To ask what YOU would do to help save the NHS?

[TamiTayorismyparentingguru]

I don’t care if you’re an HCP or not, I don’t care who you vote for, I don’t care what you think about Brexit - all opinions welcome.

Opinions on practical suggestions on how to save the NHS only though.

Our local hospital is getting worse and worse with regards to staff shortages and waiting lists getting longer and longer. I will say that our GP is really great and we’ve never really had a problem with getting appointments etc, but as soon as you are referred to the hospital things go massively downhill. (We did have a GP misdiagnose/miss DH’s cancer which was pretty shit - but I wouldn’t say that was a particular problem with the system - more just one of those unfortunate things that happens, that really shouldn’t happen, but that are just a matter of course.)

The hospital is a different story though - wait lists for some departments are insane (current wait time for an initial cataracts appointment is 42 weeks and then up to 18m for treatment, paediatric dermatology is a min of 30weeks, paediatric podiatry is approx 30weeks also. I have been on a wait list for max fax for 14mths so far. I also had an 8week wait for an appointment at the breast clinic after seeing the GP with a noticeable lump.)

DH has also had to fight for every single appointment since his cancer treatment last year - instead of the 4-weekly appointments he’s meant to have had, most of his appointments have been 7-8 weeks apart and have been cancelled at the last minute (sometimes just an hour before) at least 4 times in the last year.

It’s awful and yet I do trust that the doctors, nurses, receptionists etc etc are all doing everything they possibly can.

What’s the solution?

Massive taxes on pharmaceutical industry and sack any MPs with any conflict of interests
Also supply industry get rid
Agency staff get rid
In fact all outside agencies get rid

Oh the NHS is being robbed on a daily basis. You couldn't make it up

The problem with charging for appointments is that even if you can claim the money back, some people won’t have the money to pay upfront.. My mother remembers the time before the nhs and says that most people just didn’t visit doctors. Many women with prolapses or birth injuries didn’t get treated until it was free.

How would charging for missed appointments work with dementia patients?

Helena I hadn’t thought of that but I don’t think more people would do it so at least it would be taxed and smelly rather than just smelly? I hate the smell of cigarette smoke so I do get it.

Bring maintenance and cleaning in house
Overhaul the admin systems
Overhaul the cross border invoicing system
No golden handshakes, management gets the same severance pay as the cleaner.
Give matrons more power
Get a computer system that communicates cross department, cross services, cross discipline.
Improve pharmacy and discharge services.
Open halfway house rehab units and utilise cottage hospitals for transition purposes
Bin off inefficient management levels. Senior management must have both commercial and medical knowledge.
Increase adult social care resources that work with gp, community staff and OT to get more home.
Specialist cover weekends on rotation.
One of the biggest issues behind many problems is poor communication.

Not RTFT but i thought charging for missed appointments was not cost effective. I work in nhs mental health and it would be a nightmare deciding what was a genuine enough reason to not attend/ get charged eg too depressed to get up? Agoraphobia got worse? Child with asd had a meltdown on the bus so they had to go home etc etc. Who would decide and chase payments from people? That said, i do think that repeat offenders waste an awful lot of money. One family would miss meeting after meeting which were all multi agency, so it cost a fortune.

Missed appts arnt always wasted time where i work. I used to keep my fingers crossed for DNA's do i could do the mountains of admin! Lots of clinics are overbooked for this reason (though do cause admin a lot of time).

I also think comments about reducing sick pay are somewhay misguided. By all means have systems in place to deal with those who abuse this, but i personally dont think this is common. i dont know anyone that has done this. The only 2 people i know who went on long term sick have had valid reasons (cancer/ broken back). It might be ok to reduce full pay a little, but this security is one of the few perks left of the nhs. If t and cs are compared with the private sector, then pay, and other perks should be too ie can you imagine if nhs were entitled to free tea and coffee for staff, xmas dos etc! Staff morale is already so low without positives of the job bring tsken away.

my ideas?
if people benefit from free training, they should be handcuffed to the nhs for a specified number of years, or they pay the fees back. I'm involved in training staff, and i know full well that a lot leave posts straight after to go into private work. Some even take up training with this in mind. unethical. Same for bank/ agency staff.

