if alcohol is such a problem, would things like drunk tanks help?

Very interesting. American relatives have told me they get much less annual leave and maternity help than you get and I have read elsewhere annual leave is much lower generally. I will have to do some more googling!!

This article from 2010 shows annual leave in US is very low

Yank here. I also get 4 weeks of annual leave and had the same maternity leave benefits as PP. The study that the BBC article cited included part time and hourly employees in the average, who get paid when they work and aren't paid when they don't. If you looked at salaried, full time employees it would be much higher. The study was also from 2007.

We had a shortage of nurses here too back in the early 2000's. Hospitals and medical practices had to pay more to hire them. Some nurses who had retired or left for other reasons came back, at least part time, drawn by the higher wages. The higher wages drew more students into nursing programs, who graduated more nurses. There is no longer a shortage of nurses here.

It seems to me, that we keep throwing money at the problem, but it just keeps getting worse.

We've been steadily reducing the amount of GDP spent on the NHS in recent years, though. To the extent where we spend less than other countries of comparable wealth. And while, as you mention, our population ages.

It’s controversial but we need to discuss end of life more openly and make more living wills and discuss peoples right to end their life. There is no way I would want to carry on living with advanced dementia or debilitated after a stroke. And I especially wouldn’t want tax payers money wasted on me if my life was in effect over. I know this wouldn’t be everyone’s choice but people should be given more choice. Let people determine their paths before they get too old to be able to determine it ethically.

@jaxhog

The NHS funding is reduced year-on-year, so we aren't actually putting more money into it. We are cutting it.

The problem with NHS trusts is that lots of pay goes to those at the top of the chain - beaurocrats and consultants - rather than to those at the coalface. The trust model is a bad one and is leading to a deficiency in funding where it is most needed. Part of this is also due to private contracts, where NHS money is used to pursue private services when it should be in-house.

OH, you are so right to be so concerned. My mother, who was bright, still intelligent and spritely, became very ill indeed, very suddenly one night some years ago. She was 88 but still entirely bright, competent and very well and living on her own and managing her house-hold and garden. After a nightmare ambulance journey to A&E at a major hospital some 25 miles away, we were "eventually told" by the A&E medic who had attended her, that she had a burst ulcer, which had bleeded into her abdominal cavity but we should "not worry too much" as emergency surgery would save her. OMG that "emergency sujrgery" took 2 and a half days to actually "happen" by which time she had of course developed irreperable peritonitus, and died horribly, THREE days after waiting for her "emergency surgery"! So yes.. sadly, the NHS has lost it - and they lost my mum, and I genuinely think even more, and worse, is to come. xx

Inefficiency.

Yes, it's not-for-profit. But from what I've seen lately at our local tiny minor injuries unit - inefficiency really stands out. A lot of the funding is going to waste, in my opinion. If it were for profit, it'd be much better organised with non-essential staff eliminated.

You walk in, and there's a receptionist - permanently there, reading a book most of the time actually as there's nothing to do. Then, she tells you to turn right (it's a really small place!, not like you could get lost easily walking in). There you see another receptionist who gives you a number and tells you to wait. Then after a while, yet another receptionist comes out to call you in to get booked. Then the wait... Last time we had to go in, a nice person in medical uniform came out to inform the three people waiting (small place!) that there will be a delay, as one of the two nurses and both 'medical assistants' have gone to lunch. Great! Well, once you've waited the two to three hours (seems obligatory somehow, even when the place is nearly empty), you get seen by not one, but two or three people. One may be a nurse or doctor (yes, that's the person I'd come in to see), some medical assistant and another 'chaperone'. The latter two don't seem to do anything, I'm not sure if they're even authorised to do anything. Why, oh why have the chaperone earning a salary?! Why have the medical assistant present at the same time? Just WHY? I have no need for either, and actually the medical assistant if he/she is worth keeping could've dealt with some of the less serious cases.

