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?

In 2016 the average income of a GP was 90k.

Presumably that includes part timers and younger/inexperienced GPs if it's an "average". I was talking about full time equivalent senior/experienced partners.

@MilkAndSevenSugars Do GP practices have to do travel appointments?

My current practice makes it very clear the jabs are private, while I remember my childhood GP refused to do them and gave you a list of private clinics who did them.

My current practice makes it clear that health checks to take part in endurance events must be done privately and gives a list of clinics.

My current and last practices do however waste time not telling you, you should use one of the private sports physios in the area if you have a sports injury as you have to see them first to get a physio appointment. Patients have actually complained about GPs doing this as if the injury was that serious they would go to A&E. However if you need some postnatal rehabilitation they do tell you to go private without hesitation - again I expect they get complaints.

CHARGE PEOPLE FOR MISSING APPOINTMENTS

At my hospital, people are missing appointments because they weren't notified about them.

At all. We simply can't get the post out fast enough.

My offering:-

B
Legally bar staffing agencies from charging more than the current NHS wage for the post being covered.

Charging for any aspect of the NHS makes me very uncomfortable. Yes many people abuse it, misuse the 999 service or A and E or don't turn up for appointments. But then if you charge for this the result will be genuine patients not calling an ambulance or attending A and E for fear of not being ill enough and then being charged. This happens frequently on here - people post asking if they should go to A and E. A whole bunch of replies tell them no. Take a paracetamol or wait 3 weeks to see a GP and then it turns out the OP has sepsis or a heart attack or something.

With regards to non attenders, this is difficult. I am lucky to be getting amazing NHS treatment but this involves very frequent appointments. I am there today and tomorrow this week, three times last week, twice next week. This is a 2 hour journey involving a bus and 3 trains. So far, touch wood, I've got to every appointment but I can easily see how a problem during the journey means I don't get there. I try to counteract it by leaving much, much earlier than I need to and that means always having to take a day off work.

The only time I've missed an appointment was when I came down with sickness and diarrhoea at 2am and I had an appointment at 8am. I was too unwell to attend but posters around the hospital tell you not to attend if you've had these symptoms within 48 hours so even if I'd recovered Instill shouldn't have gone. As it was we started trying to cancel the appointment at 6.30. Couldn't get a direct number. Switchboard couldn't help. Eventually we got put through somewhere to an answerphone who told us the messages were checked at the start and end of the day. We left a message explaining why I couldn't attend. The next day I got a letter telling me that due to my missed appointment I was being discharged. PALS did intervene and a new appointment was made but another vulnerable patient maybe wouldn't have complained.

And why is the answerphone only checked twice a day? Say my appointment had been at 4pm and I phoned to cancel at 10am. If that message was picked up it's possible that a patient on the waiting list could have been called in for that appointment. Using their system that appointment would be wasted because no one would pick the message up.

It's clear that the NHS is just to unwieldy.

I would pay more tax happily

We spend a lower proportion of our GDP on healthcare than comparable countries. That has to rise either through state spending or private spending.

I think state is more efficient, more equitable and gets better outcomes than pushing more into private individuals.

I am a higher rate tax payer. I'd pay more.

Up taxes.

Really, it doesn't have to be complicated. All of these "charge people for X" plans usually work out to be cost neutral at best once you've worked out the process for collecting payments, chasing payments, managing an appeals process and so on.

Higher taxes, put more money in to NHS. Higher taxes, put more money into social care. And while you're at it, fund more hospices rather than relying on charities.

Pacer124 no it includes full time, qualified GPs only

And up further in the thread - the person saying it’s easier to ‘pop people into a gown’ isn’t providing good care. People should be encouraged to get dressed properly not sit around suffering the indignity of a hospital gown. People recover more quickly and go home sooner if they are encouraged to get up and about quickly. Pyjamas and dressing gowns should rarely be seen in hospitals during the day. This, surprisingly, reduces costs to NHS by reducing length of stay and reducing falls.
No hospital should be getting 20 people up and showered before breakfast. That’s very, very poor practice and should be datixed. The hospitals without huge deficits are those with higher staffing levels and skills mix. Good care is cheaper.

