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?

@TheBagders 4 supervisors for 9 people 🙄

The Kings Fund says approximately 8% of NHS budget is spent on management and administration. That doesn't seem unreasonable to me, we don't want clinical staff spending their time answering phones, making appointments etc. It wouldn't be very efficient. It also says less than 4% of workforce are managers.

youarenotkiddingme, I get what you mean. I have prescription eye drops and found out I could buy them OTC. Pharmacist was rather judgemental about it, don't know why. I have such trouble getting a prescription even though a specialist has said I need them, it is easier to spend £6 even though I get free prescriptions.

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.

This is absolutely not the case in the Trust that I work for. A huge restructuring two years ago which removed about 50% of the Band 8A's and 8B's and whittled us all down to cover much larger teams. I spend about 60% of my working week actually working within the ward numbers plugging band 5 gaps. I certainly don't sit around in an office shuffling papers.

Closer to 45% supervisors in the above example.

I am sure there will be particular Departments where there may be too many managers. Where DP works there is very little management. The managers have specific targets to meet around regular supervision and annual appraisals with all staff, and struggle to meet it. There also are not enough admin staff and more and more admin is pushed on to clinical staff. DP actually sees less patients than he used to every day 10 years ago, but works longer hours - longer hours are all unpaid. This is purely because of paperwork.

I think I'll go with The Kings Fund.

I have worked in different areas of the NHS for the past 10 years and I think it’s down to two things - waste and patients expectations. So, so much money gets wasted, for example one hospital I worked in seemed to be constantly redecorating - oh, that waiting area is awful, needs updating - actually all that was wrong was it was a bit dated, but does that really matter?

Patients expectations need to be managed - you see so many patients booking appointment after appointment, wanting tests, home visits, free transport laid on etc, often for very minor issues. People just aren’t prepared to be ill any more.

crunchymint, it isn't a good use of skilled staff. It always makes me laugh when people object to admin and management. I mean everyone should work out their own shifts, oh hang on no one works weekends, everyone should work out their own salary, unfortunately they probably have no clue about tax and NI, and so it goes on.

What kind of minor issues?

I think presenteeism across the rest of the workforce plays a part. It isn't that people aren't prepared to be ill, they can't afford to be ill. If they're ill for more than 7 days, they need a doctor's note, which takes up another appointment. They can't afford to be off sick, so they'll take up appointments and consultations, trying to find some magic pill or potion that will cure their ailment at massive cost to the NHS, because employers refuse to acknowledge that being ill is a normal part of the human condition, and if you hire humans, you can't then punish them for behaving like - well, you know - humans.

This is absolutely not the case in the Trust that I work for. A huge restructuring two years ago which removed about 50% of the Band 8A's and 8B's and whittled us all down to cover much larger teams
Same here. The demand on these roles is so bad, we can't recruit to that level. Local people know what the jobs are like so don't apply and those further away are not interested as cost of living is so much higher. Those who are left to pick up the pieces are leaving one after another.

Would love to know where Band 8s have it so easy!

glumglowworm
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.

You do have to be resident here to get free treatment (non-emergency anyway). I lived abroad for a few years. On a visit home to see family I developed an ear infection. The local GP refused to see me or register me as a visitor, as I didn't have a permanent address in the UK. Some people may cheat the system with a false address.

A family member lived in an Asian country for many years and developed leukaemia. He was close to death and his only chance was to get a bone marrow transplant. He could not fly home and use the NHS as he had been abroad for more than 7 years, and in the country he was living in, there were very few matches for him due to ethnicity. He was very very lucky that an anonymous donor from a third country proved to be a match and this saved his life (treated in the Asian country he was living in).

I hate how the Tories place the crisis of the NHS on 'people abusing the system' and making people feel guilty for having to use the NHS.
How do people know that what condition they have isn't serious and life threatening unless they see a dr?
No one I know would go to A and E unnecessarily to wait about all day and certainly it's no fun waiting with kids.
You would not willingly do this unless you had genuine concern.
How many people are going to feel they shouldn't bother their Dr etc and not wasting their time when they have a serious condition left untreated because everyone is jumping on the bandwagon that people abuse the NHS but if it was actually looked into I suspect like benefit fraud it's probably 0.01 % actually abusing the system.

The Kings Fund says approximately 8% of NHS budget is spent on management and administration

Even a cursory glance at the Kings Fund website shows that a major slice of their income comes from running courses for such staff. Call me a cynic, but I'd hardly expect the Fund to advocate anything which might reduce their client base/income

As so often with reports, I find it's worthwhile to look at where the authors' own interests might lie ...

