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?

As someone who worked for the NHS (not frontline) but does research with frontline staff - I can tell you that health tourism is NOT to blame.

There are entire teams in each hospital whose responsibility it is to find people who don't live here or intend to settle here and they're bloody good at their incredibly hard job. It's not to say that some don't slip the net, it's inevitable, but people bandy the term around like it's rife - it's not.

The issue is the number of managers, who get paid massive salaries for mediocre work and will be getting their big fat pensions at the end of it. As well as failed initiatives and IT systems (which are another story in themselves).

It is broken, it needs hauling to the ground and re-fixing but how does one person (or even a group of people) coordinate 60k organisations that make up the NHS?

There are so many factors that are affecting the NHS, I don't work for the NHS but I see a lot of issues going on within the NHS.

When I speak to staff all of them say there is too many managers, not enough staff lower down.

There is an issue with people not taking accountability for their own health, I've seen patients have a lot of money spent on them for a top of the range product for them. The patients then never have the product due to alcohol/drug abuse landing them in rehab and the product goes to waste as it's bespoke.
Obesity is going to be a massive crisis soon, as the disorders that go along with being obese will become an issue. This on top of the growing population is going to cripple the NHS.

People attending A&E and calling ambulances for no good reason, lack of GP appointments.

And these issues are a drop in the ocean.

Cat: Because it's estimated to cost about £2billion a year - and that's just from known/identified cases. Speak to anyone who works in the NHS and a fair few of them will tell you that the figure is grossly underestimated. Just because it may be a small factor doesn't mean we should overlook it. £2bn is still a lot of salaries/beds/treatments! A family friend of mine who is a consultant cardiologist reckons the official figures are about 1/3 of what it actually costs, just based on the patients that he sees, many of whom arrive here and claim to have developed chest pain, when it's quite clear to him that they have long term or chronic conditions.

Buttercup - that is a good question. It's morally very very difficult.

It's simple really. The medical landscape has changed so drastically since it was instigated, it simply isn't set up to deal with today's aging population, more complex medical needs, higher expectations. It's done a superb job adjusting in the circumstances, but it can't go on much longer like this.

We need a national, non political debate about what it's role should be and how that can be financed. However, there appears to be no appetite for that whatsoever. The questions it poses are too hard for our politicians to wrap their head around.

Left to the tories, they'll continue to starve it and it will collapse under that pressure. This would be a really sad end for it - we all deserve much better than that.

However, Labour's approach looks to be throwing money at it in its current state without actually addressing the problems. That's not the answer either and will just fuel perceptions of the party as profligate.

We need some very smart minds on it, input across all society and the appetite to tackle the tough questions. Sadly, I can't see it happening.

Primarily the ageing population. People living longer, but often not in good health. Many of the medical advances that have been made are also very costly to implement - eg simple X-Ray vs MRI, or complicated surgical procedures and new medications. The financial and staffing requirements of the NHS have increased so much since it was introduced and we haven't kept up. We all need to pay more tax, much more, but successive governments on both sides have been too cowardly to admit this. Those who are saying the increasing population has an effect are right too, but we are going to need more working-age tax-paying people to pay for it all.

And the sheer amount of paper work doesnt help ime when the shit hit the fan the powers that be never really gave a shit about patient care as long as the paper work was correct nurses can't get out of the office the do the no they are supposed to do because of paperwork .

@ReinettePompadour

Nurse Training is a whole new thread!! In summary there's limited capacity in the hospitals to train student nurses. They can only accommodate so many per week blah blah blah. Since the bursary has been scrapped more spaces have been made available, however, the number of trained nurses available to mentor students nurses hasn't increased. Agency nurses aren't "officially" recognised as a suitable mentor.

So in order to overcome this a peer buddying system has been introduced. I'm being buddied up with 1st year and 3rd year nurse (I'm 2nd year) and we "coach each other". Well, the 3rd year is supposed to teach/delegate to me and I do the same to 1st year. It works to varying degrees dependent upon the 3rd year student that I'm with. (This is definitely happening in England - Wales and Scotland could be different).