Higher taxes, put more money in to NHS.

But without reform, it's a bottomless pit. Labour trebled NHS spending - where does it end? If it's an extra 1% tax every year, over 20 years, that's 20% added, after 50 years, it's 50% added, after 80 years, you've got income tax at 100%. Without reform, just pouring more and more money into it will sooner or later bankrupt the country. Before we start talking about raising taxes, we need a "plan" for a long term sustainable NHS and that will inevitably include massive efficiency/waste reduction initiatives, plus scaling down just what services the NHS provides, more "charged for" services, etc. Just putting ever increasing amounts of money into it is just a sticking plaster.

Pacer124 no it includes full time, qualified GPs only

If it's the figures from the NHS digital page, it says it's "contractor and salaried GPs" - so won't include self employed partner GPs and in particular, their "private" earnings they make by virtue of being NHS GPs. It also says "full and part time GPs", so isn't full time only.

digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/gp-earnings-and-expenses-estimates-2015-16

No hospital should be getting 20 people up and showered before breakfast. That’s very, very poor practice and should be datixed.

Couldn't agree more with this. It turns care into an assembly line which is all kinds of wrong.

I'm glad no one has mentioned the much used Facebook meme of "Bring back Matron" to save the NHS. In my experience every ward I've worked on that is run by "old school" matron types are joyless environments where more care is taken on how things look than how the patient feels. Never mind Doris is scared and alone and wants 5 minutes to talk to someone, as long as her bed is pristine and she's been up and washed everything is ok.

Dementia. Oh we need to talk about dementia. Apparently we can't let people die. I'm a hospital consultant and I have many colleagues who won't even consider not treating an infection in a frail elderly patient with dementia, partly because they think its unethical and partly because they are scared of getting sued for malpractice. The trajectory of this persons quality of life is only progressing negatively, especially if they are already in a nursing home. I take the view that its unethical to continue treating them and I believe that elderly people in nursing homes with dementia should have all their medication stopped and should only be transferred to hospital in a small number of specific cases (like falling and breaking a bone). They certainly shouldn't be going to hospital for IV treatment of infections. What I actually do is largely guided by the families wishes and ability of the nursing home to cope. But I've had bed bound, peg fed, doubling incontinent, mute patients with end stage dementia and their family wants them treated in hospital with IV antibiotics for pneumonia......so they can carry on living in a vegetative state. Even a single trip to A&E, by the time you factor in the GP visit, the ambulance journey there and back the time in A&E plus any further time spent on a ward, costs thousands and thousands of pounds. And there are hundreds of such patients every single day. And my view isn't because I don't value elderly people, I absolutely do, but I also value quality of life and dignified dying. There is nothing dignified about living a life in an institution, wearing a nightie 24/7 , wearing a bib when you are 80, smearing faeces all over your room, wearing a pad because you are incontinent and consequently always smelling of urine, physically assaulting members of staff......its unpleasant for everyone. But for the majority of cases we have to keep these people alive, and I just don't understand why relatives want this. (perhaps I'll get a shit storm of enlightened comments now). My views aren't driven by potential cost saving , but the by product of allowing elderly people who live in a nursing home and have no quality of life to die is saving shit loads of money.

There are a whole heap of other things we could do to make the NHS better most of which have already been commented on - reduce managers, stop prescribing paracetamol and ibuprofen, charge for hospital transport, charge an attendance fee, stop a whole list of treatments (IVF, cosmetic surgery, gastric banding) which aren't life and limb saving, but no politician is prepared to get into that shitstorm. The reality is that the NHS is just going to continue to deteriorate so that more and more people take out private healthcare and we are going to end up with a 2 tier system.

Pacer that is a good point that there is no incentive for doctors to have more appointments available as they get paid per patient anyway. All except one doctor at my surgery are part-time and it is impossible to get to see your allocated doctor because if the time they take off.

Gosh, I thoroughly agree, weneedtotalkabouttheNHS.