Puzzledandpissedoff, I've seen the same figures quoted by other organisations (BBC for one.) I think that is more reliable than anecdotal stuff on a forum.

I think "people abusing the systen" is a thing, but also blown way out of proportion

Its just one slice.
It IS fixable but it would take a holistic approach:
No point "fixing" the NHS in isolation while homelessness spirals, social care is in crisis, carers collapse etc.
Also its not just money, theres money for recruitment but lots of posts stay unfilled for months. Need to tackle retainment, training (bursary), job satisfaction and progression routes, flexible working etc.

I agree about all staff knowing good English and not speaking too fast, and being able to understand local accents. That is an issue where I live. Some staff might be able to understand English as spoken on the BBC, but can not understand elderly people in the hospital because of their often strong accents.

Walk down any corridor and there is £000s worth of expensive equipment lying about, unusable because it needs minor or major work.

A lot of that is to do with patents. A lot of patents for hospital equipment includes parts and repairs.

We have kit that can only be repaired with parts from the US even for simple repairs that would otherwise take a handyman 10 mins to fix from a toolkit!

This will get worse post brexit IMO

The Government as a whole does not give a toss about public sector workers. So no surprise that they do nothing to better retain staff.

You do have to be resident here to get free treatment (non-emergency anyway)

Most health tourism is from family members of people already resident in the uk and they easily get around being resident because no-one asks them or questions further than whats your current address. My grandparents live in New Zealand. They emigrated there in 1968. They hop on a plane back to the UK and stay with my aunt when they need health care via the NHS because its easier to fit in a family visit with surgery. They have always remained named on the local UK doctors using my aunts address and kept their British Passports too. They visit every 12 - 18 months and always visit the GP just to keep their 'residency' up to date. My Grandfather rarely worked in the UK before emigrating and frequently got sacked so hardly 'contributed' to the tax coffers.

My Grandmother has had both knees replaced and her left hip. She has also had 14 children in the UK at an NHS hospital. Yet they live in New Zealand and have for 50 years .

My Grandfather has had 3 heart-by-pass operations in the UK on the NHS. He also has other long term health conditions that he gets checked and treated in the UK. He then goes 'home' to New Zealand and tells his GP he has been taking xx medication prescribed in the UK and he just gets a repeat prescription saving his health insurance thousands of dollars in investigating any conditions and treating them with any surgery but costing the UK taxpayer tens of thousands of pounds.

I have got really cross with them in the past and told them exactly what I think of them doing this and they just said 'everyone they know who is an ex-pat does it and they're entitled to it, so why shouldn't they'. Just to make things worse my aunts, uncles and cousins who live in New Zealand with them all do exactly the same thing. They're always hopping on planes because its much cheaper to pay for a flight than to pay for their health insurance increases.

Health tourism is massively under represented in the figures, when I've had conversations with people in similar positions, with family abroad, they all say the same that they come back to the UK for the most expensive treatments. If you have family you can use an address for, then no-one bats an eyelid. My Grandparents have never been asked to prove they live and are entitled to health care in the UK, not EVER.

I do believe this is an area that's not really been looked at properly. Its needs looking at urgently. I raised it with my MP who said it wasn't really an issue and only cost a few million at most a year. He felt it wasn't worth pursuing because it would cost more to chase up everyone who had treatment when they shouldn't.

There is a lot could be done to fix the NHS, just off the top of my head.

-Charge for missed appointments
-No prescriptions for anything cheaper OTC
-Charge for lifestyle medical treatment, e.g. extreme sports, smoking, obesity, drinking etc
-End free IVF
-Allow assisted dying
-Ban financial payouts to people suing the NHS
-Do more to stop health tourism, make it compulsory for anyone not permanently resident in the UK to have full medical insurance before getting on a plane to here
-Introduce a food menu that patients pay for
-Once patients are ready for discharge then charge anyone the full cost who does not leave. At least some money could be reclaimed off their estate when they die
-Allow treatment to be refused at A&E for anyone who should have went to their GP first
-Pay google to run the IT system

Just for starters.

"There are whole armies of admin staff wandering around with clipboards, or holding up the frontline staff with, if you listen carefully, what is often just chat. "

This is another bug bear of mine. The scapegoating of the admin staff. They keep us afloat they really do I dont know how we would manage to do our clinical roles if our admin staff werent keeping the non clinical things ticking over for us.

Reinette that is awful. I assume they don't realise it is fraud. I don't think ex pats abusing the system is what is usually referred to when people talk about health tourism, it is always the Nigerian women and multiple pregnancies.