I'm trying to stay open, positive, optimistic and embrace change - but, this isn't the training that I signed up for.

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?*

Yes to this the amount of medication that where I work is destroyed is staggering

I worked in A+E some years ago, I spent 5 years there. The main problem that I can see is that there simply isn't enough community support. Many, many patients in wards are medically fit for discharge but they don't have suitable after care. There needs to be more community nurses, maybe some rehab hospitals, more care home places. Once a patient becomes 'fit for discharge' they need to go home to a safe environment, this can take weeks to sort out with the community and in the mean time these patients pick up hospital acquired infections.

A+E was some days, hell on earth. We were stretched to breaking point. I was a HCA then (now qualified) . We had no paediatric nurses then on night shifts - I believe they do now. As I used to work bank work in paediatrics I was often put in paeds with a SHO to work through the load. Winter was horrific...bronchiolitis one after the other. It was dangerous that I was put in this position as an unqualified member of staff. I was also put in charge of triage with agency nurses, many who'd never worked in A+E. I had to triage, take ECGs, obs, bleed, cannulate, refer, transfer mostly alone as these agency nurses were no help except with basic obs and ECGs if I was lucky. Patients would be in the department more than 4 hours but we were expected to fiddle the figures on the computer so that it looked like they were there less time to ensure we weren't fined for their breaching. I was genuinely scared to go to work some days for fear of what could happen.

I moved to the private sector and it was the best thing I've done. I recently took a placement in a different A+E dept and nothing had changed. I simply don't know what the answer would be.

The main factor is the ageing population.

Did you know that, over the last 10 years, hospital admissions of people aged 60+ has grown by well over 50%? This is simply because there are more people living past 60.

Older people, on average, need a lot more spent on them than younger people. So a greater proportion of elderly people puts a massive strain on the smaller percentage of taxpayers.

Here's a useful source:
www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf

The single key issue is the NHS being used as a political football. Constant reforms depending on who is in power, new Health Secretaries etc. These reforms waste money and destroy morale. The first step to creating an NHS to meet modern standards and expectations would be to create and independent advisory board, free of party affiliations. A mixture of medical, nursing, management, academic and ecomomic experts with the explicit purpose of maintaining an essentially free NHS.

That said, there does need to be consultation on how the NHS is used and what public expectations are. While modern medical advances are often artificially inflated in cost (and this should be addressed too) they are still high cost relative to when the NHS was created. I think the public need to see the difference between "lifestyle" issues which they should find privately and basic medical care which the NHS should provide. I work in mental health and it's incredible how many people think they should have therapy, like US style psycho-analysis, for emotional issues relating to their past..when really they are well, working etc...while this can be good for some people, it's just not something the NHS can or should provide. There are examples of this across all specialties.

Public dialogue needs to take place, again free from political persuasion, about what people are prepared to pay for. Most people could afford £5 to visit the GP, while most cannot afford £20,000 for some high tech cancer treatment that isn't approved by NICE. Perhaps the many paying a little, is better than the few struggling to pay a lot?

But ultimately, we need prioritised ring fenced funding for the NHS. Our current government seems to have the NHS low on its list of priorities. Anyone who can't see that the NHS is currently being allowed to fail, to benefit the few with an interest in privatisation is living in cloud cuckoo land.

@EnthusiasmIsDisturbed indeed. I had a resident being given a drug that is thought to stem the progression of dementia. When I looked into it, they had been given this for 4 years, and at that point the dementia was very advanced. They could not do anything without assistance, and the drug itself was huge -the resident had difficulty swallowing it.

In my mind, at this stage, it seemed utterly pointless having it prescribed just to be thrown away. So I called the GP to review - they said no, continue with this drug in case it offers improvement! The resident only had the drug stopped when they were on EOL care about 4 months later...