I posted upthread that the hippocratic oath has been rendered ridiculous in many cases by advances in medicine.

Mil had very advanced dementia. Doubly incontinent, bedbound, mute, not knowing who she or anyone else was. Her nursing home insisted she was carted off to hospital twice for pneumonia treatment. She was pumped full of antibiotics and lived another two years. In an absolutely miserable state with zero quality of life. It was not the family's wish at all. Mil was on a DNR but apparently pneumonia is treatable so treated she had to be.

I don't know why they don't have a two tier nursing system.

When ds has been in nicu and picu, he had a qualified nurse with a degree changing bedding, changing his nappy, doing NG feeds, passing NG tubes, cuddling him because he's crying (all when I'm not there obvs) . Things that I, as a completly unqualified person do.

Why don't they have vocational nvq type nurses that do all those jobs for less money. Then higher paid degree trained nurses to do the more medical jobs. The vocational nurses could then apply for free degree training after x amount of experience if they agree to stay in NHS for x years.

You could then have more staff, more less qualified lower income people into jobs and more time to provide good care, chat with patients, oh and nurses could actually get brakes and work better hours.

The degree qualified nurses could also have more medical training to aliviate some jobs from the doctors. Sometimes the nurses know more than the doctors anyway because they spend more time with the patient and have more experience.

But I've had bed bound, peg fed, doubling incontinent, mute patients with end stage dementia and their family wants them treated in hospital with IV antibiotics for pneumonia......so they can carry on living in a vegetative state

One of the reasons I left elderly care was becasue I wouldn't stomach things like this.
Administering yet another round of antibiotics to a patient who's well meaning but unrealistic family insisted we kept going quite frankly sickened me. Same with continuing to attempt to feed people that a clearly dying but familynthink we are being cruel notnouching food and fluids every 5 minutes. Anyone who has ever tried to feed someone who is dying will tell you it can be an incredibly unpleasant experience for all involved. I think a very serious and frank discussion needs to be had about the nature of dying and at what point we accept that it's time. Obviously things need to be assessed regularly and I'm not looking for a return of the old Liverpool pathway but keeping people alive by any means despite no quality of life just isn't right.

weneedtotalkabouthteNHS Spot on and it’s not just dementia. We seem to have lost touch with the truth that people die and should be supported to do so with compassion and dignity rather than be forced into an existence that robs them of humanity for fear of a family getting upset. The whole LCP debacle was just ridiculous and a valuable end of life care tool was thrown out because the tabloids whipped up an ill informed response and fed horror stories.

Onlyhappywhenitrains1

I disagree. What you describe is the foundation of a good nursing. Every single nurse I know would love to get back to doing some of the more basics you describe but the sheer amount of paperwork prevents that.

The same with the Gosport War Memorial hospital. Now, I'm not sure exactly what went on there, but families were outraged that, eg, a 90-year-old relatives with dementia and cancer were "helped on their way". Frankly if someone had helped mil die peacefully about five years earlier her sons would have been extremely grateful. And I'm sure mil would too. She would have been furious if she could have seen herself in her last few miserable years!

Staffing is a huge issue. Its about the retention of staff. In my area (mental health) staff are off with stress frequently, which then increases the work load of those around them, who in turn get so stressed they leave or go off sick and the circle repeats.

My team probably looks a full staff but the staff rotate so often that by the time the previous gap is filled, one of the team will leave because their workload was unbearable in the interim. Im seen as a long stayer and ive been there for less than 18 months.

All that experience and knowledge is lost.

Make social care and health the responsibility of the same organisations (so either under a local authority or ccg) so they don’t argue about whose budgets should pay from things. Would mean a lot more was spend on prevention and getting people home from hospital quicker.

Charge for missed appointments.

Make the work/life balance better from health professionals so people don’t just leave.

because the GP can be closed for up to 4 weeks from mid December!

graphista I don't know where you live but I find this very hard to believe. I've worked in primary care for nearly 19 years and I have NEVER had more than 2 days off in a row over the festive period.

