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?

A major factor is the obesity crisis.

A&E is overwhelmed and that is a major news story for the media, I'm not minimising it but I don't think innapropriate A&E admission is the main issue. The biggest impact is simply that people are living longer, treatment policies have changed therefore care is being provided to an age group that wasn't previously catered for in the same volumes. So that's had a huge impact upon resources. Next time you go to the hospital or GP surgery just take a look around you.

30/40 years ago operations wouldn't have been offered to anybody over the age of 60. Why? It was assumed they wouldn't survive the surgery.

Today - this age group is surviving but, they require more care post op, multiple hospital admissions (taking up critical care/intensive care beds and also taking longer to discharge due to longer recovery times), time spent with the GP and cost for equipment and care at home haven't been adequately budgeted/planned.

I don't know what the answer is to fix it. There will definitely need to be a huge cultural change with regard to the mind set of delivering services. Perhaps some honesty about what services the NHS can now offer? NHS England hinted at this after the budget allocation was announced in Nov 2017 and there was a massive shortfall in the amount allocated versus needed.

I have been working in the NHS for about 18 months and am astonished at the number of people in cushy band 8+ jobs in my dept. Massively top heavy.

In my opinion a bit of everything. Poor management, lack of staff, unable to retain staff,ageing population , over use due to a growing population. Cut backs in services, wards being closed, a&e being downgraded to walk in services, time wasters.
Poor wages, bursaries gone, junior Doctors contracts, 24/7 service , paper work, trying to please managers, patients, relatives. Getting abuse from all the above. Staff moral , not feeling like you have been able to give 100% care due to other factors. Long hours, no family time. Being moved to cover other areas. Feeling that tired walking home.
Saying all that I love my job. I work with a cracking team.

I fully expect that by the time I retire the NHS will only offer emergency treatment and some highly specialist services free at the point of use. Everything else will have to be paid for.

Increasing need due to an aging population, without a corresponding increase in funding.

Doctors doing a whole raft of unnecessary work just in case they get sued.

An increasingly litigious society, huge amounts get spent in litigation and payments (I'm not talking about people who've had the wrong kidney taken out by the way, who of course deserve compensation, but eg. I spent one party talking to one young lady who was going to sue the NHS because they hadn't sewn up a wound properly and it had left a small bit of scarring which would 'wreck' her non existent modelling career).

The fact that the UK spends about 2% less of GDP than most of the rest of Europe, and that gap is getting bigger. See this report by the Kings Fund if you don't believe me - link - I don't know where all the money being 'thrown' at us is exactly?

Lack of funding and MASSIVE inefficiencies.

Staffing is already a problem and will get much, much worse. The bursary for student nurses/midwives and other HCPs need to be reinstated and made up to a decent amount. Applications to study nursing have gone through the floor since the bursary went, even midwifery applications have dropped by around 30%, with some courses going to Clearing for the first time ever.

Pay scales need to be overhauled. Nursing and midwifery need to be properly paid professions, reflecting the education needed for, and responsibility of the role.

My maternity unit is operating at more than 20 midwives less than it needs. It's not safe for the women we care for, or for us. There is no funding for more midwives, and even if there was, there's not enough Band 6, qualified midwives out there.

huge amounts of investment is needed.

Health tourism is a tiny, tiny drop in the ocean. Miniscule costs. It simply suits the current government and the right-wing press to blame it.

Zube - but why did she fly to the UK? If you flew from Nigeria to Chicago, but were refused entry by the US (because you couldn't prove you could pay for any hospital treatment), why would you decide to fly to the UK? There's plenty of cheaper flight options, e.g. Turkish airlines with a stop in istanbul.

Clue - the patient herself said her Nigerian doctor had told her that hospitals in Nigeria wouldn't be able to cope with the babies.

As I said, you absolutely CANNOT blame the individual. Who wouldn't want to try everything to help their babies? But it cost the NHS over half a million quid that it will never recover. So whilst we cannot hound this lady and her family, it is the sort of thing that I think they are right to try and control.

notdavidtenant summed it up nicely. Backdoor privatisation wanted by the government,

I fully expect that by the time I retire the NHS will only offer emergency treatment and some highly specialist services free at the point of use. Everything else will have to be paid for.

I suspect this will happen within next 5-10 years if current government stay in power.

I have to say that in my department there are only 3 people above band 7, all hugely overworked. My department manager is a band 8b, in charge of around 60 people, and we have 2 individual section leaders who are 8a's, all with postgraduate degrees as standard. The top of a band 8b scale is £58K. My DH earns about £20K pa more than that as a senior developer (programmer) in charge of maybe 2 people at most (in London).

