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?

Chronic underfunding. Healthcare in the UK is funded at much lower levels than in other developed countries. We get incredible value for money. Our per capita spending is very low.

The NHS needs to look at preventative healthcare. Cuba has the most impact for the money it spends because its focus is in preventative healthcare. Not defending Cubas general medical system though. Switzerland and Germany both spend a decent amount on preventative healthcare.
In the UK we rarely take preventative healthcare seriously. It can have a major impact but it takes proper investment.
So in my area the NHS runs a course for people with serious breathing problems to teach them home based exercise and how to manage their condition more effectively. These are people who usually can not access public transport. A lot of poorer people can not access it as they can not afford to get there. Attendance on this course has been proven to have a positive impact on peoples health and decrease their hospital admissions. Totally crazy that this is not funded properly.

I believe a significant part is the lack of accountability for patients who DNA their appointments regularly. In a previous role I saw around six per day for hour long slots. It was not an unusual day where half didn't bother turning up. This was despite the appointment being mutually agreed. And sending text reminders. I am 100% in support of the NHS being free at the point of use but I do feel that this means a lot of patients don't appreciate or respect the service they're being offered, which costs a great deal of money to provide. I was being paid around £24k per year, so I'm not 100% sure my hourly wage but on most days I would be sat in an empty slot someone else could have used for three, sometimes four of the six hours I should have been with patients. This was regular. Yet we could not refuse to re register these patients or ban them from the books. So you'd have people who'd literally DNAed ten appointments that year being offered another. Absolute madness. There needs to be a three strikes and you're out type of system as there's no consequences at the moment in a lot of services for people who make an appointment then don't bother to show up. It was incredibly disheartening.

LemonShark I have supposedly DNAd, in reality I have not had the letter that was supposed to have been sent out telling me about my appointment.
My DP works in healthcare and they have done a lot of work to get their DNAs down - yours are VERY high - and now has very few. I suggest this is a service issue. My DP works mainly with a section of people that are recognised to have high DNA levels.

jenny Go to France, Germany, Denmark and countless other Western countries and you have an insurance card plus pay for healthcare visits if you can afford to.

I'd also charge full price for alcohol related or any patient violent for a non medical based reason A&E visits. I had to take my father in one night mid week and the abusive behavior towards staff was disgraceful. Give care by all means but if you are going to be rude about it then you should have to pay for your visit.

Health tourism is a much bigger problem than most realize. So many people come back to the U.K. for care. Lots of expats do it. It's fine to go back but it should be paid for our of pocket.

Wastage is a huge thing. Real life example, having to pay over £30 for a roll of Velcro from one of the “approved suppliers,” when the identical item was on Amazon for £6, yet they’re not allowed to buy from Amazon. Now imagine that example x10000 purchases...

The challenges as I see it are people are living a lot longer and living with illness/ disabilities a lot longer. It's great that there are better treatments to prolong life but people are often left with a lot of problems. There is often a lack of community support and appropriate resources in place to send people home - we struggle to find home care agencies that can provide appropriate skilled care when patients want to go home. Thus those people are trapped in hospital . lack of support for carers is a bit issue too meaning hospital admissions because carers are at breaking point. In my job I also see a lot of people from abroad being treated - elderly people who are relatives who have come to stay from India and kenya and Africa and having complex cancer surgery on the NHS. I guess they must be entitled and have the appropriate visa etc but don't understand how it's allowed ??

I think the general public have hugely unrealistic expectations as to what the nhs can provide on current funding, increased medical knowledge and an increasingly aging population.
Mental health is chronically underfunded but equally has unrealistic expectations placed on it.
Generally everyone expects to be cured with increasing expensive medications and treatments all provided exactly when people want them. There is, IMO, a need for everyone to pay a small amount more tax.

The NHS is a victim of its own success.
People know that whatever lifestyle choices they make the NHS will look after them. The better the NHS gets at saving people with chronic conditions the more often and sicker they present. In the past lots of conditions would have killed people, they now don't.
Residents in care homes now aren't treated as though they will only leave the care home in a coffin, they will now attend hospital with illnesses which in the past would have killed them in the care home. I'm not saying any of these examples should not be happening, they are reasons I perceive demand on services to be increasing.
I have no idea what the solution is, but more funding is needed and that requires higher NI contributions. The NHS is absolutely amazing but it's on its knees throughout the UK.

And yes alcohol is massive problem - head and neck cancers and mouth cancers caused by Asian men chewing tobacco - I'm amazed there isn't more education- the surgery and resulting Radiotherapy required take up huge resources on the NHS.

I don't agree that people make lifestyle choices thinking they will get NHS care. Many poor people in the US get little medical care but are obese, take little exercise and eat junk food. The reason for these lifestyles is far more complex than a simple rational reason.

In the hospital where I work we had a lady taking up a bed for 3 months because she was terminally ill and homeless, she was a recent illegal immigrant. There is no provision for people like this so as a compassionate country we have to look after them but local authority took forever to find her suitable accommodation and support.

The charging to see a gp is doomed because a good proportion of the service is used by those that do not pay into it or will be exempt for payment.

People on low incomes but above threshold of benefits will be most vulnerable.

What we really need is better management for the people not the trusts etc. Reduce staff leaving which leads to reduction of overhead costs. Stop demonisation of whistleblowers. When things eventually come to light it will end of costing the NHS far more.

