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?

When people call on the day/ day before to cancel their apt phone up the next person on the list to try and fill the place

The purpose of the NHS in my understanding was to be free at the point of use as so many poor people were dying of illnesses that could have been treated.

The NHS needs a shake up
Everyone in theNHS should try to save money wherever practical even if it is pennies
The NHS should not be contacted out to Virgin Care
The NHS should not be a world wide health service - overseas visitors should be charged
The NHS should hold the patent or whatever for medicines whenever possible - pharmaceutical companies shouldn’t be able to hold the NHS to ransom charging ridiculous amounts for medicines which previously cost less
Invest in the education of student nurses/doctors

No prescriptions for paracetamol

I agree with this, but they should provide a card or something that allows you to buy in bigger amounts. That's the usual reason as to why people get them on prescription.

I’d also make money within all budgets transferable to other budgets.

I’ll never forget being told to order £13k worth of stationary (I kid you not) because if we didn’t use up that money within that certain budget we’d lose it for the following year.

Charge for missing appointments.

Stop prescribing over the counter cheap medicines for free.

Sort out social care so those not medically ill can stop bed blocking and get out of hospital.

Charge A&E admissions due to intoxification.

Controversial- warning..... offer only one round of IVF. No more, for anyone. Only fund one round if neither parent has previous children.
And I say that as someone who has fertility issues.

Think longer term...not quick win. The QOF annual tariffs have been killers in my opinion, because the drive is to patch it for this year, not fix it for next.

Get some actual negotiators in for contracting. The latest scandal about the contractor not disposing of medical waste should never have gone on so long. There are many uselesss over priced contracts being awarded and it needs rationalisation in that respect.

I wonder if time and money could be saved if many 'consultations' were abolished In favour of a system where more basic procedures were carried out immediately. So for instance, fillings are done on the spot at the dentist where possible. No 'Come back In A week' unless there's infection.
Or say for varicose veins.
Our hospital has a prehistoric system ...

1. see gp for referral
2. many months later see a consultant who has no equipment but arranges an ultrasound in 8 weeks or more
3. go to ultrasound and wait the whole day at the hospital on a bleeper
4. be offered some kind of procedure 6months later

In private practice (with the same consultants that work for the nhs... Most vascular surgeons work one or two private practices too)
The whole procedure , a-z consultation scan , surgery , admin, aftercare advice can be performed in a lunch hour.
Why is the nhs so backward?
Also, lets charge people who are admitted to hospital for drunken reasons . Just a tenner each would do.

Means tested charges/copayments. The NHS is woefully underfunded and there is no where else to get the money from. This policy would also help to reduce wasted appointments, encourage people to take better care of themselves and, encourage those who can afford it to get their own insurance and use the private sector which will help to reduce demand on services. There is absolutely no reason why we should be paying for people to have healthcare treatment when they can afford to pay themselves.

@Fuzzywig

I don’t understand that bit about medicines which previously cost less? Drug companies have patents at the beginning of a drug life cycle....not the end. So they go down in price usually as they head toward the patent cliff, not up?

Short term:

• cancel Brexit - would definitely help with staff shortages.

Long term:

• have a system like they do in some other European countries where at A and E you are given a ranking of red - life-threatening, seen straightaway; yellow - seen asap and you don't pay; green - non-urgent, you will be seen eventually but will have to pay.

• cut down on the paperwork in the appointments system. Let people book their own appointments online.

Charge for missed appointments/surgery dates

Charge for GP appointments (depending on income)

GP's to do their own out of hours care - stop contracting the service out to expensive external companies

Abolish totally free prescriptions. Even charging a nominal amount to poorer people will stop some medication wastage

Change the focus of NHS to prevention rather than cure to save money in long term

Some types of surgery to become unavailable, plastic surgery in most cases etc

Virgin Care Church Lane Surgery rated inadequate at all levels by the CQC

www.gponline.com/second-virgin-care-practice-essex-rated-inadequate-cqc/article/1495959

Someone should seriously look into retention of staff and working conditions in the NHS. How the nhs gets away with its staff working 12 hour shifts with no breaks is beyond me (nhs ex nurse who worked nights for many years).

Yeaaah, the thing is with looking at one case in isolation for Virgin Care. It doesn’t necessarily give you an accurate picture of what they’re doing overall. A lot of the other services they offer are very, very good. I’ve used one personally in South London and was impressed. I’ve also come across Virgin run service in my work that were very, very good.

Most GPs are NHS funded but are private enterprises so Virgin is not at all unusual in that regard.

I'd put a small charge on every prescription item whether for child, pensioner, regardless of what disease, etc. Just something small like 50p per item to focus people's minds on whether they really need it. Someone from a local pharmacy shared this pic last week of all the medication returned from one patient and, apparently, this happens regularly. People don't pay so there is no incentive to think if they really need it, pharmacies make a profit from it so there is no incentive to not order on their part and the GPs are swamped so don't have time to query every order
The other worrying side to this is that if this patient was admitted to hospital and given the doses of opiates the GP thought they were taking it could have killed them

Invest more in education - it’s so expensive to train to become a nurse/midwife/etc. Puts people off as it is so difficult.

