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?

I'm in England. I know that there are plans in Scotland to integrate NHS and social care funds. I'd be interested to hear from any NHS/social care staff whether they think things have improved (if the plans have been implemented in their area.)

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.. I always love it when the Government promise this. It takes 8 years to train a GP, where do you propose we find them in the meantime? Or should they all just work a bit harder and a bit longer? (I'm not a GP by the way, nor am I related to one) There seems to be an idea among (some) members of the general public that because the surgery is only open from Monday to Friday 8.30-6 and closes for 2 hours at lunch, nothing gets done when the doors are closed. When do people think all the home visits and paperwork (a lot of it) gets done?nYour referrals don't write themselves. I've worked in GP surgeries for the past 20 years and while I've come across a couple of lazy buggers, I've come across far more GPs who get to work at 7 or finish at 10 pm. (Rant over.)

We have closed cottage hospitals which could have been used to discharge people who don't need acute hospital care or are awaiting a suitable package to support them at home or placement in a nursing home etc.
If the NHS fails what will replace it?
There are not enough staff(most in my dept work extra days as the cost of living isoutstripping pay.You will not attract graduates with pay so low.
7day routine healthcare would need a massive increase in staff as there are not enough to manage current services.
Even if the NHS by magic was privatised,nice new shiney buildings,equipment who will you put into run these services,it takes time to train people and for them to gain further skills to do the job and who in their right mind would want to anyway as pay is unlikely to go up if run by profit making companies.
We are today not running planned surgery but theatres are running a full service as there are no many urgent cases(that may not have been so urgent if they could have been treated sooner).A&E is full to overflowing.There are still no beds as the medical patients are still coming in and other beds are blocked by delayed discharges.
Somehow we need to be managing more people in the community so that they avoid hospitals altogether but that costs a lot to set up and the political will isn't there.
Have to go now, I'm working an extra shift.

crunchy I'm not suggesting those surgeries are cancelled, as I think we may have just cross posted.

I think I may be using the wrong term when I say elective. Elective means choice. If the doctor says you need it and chooses it for you, absolutely. But anything purely cosmetic, fertility related I think we can't really justify being free or part-funded any more.

You’ve only got to read some other threads on MN to see where some of the money gets wasted.

Encouraging people to “go to A&E...” when they don’t need to and “trust your mother instinct...” to decide what course of action is appropriate, rather than using the guidelines provided regarding the various services available.

We all need to take more responsibility for not taking the piss out of our NHS. Whether by using the services more appropriately, or not becoming obese, etc.

It's periphery services too. For example, loads of old people are in hospital because there aren't sufficient care staff available to get them out of hospital because as a society we don't value carers, they are overworked, underpaid and treated like crap for doing a really valuable role, taking care of some of the most vulnerable people in society. Until we value care agency staff we won't be able to recruit the staff we need to get people out of hospital, and that'll require a shift in societal perceptions.

Quirky Yes, we need more GPs and yes that takes 8-10 years, but we should be AIMING to achieve that. The world has changed enormously since the NHS was founded and the NHS needs to change too.

Most NHS money goes on young children and elderly people. And agree the things here people call an ambulance for or go to A&E with astound me sometimes.

And yes new hospitals have been built with less beds than the hospitals they replaced. It is crazy that money is spent employing bed managers, because we do not have enough beds.

Although if social care was properly resourced, lots of elderly people would be discharged from hospital much much sooner.

I think the vicious circle regarding agency staff is pernicious. It damages morale, often leads to poor care, and is so much more expensive.
Better benefits, staff to patient ratios and support for directly employed staff would improve retention and soon pay for itself and more. However it would initially be more expensive so will not happen.
A friend trained as a midwife and loved what the job should have been, but she left the profession in frustration and stress at being unable to give the care she wanted to the women in her charge. There was a lot of reliance on agency staff at her hospital and they would chop and change so in addition to your own workload on any shift, you were having to support staff who while qualified, didn’t know where x & y are etc. etc. Cuts to housekeeping meant she’d struggle to find an extra pillow for labouring women she wanted to help position comfortably; her ladies were left in squalor unless she cleaned up because cleaners were shared between wards, felt no “ownership” and were spread too thinly. It goes on and on.
To work your arse off for 12 hours and leave knowing you left Mrs X still waiting for pain meds, Mrs Y confused and upset without having had time to sit down for a 5 minute chat that might have reassured her, that Sally should really have had a proper wash after her accident etc. Just awful!

Personally my view is that we have to start making some unpalatable choices and take the emotion out of things. Just because we CAN do something doesn't mean we SHOULD.

SHOULD we intervene to save the 23 week gestation baby whose condition presents in such a way that it most likely they will have limited life expectancy and be severely disabled needing medical care for the duration of it? Parents will obviously push for it but maybe the medical profession should take the emotion out of it and say no.

SHOULD we provide life saving treatment to the elderly patient who is going to die anyway of the condition to give them an extra few months in ill health. Maybe we should say no we won't do that and use the money to bring forward hip operations which the patient has a good quality of life afterwards.

SHOULD we provide IVF treatment on the NHS at all when people who already exist are waiting for life improving treatments? Infertility whilst painful is not life threatening. Again, individual cases will argue for it but SHOULD we do it just because we can.