We're open until 1830 on Christmas Eve, close Christmas Day and Boxing Day and then open again at 0730 on the 27th. Whilst closed all care is rolled over to the OOH service that GPs fund from their massive income.

There is so much misinformation and misunderstanding on this thread it's unbelievable. I can't speak for hospitals as I don't work in them but this whole "GPs work for a few hours a day and rake in 6 figure salaries" is utter bollocks.

GPs provide healthcare under a contractual business model. Their contract is with the NHS/CCG under fixed terms. They receive approximately £90 per annum per patient to fund their rent, bills, staffing costs, equipment, both business and clinical, insurances, medical indemnity insurance for their clinical staff, cleaners, software, IT support, and all the other things.

They do this whilst providing care to thousands of patients from pre birth to post death. They have to meet governmental/DoH targets, follow prescribing restrictions from prescribing authorities, carry out audits and follow protocols and pathways for local clinical models and provision.

For example we are open 0730-1830 Monday to Friday. The GPs (there are 3 full time and 2 part time) each do one Saturday morning a month. We also open until 2030 2 evenings per week, with 1 GP and 1 nurse doing extended clinics for prebooked appointments.

Yet the politicians and the great British Public want us open 24/7. How do you propose we do this? We have no extra staff, so any extra opening times would be instead of other clinics, not as well as. There wouldn't be any extra appointments - you can't magic up staff. Ironically GP recruitment is at an all time low and some practices are closing due to a lack of GPs - amazing when you consider what a cushy number it apparently is

The NHS is a behemoth and can in no way continue to serve the population as it is. It was created in 1948 and life now is so different to how it was 70 years ago. The NHS cannot possible be expected to be all things to all people, yet the public still demand that it is so.

It should be publicised and depoliticised. Run by managers to free clinicians up so they can be clinicians and do the job they were trained to do. All the money in the world won't fix it, it needs a massive overhaul in terms of expectation, provision and efficiency.

Social care needs joining up with health care, and the two need to be allied financially and logistically. We need to stop prolonging life at all costs and look at QUALITY, not quantity. People need to stop with the expectation that they can have whatever they want, whenever they want it. We're not Tescos, we don't open 24/7 and we provide care based on need not want.

The lack of joined up IT is a problem but patients sometimes don't help themselves - many won't consent to data sharing. There is a limit to what we can share via email or text due to data protection issues.

There is certainly some element of staff taking the piss - many hospital staff are notorious for swinging the lead, taking so much sick leave you can't believe they're not dead, doing the bare minimum. It's far harder to fire someone in the NHS than you can imagine, they end up being moved around because no-one has the balls to sack them.

Put pressure on schools and employers to stop with the ridiculous demands for paperwork (you legally can self certify for 7 days so stop asking for GPs to issue notes for children to have a day off school for sickness) and for paracetamol etc to be prescribed. As long as it's in it's original packaging and a parent has given consent WTF does it need to be issued by a doctor? What a waste of time and money - not the GPs fault but the schools.

Stop banging on about "Bringing Back Matron" and "why do nurses need degrees". Nursing is a totally different profession to what it was 30 years ago, we now do things that used to be done by doctors and HCAs do things that used to be done by RGNs. Yes I know when your mum was a nurse in 1965 they had 40 patients to 3 nurses and had time to plump cushions and wash backs but they weren't as old, or sick, or complex as patients are now. Hell when I started nursing in the early 90s a patient of 70 was an older patient - we didn't do hip replacements on 88 year olds with diabetes, COPD, dementia, Parkinsons.

The NHS is a wonderful thing, but it is broken and needs fixing. Until politicians stop using it as a bargaining tool and the public realise they've got a good thing going and stop abusing it, it won't change.

I agree with euthanasia updating

We need to be far more realistic about what we are funding.
My friend is an adult social worker and she has had to sign off 5 million contracts for 3 years to keep people alive who have NEVER experienced life beyond a bed while removing funding for respite for people with learning difficulties because their parents are on the ball.

It’s a bloody travesty