(Note, I was there with an 8 year old who needed stitches, blood everywhere. No doctor needed really, but needed a nurse or someone trained enough to do stitches)

And what about the fact we've created a nanny state where people have no idea how to look after themselves?

We've not been to the GP for 8+ years. Sure we've been ill but we treat ourselves where possible including using natural anti biotics, homeopathy and not wasting GP time every time someone has a sniffle.

Personally I think the 'cost' of the NHS should be aligned to benefits i.e. If you are on benefits you can go and it costs less than of you are in work. As it is no one appreciates the service they get which, despite being crap, is still FREE!

It isn't fucking free though is it?

It is completely shit though

My local hospital MIU is nothing like that. One receptionist who is always busy, she does the booking in, fills in all the forms tells you where to wait. She does some sort of clerical work if she isn't busy (she usually is) as you can see her with a pile of forms entering information onto the system.

I took my son there and we were triaged and then seen by one doctor. She arranged for my son to be admitted to local general hospital, told me to get him straight there and no stops on the way and a team would be waiting for us when we got there. They were and in under half an hour he had been examined, had IV antibiotics going and was on his way to the ward.

Wonderful service and couldn't be more efficient.

Much as I'm glad you don't burden the NHS with minor things sunshine, whatever else you were doing when you used homeopathic remedies you weren't treating yourself. Homeopathy is bollocks.

I agree with the health tourism comments and also the rise in children who are being diagnosed with ADHD and Autism. Vast numbers of these children are 'English as a second language" and to add to this their parents are non English speaking either. The upsurge of assessments for children for immigrants has typically run away with the service. And the addition of having to pay translators for the assessment is a big burden on the budgets for the service. Quite often the parents also claim they have no means of transport and they are also funded for taxis. This isn't a moan about immigrants however we have to realise the extent of the impact on the service - which then refers for access to CAHMS

I think this thread is very illuminating - OP asked specifically from responses from NHS staff. I have read every post on the 17 pages where the poster has explicitly described themselves as a member of NHS staff (by reference to their position, or working in an NHS environment such as a trust or GP surgery etc) and they all seem to largely be saying the same things. Then it's very telling to read the posts from people who explicitly say they are not NHS staff, but in fact patients or families of patients, to find many of them saying the same things but things completely different from the NHS staff themselves (most notably moaning about admin staff). This thread would have been much more helpful if patients didn't all think themselves as much experts on the NHS as actual NHS staff.

I'm 24, disabled, been what I consider to unfortunately be a heavy user of the NHS since I first started my mental health treatment at the age of 17. I am so, so grateful to all the NHS staff, I salute all of you, you are all amazing. I would never be able to afford the treatment that I need(ed) without it.

My husband has throat cancer - we are both teetotal non smokers and have both paid higher rate tax almost all our working lives. Our experience of Guys Hospital has been one of terrible inefficiency. We complained and eventually they admitted multiple unacceptable failures in administration that could have caused serious harm. I did a Freedom of Information request and it turns out they miss the target times for answering complaints in between two thirds and three quarters of all cases. Only today we received a letter about his care dated 11th October! 3 months late, so it is irrelevant now. Some individuals are great but some are awful. At one point they thought he had bowel cancer as well and when he went for the test a nurse spoke to me so sharply- completely unprovoked- that I burst into tears. I am not a weed but have worked in very tough male environments for years and never blubber. When I quietly asked her not to snap at me she yelled at me that she had feelings too and I had made HER feel awful. Bear in mind she knew he already had one cancer and this must be the worst day of our lives and this is how she behaves. Then my husband could not eat and so has had to have a tube fitted down his nose so he doesn’t starve to death. The hospital insists on calling the liquid nutrition ‘feed’ as if he were a pig or a chicken. Having a tube is already profoundly alienating without using degrading and dehumanising terms but they don’t listen or change.
His treatment has involved nutritionists who have contributed literally nothing of use. All they can come up with in terms of suggestions for food he might eat is jelly and carnation milk, which is unhealthy and no one has had since they went to their grans in 1989. The drinks they give as supplements are so evil tasting I wouldn’t give them to a rat for poison.
Our experience is that some individuals are incredibly compassionate and wonderful but the system seems to be run more for the benefit of staff than patients.
Perhaps we’ve been unlucky - I hope so.

