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?

My local hospital will have 10 women behind a reception for a clinic and yet probably only 8 taking blood which is far, far busier. With a wait time of over an hour or more for most of the day. Massive overstaffing in some areas. There is also a culture everywhere, from the newsagents through to clinics, that patients are a complete pain in the arse and they are doing them a massive favour by being there.

This totally
CherryPavlova

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

I would stop pharmaceutical companies bleeding the NHS dry with overpriced drugs. Put funding into teaching so training is free bring back matrons and do away with managers.

Working in a GP surgery I see computer generated letters from hospitals advising that a patient did not attend an appointment. Attached to this letter is a patient information sheet, in English and Welsh.

We then also receive a letter from the Consultant advising the patient did not attend. Sometimes we have it in duplicate because one letter is sent electronically and the other through the post.

Very interested to understand how people think all these changes would be implemented without managers and admin staff? Clinicians already do a huge amount of admin. I’m not sure how much treatment they’d be giving if they were also expected to make the appointments, collect and analyse the data and project manage the purchase and installation of new equipment, for example.

What the NHS needs is huge political change. Better education, less poverty, more equality. Better o stall public health. Proper funding for health services and no privatisation of those services. And end to the bollocks that is procurement and contract management.

I've been to our local hospital a number of times recently with sick elderly relatives, and the thing that struck me most was the sheer number of people who looked like managerial office staff striding about bedecked with lanyards and clipboards. The corridors are full of them and they seem to outnumber medical/porters/cleaning and clinic reception staff by about 5 to 1.

Some of them might have been doctors, they don’t wear white coats anymore.

I live in Wales and get my thyroxine (lifelong medication) free but would be happy to pay something for it.

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.

What about those with sporting injuries. Are you going to charge those too?

Stop all departments from wasting £50-£60k at a time buying stuff they don't need just because they "Have to spend their budget".

Meh, I'd bring back recuperating homes for elderly and recovering who are waiting to get into nursing homes.
I'd increase staff ratios to reduce stress on the staff and allow for breaks etc (this would reduce sickness, reduce mistakes and improve morale).
I'd stop the sourcing out of supplies and cleaning.
I'd invest in mental health (would reduce the front end costs of dealing with people who could have avoided a&e if they'd been helped earlier).
I'd also improve dentist & GP working conditions and work on reducing aggressive behaviour towards staff via nudge theory.

SillySallySingsSongs. I would say 95% of people in A & E are there with self inflicted issues either sporting/drinking/DIY/poor self care etc. The NHS should be free at source for ALL.

I would send a clear political message to people living overseas that regardless of what Brexit looks like, people working more than 20 hours per week in the NHS will be allowed to stay in the UK for as long as they continue to do that work. Pronto. And I’d do a big overseas advertising campaign with people talking about how grateful they are to their French nurse / Indian consultant. We need staff and we’ve successfully scared them off...

I’m a nurse so feel qualified to make my suggestions!

Bring back the nursing bursary - we are going to have a desperate shortage of nurses in a few years but the course is hardcore and people need to be able to live while they’re ‘working’ (on placement)

Too many hospitals are run like businesses. Why do accident and emergency departments get charged for missing targets? Hospitals are for sick people not budgets and figures.

Safer better working conditions for all staff but particularly those on the busiest of wards

Guaranteed breaks for staff

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.

I ended up in A&E after a night out once. I had 2-3 drinks and then I have a memory blank during which I was (so I'm told) "absolutely legless drunk", danced on a table, fell off said table, and ended up in A&E with a suspected broken ankle. I remember the latter parts of the A&E visit. Turned out I'd been spiked however that's my claim, for all the NHS know I took drugs deliberately and then tried to cover it up by claiming my drink had been spiked. Should someone be charged for that visit? I think you'd also have people covering up or hiding injuries until they'd sobered up, then lying about how the injury occured, to avoid paying a charge for a self-inflicted and/or alcohol related injury so by the time they seek help the injury requires a more costly and complex treatment or additional problems have been caused (e.g., infection).