Charge for missed appointments & abuse of ambulances.

No cosmetic surgery or voluntary non-medical procedures (gender reassignment!)

Stop privatisation by the back door - contracting services to private companies (GP surgeries, urgent care, physio)

I think charging at A&E for people who have gone in with non-emergencies could be a starter. I've been in a queue with my child bleeding from a head wound and heard the woman in front saying she needed to be there because she had a sore throat. Also, having watched a recent episode of 999 What's Your Emergency I would charge people who call 999 to perv over operators or terminal time-wasters who call out ambulances on a regular basis for no reason and divert the paramedics from actual life and death situations.

Patients of Church Lane have TURNED UP for their appointments only to have them cancelled BY TEXT while sitting in the waiting room.

Charge definitely for missed appointments
I once had a call from hospital - a very cross person asking why I had missed my appointment. I hadn't had a letter or a text reminder (my health board does both) so as far as I knew I had no appointment. Should I have been charged for an appointment I knew nothing about? Mistakes do happen. Also on MN you read quite often about letters received after the appointment date or people calling to cancel appointments but then appointments not being cancelled on the system.

Seriously now I would:
Fund social services properly so the elderly and / or vulnerable aren't blocking beds in hospital if they don't need hospital care.
More proactive care so you don't get things like people being diagnosed with cancer in A&E.
Collect tax from the likes of Amazon
Stop above inflation pay rises for some (thinking about high pay rise for MPs some years ago, or the infamous triple lock).

End austerity basically.

Take back and and reuse equipment.

Crutches
Walking frames
Orthopaedic chairs
Mobility aids

Many of these things cannot be returned after being used. 2 of these items are in my DM’s garage as the hospital won’t touch them and over the years we’ve had many others. Despite them having years of use left in them. The waste of money from these things going to the scrap yard is staggering!

why this obsession with charging for missed appointments? I've worked in a lot of care environments and no one is ever sitting around twiddling thumbs. Clinics run late and paperwork is lost and late as it is, if there were even more people turning up things would only be worse. It seems to me a typical opinion of those who choose to lay blame downwards instead of where it really should lie.

There's hellishly bad management in much of the NHS. People at senior levels desperate to hold on positions with salaries and pension pay outs that they could never match elsewhere. Sick pay too which is necessary for clinical staff is open to abuse by non clinical staff. There is no independent investigator for staff who speak up and are bullied out. There are a bunch of toothless organisations set up since the Francis Report but in the end it comes down to an invdividual to find themselves a lawyer and fight if they find themselves bullied out after bringing up inefficiency, mismanagement, statistic gaming and wrongdoing. The NHS pay out big money for lawyers and crush these people.

To get things running efficiently there needs to be independent audits by people who care, there needs to be a ban on non-disclosure agreements when peopel are made redundant or let go of, there needs to the end to use of expensive lawyers to hush those who speak up. There needs to be the end of the merry go round of senior managers moving around organisations and their ties with expensive consultants. The internal market is a complete failure because it is not a commerical market - "shareholders", i.e. patients, are disregarded and discredited, especially in mental health, if they try to speak up.

Outsourcing to private organisations is not the answer, they have even deeper vested interests to game statistics and they tend to keep staff benefits much more for management than for staff so staff are worse off than they are when directly employed (in mental health there is a lot of tendering out already).

what I'd do is try to inspire staff to have self belief and fight for their rights so that they are not patsies to a narcissistic management class.

The Gerry Robinson TV programmes were an eye opener. Simple changes such as getting departments to talk to each other
Operating theatres standing empty at weekends, he changed rotas so that they were utilised. A radio program I heard said that some people were offered earlier appointments a long distance from their local hospital, but patients refused. I heard some operations were being done in France or India where there were shorter waiting lists. I am sure that the NHS could save money by buying medical supplies from cheaper sources, buying in bulk. I agree that throwing more money is not always the best answer

Make private health insurance tax deductible - reduce the number below of people using NHS. Stop funding interpreters for non urgent appointments. Nationalise GP practices with GPs employed centrally. Any consultants practicing privarely pay higher tax on private earnings to account for publicly funded training.

One case in isolation?

Virgin Care Sutherland Lodge surgery in Chelmsford Essex.

inews.co.uk/news/health/virgin-care-gp-practice-rated-inadequate/

Prevention rather than cure might be cheaper in the long run. But they won't put money into mental health care so I won't hold my breath.

I also agree with charging for missed appointments.

I’d support a raise in tax if the money was ring fenced.

Charge “NHS tourists” many people come into the UK every day for medical treatment then leave before they have to pay. It would cost the NHS more to reclaim from abroad than its worth.

Cut the amount of middle managers. There are managers, managing managers, managing managers. It’s ridiculous.

Top tier need to stop awarding themselves ridiculous bonuses each year.

The sheer amount of waste I see daily when in and out with DS is ridiculous. A bit of actual planning could cut this down significantly.

Stop the Government and CCGs “fining” trusts for missed targets.