The cost of the drug is a lot, and not everyone is lucky enough to have a try on it in the very early stages of dementia. By stopping it for them, the GP could surely have prescribed it for someone else who may have benefitted from it and actually been able to take it! The mind boggles at the waste there.

My close friend is a nurse and says the ageing population is a massive cost for the nhs.
Most people aged 75 and older have at least 3 medications on repeat for age related conditions and many older people spend longer than clinically necessary in hospital as there often isnt an apprpriate place for them to be discharged to.

A&E are failing because social care is failing. I have had a relative who "bed blocked" in hospital because of a delay in getting a care package in place - not our fault, was delays from Council. This has been recognised as a major problem that costs the NHS lots of money.
A&E also is dealing with the reduction of mental health care. A&E mops up all the failures of other services.

Enthusiasm That is the fault of the GPs. My GP requires that I attend an annual review.

If social care was sorted so that elderly patients were discharged when they were fit to, then this would save enormous amounts for the NHS. But it means increasing the amount for social care.
There is so much short termism in Government policies.

The problem about saying that "lack of funds" is an issue - where are extra funds going to come from? Clearly from higher taxes.

Now if you are a taxpayer, you may be thinking "Well, I don't mind paying slightly higher taxes if that means our NHS is in good shape". But it's not quite as simple as that. The issue with the ageing population mentioned above by many posters means that the current generation of taxpayers would largely be paying for the current retired population (as they're the ones needing a massive proportion of the healthcare).

Remember, the current retired population didn't face this issue when they were working (as the retired population then was far smaller). AND they are the generation who has already benefited massively from rising house prices and generous final salary pensions.

Basically, funding the NHS is a very heavy burden on the existing taxpayer, largely for the benefit of the generation who could be said to need it least (financially speaking).

StewPots your example is rather different, but where I work all patients are asked to attend for a med review annually - and often asked repeatedly. Most of them do, but a significant proportion don't despite it being for their benefit. In that situation there is very little that can be done. Another problem, of course is that many people always order everything on their repeats whether they need it or not!

ageing population ageing population ageing population ageing population.

Why do people say "throw money at" like spending money must be a bad thing?

Mary - there are plenty of stories in the papers.

Exactly - that's the problem. Certain papers report certain stories, giving you the impression it's more of an issue than it is.

The fact you've picked up on certain individual anecdotes says it all.

I know someone who works as bank admin staff and they say that the state of the admin (far too many people not doing nearly enough) is a big part of the problem. They were called in on a 3 month contract recently to clear a back log (the people supposed to be doing it had gotten behind and estimated it was 3 months work for one person to catch up) and my friend has cleared it and finished within 3 weeks! She couldnt understand how on earth it would f taken 3 months for anybody to do.
That is not an uncommon situation either and whilst i fully understand it wont save the NHS i think there is definately efficiency savings to be made there.

Oh really, Mary. What does it say?

I also agree with crunchymint there is a massive gap in social care that would alleviate some of the strain on hospital beds etc.

1. How the NHS sources it staff. Staff leave to join agencies to earn more. NHS pays more for staff.
2. Cuts in social services and other frontline services that end up with people in hospitals.
3. Heath tourism.
4. Poor organisation e.g. booking appointments not telling patients, booking two appointments at two different hospital for the same referral.
5. Poorly carried out procedures which means ops have to repeated.
6. Local policies on doctors appointments meaning people end up in A&E.
7. Local policies at A&E. Send people away for broken nails etc people abuse because it’s allowed.

What an absolutely brilliant thread. I get so weary of the usual "it's all the tories' fault for refusing funding in order to to kill the poor" and it's utterly refreshing to see a sensible discussion about this for once

Since there are clearly a lot of well informed posters here, please can I single out a point around elderly care and ask a question? I thought, when treatment decisions are made, a formula existed for looking at life expectancy, the quality of that life and cost of therapy in order to decide if the treatment would be allowed?

I can't seem to find anything about this though - so have I imagined it, was it suggested and discarded or is it actually being used, and if so please can anyone link further information?