So no, at least according to my experience, it is not in any way 'top heavy'.

Theres too many managers and not enough groundforce staff.

DM works for NHS. She is 1 of 3 people paid at her grade in her department. Theyre all at the top of the pay scales so long term employees with maximum flexibility of working conditions.

Immediately above her theres 5 managers solely for her specialist department. They need 5 managers because they run 5 shifts that the 3 staff cover between them. They used to have 5 staff (plus 5 managers) to cover 5 shifts but needed to make cuts due to budget restraints.

1 manager is responsible for hr, another stock control and ordering, another 1 is responsible for staff training, 1 responsible for the day to day running of the department and the other one has no specific role that dm knows of.

Its this sort of daft decision making that takes hands off the ground where its most useful and causes some of the issues we see today. Why does 1 hospital department with 3 full time staff need 5 managers to run it? They don't is the answer.

I've posted about this before and got told those managers are essential, will probably free up the ground staff to do their job, will be supporting other departments etc. I put these comments to my dm and she laughed because these managers are solely for her department at the hospital she works in and they don't support any other departments.

When dm first started her job 35 years ago they employed 1 manager for the department and had 9 full time staff.

Some issues are also health tourism (a massive bug bear if mine due to family members hopping on planes for heart by pass ops and hip replacements courtesy of the nhs) and the fact funding is too low to train more nurses/doctors etc. I recently looked at going in to nursing myself. The university I spoke to said they offer 300 places a year but get around 6000 applications. So my question is why, with a national shortage of nurses , are universities and hospitals restricting the number of students?

The NHS needs more money but targeted at training new nurses/doctors etc. They can free up some of that money by getting rid of a lot of management roles and consolidating a lot of roles.

So, I only know of one place that has been privatised - St Mary's Urgent Care Centre, it has just been assessed as failing - I don't see / understand how the government can justify privatising other places when the ones they have already done so with are failing.

The main problem....nhs is doing too much. When set up it was births and deaths. Now we treat cancer, ivf, etc. One hip replacement costs about the same as someone has paid in national insurance from memory. Theres too many people using it as population has increased

We need to spend more money. We actually get real value for money with the nhs. We spend less per head than most developed nations. We need to be prepared to pay more tax for it. As going down the private route will end up costing way more per head.

We need to cut middle management and cut down on all true paperwork excercises and concentrate on clinical work and clinical staff.

We need to improve pay for clinical staff. It’s a lot harder to accelerate up the pay ladder if you stay in clinical work.
He pay is really quite poor considering the amount of qualifications I have compared to private industries/ even civil servant/teaching type professions and I am on a relatively high band for the nhs (band 7).
I am at the top of my band now with nowhere to go no matter how many extra courses/ new things i learn I can’t affect my pay. If my boss retired tommorrow I know that her job would disappear, the next person would be expected to do the job at my grade or I would be managed from a larger satellite hospital. So there really is nothing for me to aim for apart from going private of which there are more and more opportunities going forward long term. So I have no real incentive to better myself, stay in the nhs.
I am just waiting it out till my kids are older and I can be more flexible.
This will happen more and more and the nhs will be deskilled.

And of course the aging population as others have gone into detail.

@Rebeccaslicker

The question that hasn't been asked is - so at the point of access who does the checks? Who is the person to say "nope, you cant pay for the service so you need to leave...." Whilst she's in labour?

I doubt I could do that job, it is what's needed, but you'd need to have a heart of steel and grit to be able to do that on a daily basis (and access to lots of counselling)

If they would only put some money into preventing ill health it would really help. Exercise classes, including balance, for older people, including one to one sessions at home if needed. Tackling the obesity crisis - particularly causing expensive complex maternity needs and also diabetes. Putting in some effective help for those with back pain. Sadly it has deteriorated into a fire fighting exercise.

More funding would be useful for care in the community, to pay decent wages to visiting carers and financial support and respite for family carers. Speed up and increase funding for getting support and adaptations in place for people to be discharged from hospital would free up beds from people physically fit to be discharged but unable to cope at home. And prevent some people becoming ill enough to need admission in the first place.

More NHS staff are desperately needed, doctors and nurses and paramedics and support staff. They need to be made into attractive careers and it’s not just about wages.

Stop health tourism from British ex-pats who live overseas but still expect to receive free treatment on the NHS. If you’re not resident here then you should have to pay for treatment.

Health tourism has been proved over and over again to be negligible, I don't even know why that keeps coming up.