CEO of trusts being paid more than the prime minister and not being accountable.

NHS is being ripped off by pharmaceutical companies

Brexit long term could affect staffing even more

From what I have read, the healthcare inflation is around 4% a year - to maintain the exact same level of care year on year. However, the NHS has received an increase of around 1% annually since 2010. There has been underfunding of 3% a year, for 8 years - so that's 24% in total.

It makes me very cross when people say that 'throwing money at it' wouldn't solve the problem. Simply maintaining the budget in line with inflation would solve a big part of the problem.

It is very obvious that social care budgets (by local authorities) have been cut - leaving a huge gap in care for elderly people. And as people live a lot longer than before, this is increase the cost of the NHS and they do need more money to deal with this.

You kind of have to pay the CEOs more than the prime minister or nobody would do it. They’re not tied to the public sector or the nhs. A CEO capable of running an nhs trust is generally someone who would also be in demand in large private sector organisations so the pay has to compete with someone at that level. If you only pay 80k then you’ll end up with total numptys.

In my branch of the NHS, (maternity) we are seeing patients with more extreme health issues, who need more care, more scans, more prescriptions, more hospital stays, poorlier babies but being funded for ordinary low risk care.

Women who are at very high risk of a deep vein thrombosis are offered 6 weeks of blood thinner injections which cost the NHS £1200 per patient. They have to give the injections to themselves which is difficult to do so the compliance can be low, and some women then go on to develop a DVT anyway.

There is an obvious answer to this - voluntary euthanasia. Not all of us want to go on for as long as we necessarily could. Speaking for myself, i‘m quite healthy at age 62 but so utterly p1ssed off with the hand life has dealt me, i‘d happily throw in the towel a bit early if it cost me nowt.

Very few of us are experts and imagining that because we’ve used the NHS or even worked in one part of it we know what the problems are is just silly. I do research for a living and I will trust the experts who have done the research. We pay too little and expect too much. I also wish we could depoliticise it like we did with the Bank of England. Ditto for education.

I have worked in the NHS for ten years
Currently I work for the community nurses however I have spent 5 years in an acute hospital and 2 years in a community hospital in MIU
The only place that was well staffed was MIU but even then that wasn't enough.
There are too many "managers" and not enough boots on the ground. Staff morale is low and nobody does anything to help. We get promises of recruitment and fluidity of staff between teams but that rarely happens and if it does it doesn't scratch the surface, it just gets swallowed up and the whole thing starts again.
Our trust offers a wellbeing service - seems like a good step? Well it is if you've got the time to pursue these things or are free in an evening to take a yoga class or massage therapy.
Then there's the "we've done a piece of work surrounding..." right ok so why haven't things changed? You may think that offering a yoga class is a great idea, it probably is but who on Earth has the time? They then get scrapped due to poor uptake - back to square one.
I don't know about anyone else but I'd rather someone actually ask me if I was ok and when I reply no because of x,y,z that they seriously consider what I've said and try to implement something to help - for example instead of spending money on hiring some one and somewhere to hold yoga employ another member of staff, update our hardware so we don't face a constant uphill battle daily just trying to do our work or even a little Christmas bonus? (I know that sounds grabby but it would make me feel more appreciated - the MIU unit used to get either a Christmas meal paid for or we got a £10 bonus from the friends of the hospital)
The wards I used to work on used to have a pot that any patient donations used to go into which paid for in full or part of a Christmas get together - that's stopped now and it gets swallowed up into an equipment fund or the pot which is never to be seen again.