I also wonder if giving staff training (along with their mandatory training on infection control, fire etc) on how their time costs money e.g. knowing much a two hour meeting costs, might make individuals think about how they spend their time. Staff are completely removed from finance most of the time so never think about this ime.

also more use of IT. Dd had an operation recently. We had 3 pre op assessment appts with the consultant, once she had been put forward for the op. One was to do weight and height but she refused that anyway (2 and awkward). The rest the dr could have easily done over the phone eith me/ skype. I had 3 mornings off (nhs) work, time taken travelling/ parking etc/ had to occupy 2 toddlers, and would have been way easier for everyone if he'd just called me.

i hope someone up high is reading all these posts!!

Do people really think that people should pay to go to an emergency room?
The system is under pressure and more funding is ultimately the only way forward. You cannot treat the nhs like a private business.
It’s one of the biggest employers in the world. The staff work their mother fucking arses off.
It’s like no other company, and therefore no other comparison can apply.

It maybe on its knees but it will always survive.

My main would be stop stealth privatising the nhs

Nothing. let it die. The last 6 pages just show what the problem is.

It will never die.

It will die within the next 10 years . And the so called caring NHS staff will kill it.

I understand the sentiment behind the suggestions to charge for missed appointments but realistically the cost of admin would probably outweigh the gains. In my department we were thrilled if someone failed to turn up (relatively small numbers and long examinations) as it was the only way to fit in urgent cases without descending into chaos or working well beyond the end of our shift.

I know the OP wanted opinions from everyone, but the suggestion that consultants are sloping off to the golf course on a Friday afternoon - what century do you hail from? And yes, if someone cancels, staff make every effort to get someone in to replace them, without waiting for a suggestion on here!

I would have suggested that A & E, minor injuries & 24 hour GP be housed next to each other so patients can be triaged and the drunks and stubbed toes can sit there for as long as it takes, but a poster upthread has experienced this so perhaps it can be rolled out to other hospitals.

Bring back bursaries for healthcare training.

Definitely there are issues with supplies - we needed a common piece of equipment for the department which we could have nipped out and bought from Boots for about a tenner - £120 from NHS Supplies.

The NHS and social care should be one entity instead of them working against each other, so that elderly patients who do not need to be in hospital can be dealt with in a more appropriate setting, leaving acute beds to be used for acute cases.

Do not prolong life where not appropriate to do so - and that applies to patients of all ages, the very young as much as the very old.

So many pages of suggestions and yet one key role in keeping people out of hospital, A and E, reducing missed appointments , reducing prescription waste , reducing bed blocking etc etc etc is always always ignored. We get the pat on the head, told how many millions we are saving the NHS but we are never seen as a central piece in developing an overall strategy . WHY?
I am talking about the role of Carers who look after family members for the paltry sum which is Carers Allowance of £64.60 a week for a minimum 35 hours a week. People who are working day and night shifts doing healthcare tasks, training and supervising agency healthcare staff and who play an important role in coordinating multi agency inputs. There are a group of patients who have chronic often life limiting health conditions who need and use the NHS more. Focus on this group of patients and start thinking outside the box on the role of family Carers in integrating health and social care. Savings can be made and health outcomes improved.

End austerity basically OMG yea!!!

Ex nurse (though I know you said you welcome answers from all)

Honestly I'd

Set up a cross party committee or whatever it's called, with its primary responsibility being the maintenance. Support and promotion of the nhs.

And yes I agree with properly nationalising again, central funding, central supply admin etc

SERIOUSLY sort social care so that patients that don't NEED to be in hospital aren't blocking beds.

Reinstate nursing bursaries.

Vastly improve ground floor funding (rather than giving pay rises and bonuses to execs!) there are FAR FAR too many generals and not enough foot soldiers!

Vastly improve funding for recruitment and retention of ground floor staff!

Get IT systems replaced with ones which actually work!

Overhaul admin systems so patients appointment letters aren't SENT AFTER the appointment time! Hell even email is relatively antiquated but I appreciate its mainly the elderly using who may not be keen on electronic comms.

Personally - I'd make drink drivers pay for accidents caused by them whether it's them or others that sustain injuries.

Free prescriptions for all. Works ok here in Scotland.