Ditto charging for GP visits. People would put off going and by the time they do go they'll be past the point of early interventions/treatment and will need a more complex and expensive treatment. The people abusing GP appointments will find the money regardless and will then expect to get whatever they want because they're paying for it, the people who aren't abusing GP appointments or who can't afford the charge but don't meet the threshold for a means tested free appointment will be the ones who put it off. I got a UTI on holiday and I put off visiting the hotel doctor because I didn't want to waste money on something that I might fight off by myself. I drank plenty of fluids, rested, etc and yet two days later I was in agony, high temperature, vomiting, and was pissing blood so had to see the doctor anyway. I was thoroughly told off, doctor said if I'd gone at the first sign of symptoms and a dip test confirmed infection then I could have had a three day course of penicillin, job done. As the infection had taken more of a hold I needed IV fluids as I was dehydrated and a longer course (seven days) of stronger antibiotics, all of which was more expensive. My travel insurance covered it all so we got that money back but if that was our actual health care system I can see how and why people would delay seeking treatment.

I would charge for missed appointments and also review the clerical/admin side as well as the top brass running it. With service working like the NHS there should front line staff should always be more strongly staffed and focused on, admin and top brass structure should maybe be stripped back to the bare bones and re build to ensure that front line is the strongest area and only have those in the background that are really needed. Also review top brass wages to make sure that their wage yes reflects the responsibility they hold but is also proportionate.

charge non uk people using nhs

Troysmammy shows a good example of wasted resources, of course clerical staff and managers are required, but any service provider needs to constantly check to make sure that they are not top heavy and are productive and efficient with no excessive pay packets for the top brass.

@TheProvincialLady by changing the PROCESSES. Just in our case- DS sees a paediatric cardiologist every 6 months for a heart condition. It’s not necessary to receive a letter from the consultant, a letter saying the same thing slightly differently from the GP, and then inevitably several changes of appointment letters also. By the time the appointment comes around, you may have had 6-8 different letters and 4 different appt times, meaning it is way more likely you may get confused and miss the appointment. A centralised booking system with text or email confirmations unless you opt in for paper would save both resources in terms of the reams of paper used for letters, the time spent writing, printing and sending all those letters, and the cost of the inevitably missed appointment becuase you are confused as to when on earth the appointment might be.

Oh I agree with you that there are hundreds of stupid inefficiencies that need sorting and maybe a fraction of those would reduce the need for an admin post. Reality is that tgeee things wouldn’t save the NHS. It would improve patient experience and would probably save some money - but what’s actually needed is huge political and social change. Which isn’t coming any time soon.

Based on my recent experience I would join up social care funding and nhs hospital funding
My Dad was bed bound in nursing home and needed patient stretcher transport in ambulance for some ridiculous appts such as a pre op where they asked a couple of routine questions and took his blood pressure all of which could have been done at the nursing home
I would build elderly nursing home within hospital trust grounds so that any patients could be discharged to their nursing home beds more efficiently without the cost of ambulances etc and less bed blocking
Dad was placed on palliative care on the tuesday and we were initialy told it would be Saturday before he could be discharged as we had to wait for doctors to write up prescription and discharge , collect prescription and wait for team from finance who were offering to pay for his final costs at care home, I jumped up and down and got him out wednesday afternoon but they were all quite happy for him to stay and bed block

Harlow hospital has a big new fancy reception with the trust name right in front of you , when what it needs is a big bloody map explaining where wards etc are
They also have a minor injuries next to a and e which is a great idea

I absolutely agree with the issue of letters. We have to opt in for paper bank statements and even for toll receipts now. Why should the doctor be any different?

Case in point: DH was on monthly appointments for his first year post treatment (he’s now on 2-monthly appointments) and will continue to have regular appointments for the next 4 years all being well.

Here’s how one of the 12 appointments he was supposed to have in the last year went:

