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?

Helena unfortunately I think it's yet again not really those on the frontline making the decision.

I think that it's more to do with targets on reducing absenteeism aimed at those families who's children are missing school regularly for no good reason but instead it's ended up adding more layers of bureaucracy that mean that normal families who's kids are off school with genuine illness are having to use GP services to prove it.

My own experience in Scotland is of schools generally accepting absence unless it's frequent or medium to long term absence. Then it gets trickier.

We weren't so bad at start of primary school, but later part of primary school and start of high school, when dd was pre dx but getting a lot of problems with symptoms, some of which I only know now were even related to her disability, there were difficulties and not having a dx made that harder.

Even after she had a dx and we had letters not only from GP but consultants, school were still sometimes less understanding of her time off due to symptoms and complications.

Frustrating but I did get the feeling it wasn't the school not even the head that was insisting on letters for each absence, but higher bureaucracy, because all absence is a black mark on the school.

Bit jumbled hope it makes sense.,

YY Graphista Bloody frustrating though.

There are so many areas in dire need of improvement it's hard to know where to start. But I will say I really really worry for the future, and for my old age and my family.
Staffing levels are so poor, morale is at an all time low, everyone wants to leave, the wards are dangerous.

A friend's daughter came to see us in our department the other day, it was 4pm, her first break of the day having started at 7am. She's a student nurse who should have been supernumerary. The ward was staffed by two trained nurses and one HCA and her for a 12 hour shift caring for 24 elderly/dementia patients. I have no idea how they got through the day, it is impossible to give even safe care let alone good quality care with that staff/patient ratio. 24 bodies to wash, 24 frail elderly to pot/clear up incontinences, attend pressure areas. 24 that needed feeding and getting adequate fluid intake. The drug round alone takes an age, you have to help them swallow each pill, they are all on tons, it can be painfully slow getting those pills down when you are desperate to crack on and get the job done.
One patient had fallen twice the previous day. A fall takes at least an hour to sort, depending on the level of any injury resulting. There is a special contraption to return the patient safely to bed, a sort of blow up mattress that rises up to the level of the bed. The porters have to bring it to the ward. It takes three to safely move the patient onto it, a lot of time consuming fiddling and faffing to get it blown up, three to transfer from blow up mattress to bed. That's assuming the patient isn't excessively heavy in which case you need more than three! Doctor to review. Time consuming paperwork, harm event reports etc. While your other 23 patients are left to their own devices!

What is the legal ratio of carers in a nursery? I think I am correct in saying 3 babies/toddlers to one carer. But it's ok to have 8:1 frail elderly?

Meanwhile on the acute wards...it's just very frightening to be responsible for very sick patients with so few staff and the constant feeling you are not able to give adequate care and something bad may happen on your watch. Staff are on their knees with exhaustion.
Throw in all the times you get to the end of a 12 hour shift and the agency or bank nurse doesn't turn up and suddenly you are staying on another hour or so while management dither and argue with other wards to extract a member of staff to be moved and come and relieve you. It happens really often. Or someone calls in sick at the last moment and the nurse that should have been coming to your ward is diverted elsewhere but management don't bother to let you know. Night staff who are meant to be off at 7:30 am and need to get home to take children to school find themselves stuck waiting to be relieved. Two excellent night nurses packed it in within a month recently, they were so pissed off to be treated this way.

Throw in the loss of the student nurse bursary. My DD is having a brilliant time at uni, she works hard but outside her academic requirements her time is her own, for sport, producing a play, singing in a choir, having a job and let's not forget about 20 weeks holiday a year.
Compare this to life as a student nurse. About six weeks holiday a year. Combining working on the wards, being counted in with staffing as above when you are meant to be supernumerary, not getting to choose your shifts, and completing academic requirements. Very little spare time for extra curricular activities and being a student.
I have seen student nurses in tears of frustration regularly.
They have to get their ward placements signed off by their mentor. One was having a tearful argument with the manager of her placement as her mentor had gone off sick and everyone she asked to sign her off refused to on the grounds they hadn't worked enough shifts with her. Another in tears as her second placement was eight weeks in outpatients. She had spent the time shuffling notes and chaperoning. Only two placements in her first year and that was one of them - a complete waste of time and she will struggle when going onto a busy ward with so little experience for her next placement. And paying, running up dept for the pleasure.
I would never recommend student nurse training to anyone.
There is going to be such a crisis of staffing as my generation retire over the next few years and meanwhile a dearth of young blood coming in.

So that's just a glimpse of one specific set of problems. Don't forget Doctors are feeling similarly stressed and burnt out.