Another personal experience informed opinion - remove most of the bureaucracy around GP's referring to specialists:

Endometriosis - 14 years, 2 mc, numerous prescriptions of meds to treat symptoms (which didn't work) until FINALLY getting a referral and Dx. SURELY it would have been cheaper to refer me within the first year of repeatedly reporting TEXTBOOK symptoms - to a gynae, get an accurate Dx and effective treatment which would likely have meant no mc's. I was also misdx with ibs and received treatment for THAT which didn't work which is now believed by my Drs to actually be due to the endo on my bowel!

Dd - disability we NOW know AGAIN textbook symptoms for 8 YEARS before a locum looked at the full history and referred us to appropriate specialist, dx on first visit!

Relative - AGAIN now know classic symptoms of the condition they were finally dx with after 12 YEARS of repeated visits to GP. New GP, referred to specialist. One set of tests accurate dx of condition reached and treatment now working well. Had SHE been referred earlier she'd also still be working.

The above examples also relate to the HUGE misogyny in the nhs. It takes women/girls 3-4 times LONGER to get a referral to a specialist (including for non female specific conditions) than men/boys.

Also problems with getting referred if you're poor, black etc - basically white mc men get the fastest and most accurate treatment

Shocking in this day and age!

Go back to previous practice for infection control. On another thread I was pointing out the changes that have happened since I trained. Back to daily bed changes, limited visiting, proper handwashing not just using sanitisers, enough AND appropriately specially trained cleaners, stop staff wearing uniform to travel to work, go back to the old rules on tied up hair, no jewellery, no make up - this is ALL infection control common sense!

Go back to old practices for prevention of bed sores and NOT relying on pressure mattresses alone! (Another bug bear of mine!)

Stop GP's only working office hours - making it MUCH harder for patients to make and go to appointments.

Stop them refusing to do home visits where there is a clear need! I know of bed-ridden patients who repeatedly are having to use ambulances to go to a&e for ailments that COULD be dx/treated by GP's BUT because they're bedridden and GPS VERY rarely will agree to do home visits! Appalling waste of nhs money because too many GP's seem to think home visits are what? Beneath them? Too inconvenient? Pisses me off!

"GP's to do their own out of hours care - stop contracting the service out to expensive external companies" yes I'd stop this crap too! Don't wanna do anti-social hours? Pick a different career!

DITTO for bloody specialists and surgeons! I don't expect them to work too long hours but to expect at a certain level to only work mon-thu MAYBE fri mornings on very high pay? Total piss take! No way should operating theatres be regularly empty at weekends and bank holidays - AGAIN if you wanted office hours should've chosen an office job! Where you'd be paid probably a lot less!

"stop consultants swanning off midday on a Friday for their lucrative private practices/rounds of golf." Yep! As I said, total piss take!

Yes I also agree with no PURELY cosmetic surgery - breast reconstruction after cancer, scar treatment fine but a boob enlargement cos you're pissed they're too small? Or self conscious about a slightly big nose? Fuck off! Learn to live with it or pay for it yourself!

I don't agree with charging patients BUT I do think a campaign inc a website where you can look up what your treatment costs could be a great idea.

"Stop putting ornamental structures and works of art in hospitals." Oh bloody hell yes! Ridiculous waste of money!!

SUGGESTIONS I DISAGREE WITH

Charging for attending - completely against the ethos of the nhs AND Under the current austerity measures would make matters MUCH worse. Because people will avoid going when they are first symptomatic, which means they'll get more ill so when they DO eventually get treatment they'll need more and longer - that's more expensive.

Educate on how useful and well trained pharmacists, opticians, dentists, nurses and other non dr primary hcps are. Too many people STILL think of GP as first port of call.

Make it uk wide that patients can make direct appointments with chiropodists, midwives, physio etc my GP surgery is really good for this it makes no sense for a patient to have to make an appointment with a GP PURELY To get a referral to services they can reasonably assess themselves that they need.

Means testing prescriptions - with UC, austerity policies, poverty increasing I REALLY think it entirely possible there are families out there that CANNOT afford even cheap paracetamol.

Discouraging patients going to Drs with minor ailments eg colds - some patients with certain possibly even at that point undx conditions, a cold or other minor issue can be serious for them.

Judging patients on WHY they're ill. Arguably aside from genetic conditions ALL health issues are caused by poor lifestyle. Where do you draw the line? Plus not all patients are educated well enough by parents/school/society on the "correct" way to live PLUS what was advised as healthy 10 years ago and taught as such to vast swathes of people, then turns out to be wrong - how would you deal with that? Seriously tell me your ailments and unless genetic I'll bet I can find research that could be used to support the theory that it's YOUR fault!