I had the misfortune of getting pneumonia when I was 30 weeks pregnant & my ward was full of old people. The nurses that were on duty couldn’t even get on with their work as they had to supervise the patients. One was waiting to be collected by a community ambulance but kept walking around & opening things. One had dementia & was hurling abuse & threw her dinner across the ward. I wouldn’t want to work in those conditions tbf.

Wooly I would also add that assisted dying needs revisiting. Yes, there needs to be some protection in place, but if people with conditions that make their lives unbearable want to go, we should be allowing them to do so with dignity and not keeping them alive against their will.

Shatners yes that's fine, and I agree it should be a long-term aim, but there do seem to be a lot of people around (not on this thread particularly) who seem to think it should start next week ....

The NHS is a hugely complex issue and all successive governments seem to do is apply sticking plasters. I don't what the solution is, probably a combination of many things. But all our 'leaders' on all sides seem to do is use it to try and score points against each other. Why, oh why, can't they for once try and work together. [I've just heard them bickering about it on the radio again.]

@woolythoughts

A very very valid point, but, I think it's too late to turn back the clock and adopt that approach. Look at what happened with Charlie Gard last year.

The NHS needs a complete overhaul. People do abuse it because they think it's free. Which of course it isn't. I don't know how European countries manage. They don't have trolleys lined up in corridors. I think the population has grown too quickly for services to cope.

But it's also not very efficient at all. Every single winter we have this. I just switch channels now as I don't want to hear about it as it's so predictable not to mention infuriating. And they act all surprised. Winter = flu. Haven't they cottoned on to that yet. Seems not.

ShatnersWig Sorry, I was just using your post to highlight that things which you and I would regard as impacting on a normal life, and the proper domain for the NHS, are already being regarded by others as postpone-able "elective surgery", as if they are some sort of lifestyle add-on.

The thing I find most frustrating with all political parties is the whole “short term gain” mantra. Selling things off for a quick buck which then costs us more long term. Why don’t we have more investment & plan for the future?

@Nursebuttercup

Personally I think when babies are born like Charlie there should be a "committee" approach for want of a better word. Multiple HCP's from different hospitals to consult on the case and if they are all in agreement that its futile, then that should be the end of it. There should be no recourse to the courts by the parents.

The only reason I say multiple HCP's from different hospitals is so that unless you want to go down consipiracy theory routes, there can be no allegations of malpractice or victimisation. The chances of all of them making the same mistake are slim.

I'm probably going to sound really naive now ... but we all surely want the best NHS that can possibly be offered? I would be more than happy to contribute a little more within my taxes to help contribute towards the rising costs. Why aren't some earners taxed more to help towards NHS costs? Even if it was just mid-high earners and they charged us all an extra 5p a month, surely it would help?

don't judge me as I know it probably is a lot more complicated than I just said

Shatners an advance directive allows a person to specify do not resuscitate and other decisions such as no antibiotics if I get pneumonia and my diagnosis is only a few months to live. People don't choose to sort these things but there is a greater uptake in the USA. Assisted dying is the proactive taking of life and that is a further step which I do not think should be brought in.

An advance directive is not costly you can get a draft from the Alzheimers Society website but it does need people/carers/family to have open discussion.

ShatnersWig You can see literally any GP at your practice. They just divide up the patient group into named GPs so there's in theory someone ultimately responsible for their care. But nobody I know has 'a GP' of their own. So don't worry if you get sick on a day 'your GP' is off!

Wooly I think the Gard case did go to committee who ruled he should be allowed to die. The problem was the parents were indulged with multiple fruitless appeals. I fully understand their desire to help him survive but they refused to listen to actual medical experts as they were so blinded by emotion. I often wonder whose interests it was in that they were allowed to appeal several times and make a circus sideshow out of the whole thing while their poor boy suffered.

I fear our country is in a real mess. Not just the NHS but in general especially education. Whilst I agree schools and hospitals need to be accountable but it feels like somewhere along the line its become all about targets and box ticking that is destroying both services. I feel (and I’m mid 30s) that society has changed. We’ve become much more entitled and selfish. We want something amazon prime it, iPhone X I’ll pay through the nose because I want it. It feels like these days the state is meant to pick up the tab for a lot of things and that’s what people expect. I can’t afford another child but I want one, the council will house me 20 minutes away and I’ll complain. The NHS hasn’t moved forward like we have. And it needs to. I think the Tory would like us to pay for it and I do think some things such as drunks and alcohol related things that clog up A&E deserve to pay for it. There’s no quick fix.

loobyloo1234 Same. I'd happily pay much more in tax than I do already if it meant a properly financed resourced NHS that worked! I don't think solely more money will solve the problems but it's a necessary part of it.

For example, loads of old people are in hospital because there aren't sufficient care staff available to get them out of hospital because as a society we don't value carers And one reason we don't value carers is that we as a society don't value "old people", so basically we don't view the carers as doing a valuable job because all they're doing is "bum-wiping" - not you DMeatmyshit, but society as a whole, as witnessed by the acceptance of ageism across all our media.

A big problem is that we've increased life expectancy without increasing healthy life expectancy by anywhere near as much, so what a lot of us are looking forward to is an even longer period in pain and ill health, being cared for by others who don't care a damn about us, with no control at all over anything that could make life more tolerable. Shatner'sWig is right. And none of this nonsense about "terminal illness with less than 6months to live" - someone who is looking forward to 5 years of unbearable life is in a far worse state.