That's before starting on lots of other issues mentioned up thread.
Huge compensation payouts represent a massive threat to NHS finances. That's a whole new topic for another day. Bed time. 

Iusedtobeanoptimist- that reminds me, I used to work in geriatric, so many meds prescribed for patients who have difficulty swallowing in TABLET form! When they're available in liquid or other more easily administered forms. Ridiculous!

8:1 ratio is I agree DANGEROUS. No wonder they're having issues with patients falling etc. 2 falls suggests something going wrong with prevention but then low staffing levels, lack of equipment makes it shocking but not surprising!

I agree the poor management and planning re recruitment and training PLUS the exodus of eu staff is going to lead to a crisis. I strongly believe (but REALLY Hope I'm proved wrong) that there will be at least one major crisis that will make mid-staffs pale in comparison!

It shouldn't happen but I and others I know who are still working in the nhs are seeing signs of a perfect storm brewing.

Our CCG at least (and I think it's a national thing) have issued new guidelines preventing the prescribing of OTC meds if not exceptional circumstances. Happened a month or two ago.

I work in a doctors. The problem with charging people for missed appointments is that more often than not people that regularly miss appointments lead chaotic lives, or have MH issues or memory problems etc.

Social care needs more resources, as does MH care (massively). We have lots of people who book appointments with their GP nearly every day, ring 111 and 999 every day etc because they're mentally unwell but there is nobody to help them. Costs a lot of money, I'd imagine.

Less money to CEOs etc. And yes, maybe tax free private healthcare to encourage more of that?

The expectations people have though are ridiculous. I am shouted at and called names every single day in my job, because the NHS is failing and people can't get hospital appts as soon as they'd like and we won't prescribe their paracetamol anymore etc etc

I feel like saying - don't you read the news? Don't you know the state of the NHS? Instead I just have to apologise 🤷🏽‍♀️

And we have a prescribing pharmacist at our surgery. She's amazing, handles all the script queries - we couldn't do without her. She can't do benzos but can prescribe everything else. She's amazingly thorough and knowledgable - the doctors often ask her advice. I think a push for more community pharmacists (or any? Unsure if they exist) to become prescribers for minor stuff would be brilliant.

Oh and... (I believe this is coming in soon) STOP travel appointments. The amount of grief we get because we can't do you your jabs for Thailand next week, and no, your named GP won't do them for you. 

AFAIK, GP surgery's don't get paid for travel appts. They are long appointments when we have such a shortage of nurses. You can afford the long haul holiday - book your jabs private! No idea why this isn't mentioned more when IVF is mentioned frequently in these types of thread.

I'll try and make this my last post 

sickness of a relative is one major reason why someone would become poor in developing world.
I would charge each visit to the GP 1 pound or 2. Free for children. If you have certain types of illness ( cancer, chronic, disability...) it would be free, also roulette illness ( genetics, reproduction, you don't choose to have an IVF). I would encourage women to have their child before 25. More prevention : not taking weight during pregnancy, weight management for children and teens. (sports). encourage walking for seniors. We might have to find creative ways to fund the NHS. THe shop in the hospital might be the hospital's shop and not a franchise. A and E should remain free, we must pay higher tax and clearly label it NHS.

Milkandsevensugars (are you my dad?? Lol)

Yes! Hadn't thought of travel vaccines! If for work purposes maybe ok but DEFINITELY if you're getting them for a holiday - go private!

"I would encourage women to have their child before 25." As someone with endo who had a strong feeling pre-dx I would have difficulties in this area I had it in my head I wanted to ttc before 30. I think 25 is maybe pushing it financially given many don't graduate until at least 21, 22 here in Scotland. But certainly before 30. Unpopular maybe. Culturally we might want to ttc later but you can't rush evolution and currently it's still true that fertility in women starts to decline slowly at 25 and accelerated in decline from 30. I don't know anyone in real life that conceived and had smooth pregnancies easily after 30 not one. All had either difficulty conceiving, mc or very difficult pregnancy and birth and sometimes combination of those.

Also I remember seeing Dr Robert Winston on tv saying that many of the couples he saw that were apparently having difficulty conceiving really weren't having frequent enough sex! That telling them to have more sex in many, not the majority but many of the cases resulted in conception, and even for those who did have conditions affecting fertility having more sex kinda got the right hormones increasing and prepared the woman's body for conception and pregnancy so that then adding various treatments into that, kinda the combination of everything made success more likely. I know it's more complex than that depending on the precise condition but that was the gist of it.