There are too many reshuffles and rebranding of teams, for example at the moment my trust are implementing neighbourhood teams - again a brilliant idea, but we are all on different systems, all work in different areas and are rarely ever together. Plus the trust I left to come to the current one did this and scrapped it after 6 months because it didn't work and wasn't good value for money.
Nobody seems to look at what other trusts are doing and see what works - it's almost like it's a competition. Every single trust in this country should work on the same basis, same systems and help each other out.
Just from a patient point of view, my gp is under one trust, my hospital under another (15 miles from where I live) so I've had to travel for 35 mins to get a blood test done because the systems are different and the hospital cannot see what the gp has done - everything gets repeated costing more money and time.

Patients also need to understand how to use the NHS - we often blame them for the hold ups in a&e because they could've accessed a more suitable service. However sometimes it's because they have no idea who does what and end up in a&e because it's a hospital and they know they can't be turned away.
Gp surgeries cannot cope with the number of patients in their areas. I live in a small rural town with three surgeries I have to wait two weeks for a routine appointment and even then sometimes you can't book a routine appointment you have to phone on the day to be triaged - this is not sustainable and a poor way of working. Some surgeries still have the sit and wait option but they are primarily in small villages that can handle that.
There is not enough being done to educate people on which service is best for them, I'd like to see more tv and online advertising - yes it costs money but surely in the long term it would save?
Patients have also lost the ability of self care, in MIU we used to get hundreds of people attend with a sore throat, a very minor cut (think paper cut) and other ailments that a pharmacist could help with or that simple rest and fluids could solve.
Don't even get me started on the people who attend for d&v, unless you are frail or have a chronic illness that can be affected or are neutropenic there is no reason to go anywhere - stay at home and do not spread the love. I remember one incident with a patients relative, who came in at visiting time and was talking to the ward manager, about halfway through projectile vomited all over the ward manager and the relatives bed (relative was in said bed)
Unfortunately then said that had been vomiting for the past 18 hours! This person wasn't old, even said they didn't think they should come in but did anyway. The point of this is in a couple of days we were closed with norovirus for two weeks! Luckily we came out unscathed but it could have been devastating.
We've become so bubble wrapped that we cannot do anything for ourselves, it's high time we got into schools to teach kids how to look after themselves, then at least when they are older the pressure may relieve a bit.
I actually want to cry when you get people attending for a sore knee they've had for months but have bypassed all the other services straight into a&e at tea time on a Sunday because they just cannot face a day at work on the Monday and then you have little old Betty who has severe chest pain, doesn't want to bother the NHS services who then ends up dead from a heart attack.
Mental health services are beyond rock bottom

Sorry for the essay! Have a gin if you got to the end (responsibly of course)

Smudge I believe that more Advance Directives could be useful, but with actual euthanasia it might not be easy finding many of those "volunteers" - and that's before we consider the potential issues around family/carer pressure

That said, I can imagine complex interventions becoming much more severely restricted for those in extreme old age

CEO of trusts being paid more than the prime minister This sort of comparison annoys me so much! The prime minister gets a London home and a country home on top of his salary, so the comparison is nonsense anyway. And then of course most of the prime minister's reward comes from the immense profits that can be made by being an ex-prime minister.

I left the NHS after a decade in October 2017. I worked for a paediatric cancer unit....
No you can't cancel an MRI to go to the zoo.... there are 8 slots a day, we book the theatre and all the staff.
No you can't come on Friday... your child has a suspected cancer, that clinic is only held on a Tuesday afternoon.
No you can't have an interpreter.... you have lived in the UK 20 years.
No your mam and your sister, you and THE PATIENT can not travel in NHS ambulance transport... its a hospital visit not a day out to the bloody seaside.....

I work for the nhs and in my delay the amount of patients who access free hospital transport is unbelievable. 60-70% are well able to hop on a couple of buses to get here and back or have family/friends/neighbours who could drive them. It’s not ideal but if I lived far away from the hospital I would be expected to do it! The cost of hospital transport system is huge! Also providing free prescriptions for paracetamol which can be bought for 25p a pack. My department is top heavy with USELESS management on band 8+ who provide no support for ground staff. Morale is low and environment negative