It’s so complex & I defo agree people need to take more responsibility & we need more preventive care/education.

From my experience there is a lot of waste, the procurement processes needs overhauling. There are too many overpaid managers & not enough nurses etc.

The overwhelming issue though is the aging population & also the pension bill. The only way to solve it is to increase taxes but the section of society that pays these taxes is shrinking. In an ideal world the likes of Amazon etc would pay their share.

I’m not sure how we are going to sell higher taxes to generations that are becoming priced out of university & home ownership & who can only dream of retiring.

Babyroobs I have never seen any education material aimed at those men. I am amazed there isn't.

Fruit. Absolutely, but it does make one question the whole idea of prescription charges. Are they worthwhile, or should they be scrapped. Or reduced, but paid by a wider range of people? Should the elderly be exempt based only on age, or should their income be taken into account? I just thought it was an interesting fact as I knew it was low, but not that low.

Shortage of trained people, misuse of A&E mainly due to GP surgeries and lack of availability (7weeks waiting at mine). Poor working conditions, poor pay, etc.

Nurses/ doctors do a great job, but too many hours and are far too stretched.

Taking away bursareis for nursing, etc degrees was also a wrong move. I'd go back and retrain if it was still available.

popcorn Simply saying people need to take more responsibility does not work. The massive work to reduce smoking in this country has worked. But it has taken political will and money. If we want to increase the number of people say exercising, it will also take real political will and money. But it will save money in the long term. Sadly I don't think it will happen.

"Today 14:05 crunchymint

LemonShark I have supposedly DNAd, in reality I have not had the letter that was supposed to have been sent out telling me about my appointment.
My DP works in healthcare and they have done a lot of work to get their DNAs down - yours are VERY high - and now has very few. I suggest this is a service issue. My DP works mainly with a section of people that are recognised to have high DNA levels."

These were appointments that we'd mutually agreed, that means you've spoken to them verbally and both agreed on the appointment, so they knew about it and agreed it was something they'd attend.

You're definitely right though, there's a lot can be done from the service end and management have been working on different ideas for a while and improved the attendance rate. But for the ones who continue to DNA despite every effort to enable them to attend there comes a point where there has to be a consequence.

This might be identifying but I don't care.....

I'm currently writing up a "story" based on my mothers experiences over the last five years. She had a knee replaced in 2012 and was supposed to get a hip done six months later.

Roll on December 2017 when she finally got the hip replacement (by which time her natural hip had completely smashed up inside her and she couldn't move).

25 pre-ops and 12 cancellations in five years. The ones I can remember off the top of my head - double booking a hospital bed, being called for a pre-op but the wrong patients files being used. Last minute pre-ops because the previous one has expired only for the op to be cancelled again. Being transferred from one surgeon to another for the second time when they'd already said it was too complex for them.

The only one's that could be down to medical needs:

1, BMI too high despite her BMI being the same as when she was first passed for the surgery - and give she could barely move and had to eat with tablets several times a day losing the weight to comply was a miracle

1. Finding a new heart murmer that was exactly the same as the one she had on record which resulted in three months of further tests only be told like the first time, nothing wrong and the op can go ahead

1. Blood results at a pre-op being off leaving them convinced she was dying of something "untoward". Queue MMI's and various other tests only to find nothing wrong with her and the test results were mixed up.

I refuse to believe that she is the only isolated case of mal administration and organisation cock ups in the NHS. I'm waiting for a copy of her medical records which have been requested so that I can get the time lines and dates correct when I put it all together.

Pressed send to early.......

If the administrative chaos was sorted out then money could be saved.

Jenny - yes. A lot of high earners will have private healthcare so would simply use that instead. I honestly can't remember the last time I saw my GP; I either use the private healthcare policy that I am lucky enough to have, or I just pay for the private GP to get seen the same day. One of the things I have wondered about is encouraging/incentivising employers to offer private healthcare to more employees - this could help to ease the burden on the NHS. But then maybe that treads a fine line between not wanting practitioners to give up NHS practices because the private patients are more lucrative, or to turn down NHS appointments in favour of private ones?

the NHS is an enormous burden to the tax payer

You see I think this is part of the problem. Why do you think it is a burden? We collect taxes to spend on things we need as a society like health care, good roads, education. Thinking of it as a burden suggests that is a cost that has no benefits to us!

GP surgeries need to be 8-8, 7 days a week to reduce the ridiculous 2-3 week waiting times to see patients, which is what is causing problems with 111 sending people to A&E and people rocking up to A&E. It would reduce the impact elsewhere in the NHS.

Unfortunately this doesn't address the lack of doctors so the number of appointments will remain the same but spread more thinly across the week. So waiting times will remain the same.

I honestly think a charge to see a GP would lead to greater costs as people put off seeing a GP until their illness has got worse.

As has been said 10% of prescriptions are paid for so only 10% of appointments would be charged for, and who would be responsible for parents who choose not to pay for their sick children's appointments...

Oh - and another thing, patient transport. My mum, even in her worst condition, is quite able to drive herself to hospital. The problem is, she cannot walk from the disabled spaces to the clinic at the other end of the site.

All she needs is to be able to book a "porter transfer" for want of a better word, to be able to meet her at her car and take her to the clinic in a chair.

Nope, not possible. instead she is told to book an ambulance to pick her up from home and take her to the hospital. They then push her in a chair and return the journey home.

Waste of an ambulance for want of a porter