As someone who was skinny until mid - late 30's and is now overweight even though I manage maybe one meal a day (mh) I have to say all the comments about weight issues - yes the biophysics is more cals out than in but the reality for many who are overweight is that there are other complex issues at play. Not just psychological, but physical too - eg I'm physically disabled too so I'm very limited what I can do activity wise. Add that to being housebound with agoraphobia and fear of injury and I am very sedentary. In addition I'm on 2 meds that are known to slow metabolism and thus lead to weight gain that way, plus they inhibit certain nutrient absorption which leads to cravings (and nuisance blood tests on a regular basis to check these) plus at 46 I'm pre-menopausal so that doesn't help either, and genetics - I'm an apple shaped Scot so designed to lay down fat for warmth, plus I've noticed that the women in my family who have DC are the ones that end up overweight. But not from pregnancy weight. We're all very slim unless we have babies, have the babies, lose the weight no problem in first year of or so and then start gaining. No idea why this is some weird genetic thing I believe. So ALL that combined and it's not just eat less do more.

An aunt who needed to lose weight for a specific health reason followed a relatively strict diet by dietitian to do so. Wasn't working at first and dietitian and dr thought she simply wasn't following. She really was (pathologically honest! Gets hiccups if she lies - weird family!) eventually managed it but on far fewer calories than she should have needed to go down to according to the standard calculations. Definitely something off apparently evolution doesn't want my family reproducing (can't imagine why 🙄😂).

Although you might be interested to know here in Scotland in many counties swimming is free for school age children and oaps. I believe it has had a significant effect on obesity levels and therefore associated conditions. There are lots of walking groups and 3 park runs a week where I am all free which is also good. The swimming is council funded and the walks/runs I think are voluntary organisations. The big problem which is difficult to deal with though is the weather! Too much rain in the wine makes people reluctant to go out in Eve and weekends. Even to go to other indoor places, people get in from work/school, do whatever they need to at home, think about going back out having got warm and dry and just go "urgh no!".

At my practice you have to pay for travel vaccinations. And letters conforming fitness for extreme sports. Quite right too.

@barcode Quite. I would have no issue in actually giving the NHS the £6 for a year's worth of injections. I'd rather pay them the £50 I am spending on pills instead of to a company. But it's the whole notion of the NHS paying for what some people merely WANT rather than what others actually NEED.

My father has been in hospital twice in the last three months. Each time he has been discharged in a hospital gown and with a hospital blanket. In hospital everyone is given slipper socks. When did this become a thing? I took Pj's and slippers in for him but they don't get used. Surely the cost of blankets/gowns/socks add up over the year. After the first time I washed blanket and gown and took them back... I was told thanks but we don't need to get them back!

IUsedtoBanOptimist that sounds horrendous and I agree about the student bursary although strongly feel it should be paid on the basis of 10 years service or turned into a loan - same for fees.

Those working conditions are horrendous but I also think the public and the NHS is to blame. For generations there has been an expectation that poor standards should be sucked up because the NHS is free. It is NOT free, it is free at the point of delivery and not one individual receives a free service. The public have allowed this to happen and it has been facilitated by the NHS and all those who work for it.

For the last two years my tax statement has broken down how my taxes are spent and that breakdown includes the NHS.

@Magissa we have to use slipper socks because they have sticky pads on the bottom and elderly people often slip over in their slippers, gowns are so much easier to get on than pyjamas, obviously don't know your grandad circumstances but when you have 20 patients to bathe and dress before breakfast slipping a gown on is the best option.....

My SIL pays for private health care after what she went through due to the NHS and I don't blame her! I'd rather pay £100 odd a month and know my family are looked after than pay of for a new car or other luxury's....

@Magissa sorry I read it wrong! Father not grandad

And they're STILL imo being greedy, getting payments on top of their basic (not small!) salaries for providing certain services that actually are bloody obviously part of the job THEY ALREADY GET A SALARY FOR! And refuse to provide these services unless they are paid.

And, of course, GP suigeries are paid "per patient" so they get paid whether they see a patient or not. So there's no incentive for them to increase the number of appointments available - they get the same cash! If you changed their funding to "per appointment", you can guarantee that GP surgeries would suddenly find lots of available appointments!

Don't get me started on profiteering GPs in other ways too. Like the way our practice GP partners have put in their own pharmacy within the waiting room (despite there already being 3 pharmacies within sight on the main road outside) and then encouraging patients to use their own by telling them their repeat prescriptions would be quicker (pharmacy do it all, so no need to go near reception and the 2/3 day wait for a doctor to sign them), and if you see the practice nurse or nurse practitioner, they can give you an unsigned prescription to pick up your meds from their own pharmacy - the alternative being you go back and wait in the waiting room for 30 minutes until a GP is free to sign the prescription. It's so blatantly pushing you to use their own pharmacy - and yes, it is their own - the company is on Companies House with the partner GPs and their wives (nice tax dodge) shown as directors and shareholders. It's just a hair width from corruption.