"People don't want to wait for healthcare. They want to be seen today, now, this moment. So off they trot to OOH and A & E, for something that can perfectly well wait a few days to see a GP." I think you'll find if you look deeper it's actually more likely people are having MAJOR problems GETTING GP appointments. My dd is having a recurring issue which she is more susceptible to due to her disability, (frankly she SHOULD have had a specialist referral MONTHS ago!), our practice RARELY has appointments available to book in advance so instead we have this RIDICULOUS situation where they open "emergency on the day" appointments daily at 8am, everyone and their mother calls then to try and get an appointment which basically means you are CONSTANTLY redialling to try and get through and then have to HOPE when you do that there's any appointments available. We've been trying for almost 2 WEEKS to get her an appointment this time round. THIS is why people either:

Get fed up/worried and go to Ooh/a&e

The condition becomes one that REQUIRES emergency treatment because the patient couldn't get access to a GP appointment to deal with it early doors - eg an untreated chest infection turning into bronchitis or pneumonia.

"would allow pharmacists to prescribe antibiotics for minor infections like throat etc" there are VERY good reasons why this doesn't happen inc over prescription of antibiotics leading to antibiotic resistant infections.

SURPRISINGLY ALREADY TRUE

Allow pharmacists to diagnose and prescribe certain medications to relieve some of the pressure on GPs. - already happens.

Have to prove you're eligible for free prescriptions - already true in England and Wales, but is frequently cocked up - huge problems with UC as not everyone on UC is not eligible but this isn't being made clear to claimants, and/or the part of online journals that is SUPPOSED to do this is frequently wrong.

@User139328237 I have reported your disgusting racist/xenophobic/sexist posts which are also ridiculously inaccurate!

Kick this rubbish government out. They're systematically destroying the NHS for ideological reasons and financial gain for their buddies

basically white mc men get the fastest and most accurate treatment

PMSL dp white middle class male.

Took him being diagnosed by a friend who recognised the symptoms (pre internet) to diagnosing him with type 1 diabetes after losing nearly 9 stone (please get your head round losing nearly 1/2 your body weight) in a few months.
Went back to the GP virtually weekly for months and kept being told to not stress as it was stress he was suffering from.

Then 2.5 years ago after again visiting various doctors over the course of a several months it took him virtually collapsing before he was diagnosed on a trolley in A&E that the bulge in his stomach was an abcess the size of a football which was within 48hours of bursting and killing him (one doctor had tried to wrestle this abcess to go into his diaphragm as she thought it was a hernia) and stage 4 bowel cancer. In the words of the doctor. It is too late it has gone everywhere. Why didn't you see your gp sooner.

Dgf was told that the pain and tightness in his chest, heartburn and pins and needles in his left arm was indigestion. A&E fobbed him off later that day and a few hours later he was dead.

So forgive me if I don't have experience of white males getting better treatment.
They get worse treatment in my opinion.

YY @Graphista

www.newstatesman.com/politics/welfare/2017/11/universal-credit-flaw-forcing-patients-risk-50-prescription-fine

I would get rid of the entire of their admin and booking process and replace it with a more streamlined, digital service. The whole process of referrals and bookings is leaden and impractical, and wastes both staff and patient time.

I would cut middle management drastically and make a policy of all management having to spend 1 day a month working on the NHS frontline to know what they are working for at a grass roots level.

I would charge for missed appontments.

I would reintroduce the nursing and midiwvery burseries.

I would run a much more extensive volunteer programme.

I would partner with the Job Centre to create more schemes like the ‘Get into Healthcare’ programme.

Introduce a centralised IT system where your patient file is accessible to all doctors in the hospital, with the idea being that eventually this is transferable/accessible by other trusts when you move. I know this costs £££ (my dh worked on a system as part of his post-grad project which would have been perfect but no one can get the financial backing to implement) but when my oncologist is trying to get me in for a meeting when I'm scheduled to be mid-chemo on the next ward, there's clearly a lack of information sharing.

Set up a payment system so that those who can and should be paying (non-NHS eligible) are actually able to settle a bill.