On the other hand, we're about to lose huge quantities of our staff because of Brexit, I already know of two people who've gone back to Europe where they feel more wanted.

In addition, there are about to be fewer people of working and tax paying age coming over from Europe who can help to fund the system.

What Rebeccaslicker posted

We simply don’t pay enough in a s cutbacks are increasing problems

Also the social care aspect (including mental health costs) are often huge this was never accounted for when the NHS was set up

No party is really willing to say the NHS is broken becuase we hold on to it with great pride but it needs to change and we need to decide what the NHS will cover costs for and what it won’t but then it is no longer the NHS it’s a different health service

Loads and loads of issues. Mainly:

1. Not enough nurses and doctors, meaning there's a recruitment crisis and changes to bursaries etc coupled with Brexit and stagnant wages is making it much harder to recruit more staff. Due to a large number of NHS staff due to retire in the next 10 years it's going to be at crisis point soon.
2. Too much of a 'suing' culture meaning now people are constantly going to their GP / A&E and doctors are constantly sending patients for investigations 'just to be on the safe side', when really they already know what the issue is (usually something minor), meaning tens of thousands of pounds being spent on unnecessary tests each year. Ditto the suing culture is leading to an ever bigger mountain of paperwork for staff to fill in for every patient (ever patient that comes onto our ward has to have a falls assessment completed, a pressure sores assessment completed etc, etc, regardless of whether it's relevant to that patient's individual needs or not).
3. An ageing population who are living longer and in poor health, without the money or resources to back this up.
4. Drugs are more expensive, and many advances in medical treatments (whilst great) are normally expensive.
5. Cuts to social services mean that patients that need care packages / care homes on discharge may be stuck in hospital for weeks, with the NHS footing the bill.
6. Pharmaceutical companies making millions by over-inflating the price of the drugs they sell.
7. Stagnant wages mean many staff are taking up agency contracts instead of NHS bank contracts, which earn them twice the wages but cost the NHS 3 times as much as well once the agencies have taken their cut.
8. Too many people are obese / smoking etc too with the inevitable health consequences, and not taking responsibility for their own health.

I do think the issues can be fixed, but it's not a simple solution, and would take a lot of time and money to correct. BUT, I fully believe this government want the NHS to fail now (for example taking away the nursing training bursaries when there's already a nursing recruitment crisis), so I think they are just going to let the NHS collapse now so they can all turn around and go 'oh, let's just move to US-style health insurance system instead then'.

There have also been cases of people working within the NHS bringing in relatives for treatment or prescribing NHS drugs for relatives abroad, e.g. this chap:

courtnewsuk.co.uk/chattopadhyay-doctor-prescribed-drugs-for-his-mother-in-law-in-India/

Ok so £1000 on its own isn't going to make or break even one second for NHS funding, but it highlights a culture where people just see it as a freebie instead of the precious resource that it is. That sort of thinking needs to change across the population, I think, as other PPs have said more eloquently than I have.

Lack of investment in social and mental health services, which is causing problems for the NHS because we're having to take the patients who are being left in the cold.

So many factors, but mismanagement and also an ageing population with no thought put into long term care, or closure of "convalescence homes" by councils.

Advances in medical care mean that many conditions that were fatal years ago are now treatable with increased life expectancy. All well and good of course. However, what happens when someone can no longer manage a condition by themselves?

Usually that now involves a trip to A & E, then a long term stay in a ward until a place can be found in a care home or a package of care set up in a person's own home. However this takes time, resources, staff and money. And it is now a major issue.

I've known patients to stay on wards for 3 months. Although medically fit for discharge, there is no suitable package of care for them to be found, so they stay in the ward at the cost of X amount per day. Add in the cost of a 1-1 HCA to stay with them if have dementia 24/7 and the cost for that one person spirals. Replicate that thousands of times over hundreds of trusts....but what the answer is, I don't know.

I left the NHS a while ago to go back into residential care, and everyday we get at least 3 calls from social workers trying to find a place for a vulnerable person. We are presently full so the answer is "no". But as soon as one resident passed away, within 24-48 hours that room is "booked" following assessment.

But my other concern is the sheer amount of drugs handed out with no regular reviews by GPs as to whether the medication is still beneficial or not. The amount of tablets I send back for destruction everyday breaks my heart. The cost of the waste must be astronomical to the NHS, as well as however much it is to adequately destroy them...But again what the answer is...who knows?

An ageing population is not the only factor of the ailing NHS. But sadly it is a big one and no one has a clue how to deal with this issue.