I don't think GPs get very much per patient. I have been to my GP once in 12 years (I very very very lucky compared to most people in the UK and I do appreciate that and have not even had a cold for 2 years and I also pay huge amounts of tax which keeps going up and up and that's only the income tax, the indirect taxes hitting us all keep rising, but that's a separate issue). I think it's only about £60 per patient they get each year and then they have all their expenses and then they have tax taken off whatever is left (for self employed doctors)

Graphista, I don’t know any GPS who work part-time. I know part-time GPs who work full time hours and more besides. I know GPS who have given up and retired because the workload has become unimaginable. I don’t know any ‘greedy’ GPs.
Many work evenings, many work weekends and all do home visits - but obviously restrict who can have a visit because you can only stretch a doctor so far and better they see patients than spend time travelling.
As for payments for non essentials, I think the NHS shouldn’t be paying for passport signing, letters saying someone is fit to fly, school absence letters, insurance medicals, HGV medicals, Diver clearance medicals or occupational health assessments. These are not part of the NHS provision. Of course individuals or employers should pay.

I don't think GPs get very much per patient.

But each GP has thousands of patients on their books, so it all adds up, especially as the majority of people only go to their GPs very rarely. GP practices also get funds in other ways for other reasons, i.e. more for each patient with certain conditions, so it's not just the "per patient" fee. Official figures show the average full time equivalent "wage" for experienced/older partner GPs is well over £100k - that's after all the practice expenses, etc. Not too bad is it? In fact, they earn enough, enabling them to reduce their working hours, ironically often to avoid paying punitive marginal tax rates on their earnings over £100k!

Skipping straight to the end to post, bad form, I know,
I would, for a start,

• get rid of a good proportion of the wasteful middle management and do a bloody good audit of all of the time-wasting crap that we have to go through in the NHS. Record keeping /electronic data needs a better and more efficient system.
• weed out the "off on stress" career bludgers (the real ones).
• scrap free prescriptions for many meds and review waste. My god, the waste!!
• go for a two-tier system with private health insurance bringing a tax rebate to those who have it - encouraging people to use private facilities thereby freeing up public health beds etc

_ encourage GP facilities and community health to rent our rooms to private HCP

• use a deposit, money back on attending, system for OPD
• charge referral sources correctly - including telephone time, travel, faxes etc - not just for contact time

The waste is horrendous - down to things like wasting paper, leaving lights and power points and wasting the time of practitioners who are ; paid by the hour due to poor communication and bureaucracy.

I would part privatise it - wait before you erupt.

I would have elective surgeries avalaivle at NHS hospitals for a fee. My friend had a tummy tuck and boob lift at spire hospital in Southampton. It was performed by an Nhs registered doctor and the private hospital is in the car park of the actual hospital!!!

When actually the £20k she gave them could have gone straight back into the Nhs

I would make overpriced medical equipment and tools a crime. Moderated heavily by the government. My brother is a £70k a year commission added seller of medical supplies to the Nhs and proudly discusses how he can buy a needle for £0.10 and sell it to the Nhs for £10

Yes I know he’s a prick. No it doesn’t change the reality.

I would drastically cut managers and directors, offer more money to nurses and doctors and remove the ridiculous piles of management that exist.

I would charge people for misuse of services, like calling ambulances because they feel like it Etc.

I would have prescription drugs available from pharmacies without prescriptions. I’m a sports therapist and I know when I need stronger pain relief/muscle relaxants and so on. This stuff we should just be able to buy, remove the need for trapsing to surgeries and meeting doctors to be told what we already know.

In 2016 the average income of a GP was 90k. That’s not a huge salary given the level of training and responsibility. They have to pay indemnity, registration, exam costs, training costs in order to continue to practice.My daughter is a GP registrar. Her hourly salary works out at less than the hospital porters and HCAs she works alongside.

If anyone wants the ‘easy life’ of a GP they can simply do the 11 years training once they’ve achieved their three As at A level. There’s a huge shortage, so you’d be very well received.

As for payments for non essentials, I think the NHS shouldn’t be paying for passport signing, letters saying someone is fit to fly, school absence letters, insurance medicals, HGV medicals, Diver clearance medicals or occupational health assessments. These are not part of the NHS provision. Of course individuals or employers should pay.

None of these services are free at my GP surgery. Is that not the case everywhere?

Oh and GPs cannot sign passports unless they know you personally and not as a patient.

All the GPs in our practice work part time. The most any of them works is four days.