• 6th June check up. Appointment made for 4th July and letter handed to him as he left the department.
• 7th June letter arrives in the post saying that 4th July appointment now changed to 11th July.
• 11th July phonecall an hour before appointment saying it had been cancelled and would be rescheduled.
• 12th July letter arrives in post saying that 11th July appointment was cancelled.
• 14th July letter arrives in post saying appointment now on 25th July. We are on holiday then (holiday arranged around his projected appointments as we had been told repeatedly how important it was that he kept his appointments and was seen every month in the first year.) so DH phones on 16th July and explains.
• 17th July letter arrives in post with new appointment on 18th July (they’d obviously tried to squeeze him in at the end of the clinic)
• 18th July he gets a phonecall at 11am to say his 12noon appointment has been cancelled and would be rescheduled.
• 19th July letter arrives in post saying that 18th July appointment has been cancelled.
• 31st July letter arrives with new appointment slot of Sat 4th Aug. DH calls hospital to confirm as all appointments are usually on a Wed. Confirmation than an extra clinic is being held to try and clear a backlog.
• Sat 4th Aug DH has his appointment 2 months after his last one instead of 1 month after and it’s with a junior doc who can’t actually perform the scope he requires for his check up. No admin staff available to make appointments as it’s a Saturday so one will be posted out to him.
• 8th Aug letter arrives in post with next appointment date of 5th Sept.
• 5th Sept seen as planned (albeit 50min late even though he was the first appointment of the day) and got a telling off from the consultant for missing appointments and for the fact that he hadn’t been scoped since June!

Someone please tell me there isn’t a better way than this?! (I wish this was unusual but it’s not - almost every appointment in the last year has involved changes of time/date/doctor and way too many letters and stamps wasted.)

I love our NHS - they saved DH’s life last year and I know know genuinely fortunate we are to live in a country with freely accessible healthcare. (We have previously lived in the US and so many of our friends there just couldn’t believe that we have never paid a penny for any of DH’s treatment.) But there must be a better way than this. Admin costs CAN be cut - I’m sure if it, and no; that alone will not save our NHS but it will make a dent. I think we need to start with the small things and make lots of dents!

The letters in pigeon post is mad

Royal mail would go out of business if it wasn t for the nhs It would be an interesting request under freedom of information to see he overall cost of postage within each trust

look after the pennies and the pounds look after them selves !

Charge for self inflicted alcohol related injuries

Poor administration/organisation is a biggie. How many appointments are wasted by the letters being sent out late (or not at all)? Or time wasted because an unsuitable appt has been issued requiring the patient to phone in to change it, resulting in another letter being sent and wasted admin time again.

Lack of integrated computer systems - I go to two departments regularly and both have two computers per desk. The staff say they have to enter the same data on different systems so are copying info from one screen and typing it into another. Just why?? Not only is it wasting their time, it's also massively increasing the risk of data entry errors!

Why are paper based systems still used? At one of the depts I regularly attend, they have a printed sheet of appointments on their desk which they tick off by pen when you turn up and write down on it the time you arrived. Why isn't that done on screen - a simple tick on the appointment diary screen and the computer should be able to record the time. Instead, someone later will have to enter the yes/no and time manually onto the system. (and of course, there's the paper/ink wasted to print off the list at the start of each session too). All wasted time.

This kind of thing is why there are so many receptionists/admin staff - completely unnecessary if they actually designed more efficient working practices. It's like a socialists wet-dream of making things inefficient so more staff need to be employed, i.e. job creation rather than patient service efficiency.

I’d cancel spending untold billions on new nuclear weapons. I’d stop wasting untold billions propping up incompetent bankers. I’d stop wasting money on a useless monarchy.

I’d decide if my priorities lay with healthcare or all that bullshit.

Oh I agree with you that there are hundreds of stupid inefficiencies that need sorting and maybe a fraction of those would reduce the need for an admin post. Reality is that tgeee things wouldn’t save the NHS. It would improve patient experience and would probably save some money - but what’s actually needed is huge political and social change. Which isn’t coming any time soon.

Not just not coming soon, it will never come. So rather than just expecting ever increasing sums of money to patch over the inefficiencies and unsustainable service, it needs radical root & branch reform. If that means charging for more, then so be it, if it means stopping some services, then it needs doing, if it means more private sector involvement, then bring it on.

There's too much waste - so many comments on here about minor things that cost little so apparently don't matter. Utter rubbish. Minor waste in every department in every hospital adds up to millions. Comments above about the minor costs of a letter and stamp, so don't matter - again, millions of wasted letters/stamps adds up to millions of pounds. And if there's so much "minor" waste, that's a strong indicator of waste in other areas too if there's a "doesn't matter" mindset - how many pieces of expensive equipment are damaged, or wrongly ordered, or not used enough? How many expensive consumables, such as dressings, tubes, cables, medicines are carelessly discarded? The entire mindset needs changing.