We have a shortage of district nurses here because 10 years ago, when they had to pay for the DN training, there were no jobs and 8 qualified and out of pocket district nurses having to go back to their old jobs. Oddly enough, others declined to follow suit so DN training wasn't picked up. Now, a large group who trained at the same time back in the day have retired and there's not enough trained DN to fill their spaces. Lack of foresight that yes, people will retire and usually earlier in the community, has led to these when common sense and staggering the training programme would have overcome this. But then I worked in the oil industry that kept laying off the junior staff members (engineers etc) and wondering why they had problems when the senior staff took cushy redundancy packages/early retirement and were left with no one to do the offshore jobs

Oh I forgot to add...
One of the biggest things that would help the NHS is to fund Social Services well. This would help with bed blocking.

Also patient expectations are so high. “I’ve been coughing since last night. I demand to see a GP” “I’ve had a cold for 4 days and it won’t go away. I demand to see a GP today” “My child has had vomiting and diarrhoea for two days (ie a bug), I demand to see a GP today”
Stop GPs having to do referral letters to private consultants. Surely if you have private medical cover the consultants there can triage you? Oh and make the private medical companies pay for using NHS equipment! They get away with not paying bills far too often!
To those saying GPs should do OOH, do you know they fund this out of their budgets? Each GP surgery pays a huge levy each month specifically to fund the OOH GP service.

@ Leigh, you may scoff at my suggestions re management & make condescending comments re those who have views on management but it strongly suggests you have little clue as to how ineffective many are. These people are earning 35-41k per annum, you don't think as non clinical staff they should be effective? Have you any idea how many managers at this level there are & the overall cost to the NHS?

These managers earn more than nurses, I have 4 of them in my area which equates to £149,118 a year.

To the commentor on lanyards & clipboards, you have to wear a lanyard & you use a clipboard because you frequently have to write stood up as there are no desks/chairs when you attend wards & some other other areas.

I've experienced (and worked in) both the NHS and Australian Medicare and I'd do the same to both.

All morbidly obese with multiple comorbidities are given the option of having bariatric surgery by the NHS. An obese 30 year old type two diabetic that has hypertension will cost the government over $250 000 in subsidised care over their remaining life. A gastric sleeve will cost $20000 once and only a small percentage will remain diabetic (less than 10%) and other comodribidites are gone.

Cancel all cosmetic surgery that is not medically necessary. Im sorry but feeling sad and wanting surgery because your boobs are small is not necessary.

Charge people to see the GP unless you are on a pension of some kind.

Charge a nominal fee for people who use free services inappropriately e.g. $5 for calling an ambulance or going to the hospital for a runny nose.

This may be controversial but lets look at how and why we are keeping people alive. There are 1000's of older people who are sitting in nursing homes and hospitals who are alive, unable to care for themselves and have no quality of life due to medication. Why not let these people die a natural death? The same can be said for subsidising medication that benefits only a small number of people. Lets do reverse triage. Lets do the most we can for the most number of people.

The NHS is actually one of the most efficient healthcare systems in the world. Lots of people believe what is in the Daily Mail. Lots of the Tory party are politically opposed to the NHS.
www.kingsfund.org.uk/publications/articles/big-election-questions-nhs-international-comparisons

The issues that need addressing are

• better adult social care provision
• increased funding in line with other rich nations
• increase bed base ( community hospitals for elderly)
• stick with generic drugs
• reinstate bursaries for healthcare professionals
• reinstate crown immunity and get rid of ambulance chasers

🤔 How about issuing a £100 charge for ‘Intoxicated Injuries’.

When A&E is packed on Friday/Saturday nights with drunk idiots who could easily have avoided their injuries I have very little sympathy or patience.

If you choose to go out, get bladdered and then start fights/ fall over (generally get hurt like drunk CF’s so often do) then that’s not something NHS should be funding.

“But what about the 1/100 who had two sips of wine and then a piano fell on them?”
I hear you cry- You’re the reason nothing will ever be done to rectify/ save our society. Because everyone wants to ignore the 99/100 and focus on the 1/100 for whom it may be unfair!

Doctors and paramedics can apply common sense on who should be charged/not 😒 you trust them to save you but not the judge who deserved charging or not?

Id pay more tax, but i think tge biggest thing would be getting rich individuals and large corporations to pay tax properly.

Re withholding medication to the elderly and infirm isn’t this a slippery slope. The Liverpool Pathway is horrific how do you suggest we withdraw medication and let them die?