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?

It is one of the most efficient in the world and I would keep it and may Tories want it kept too.
We can certainly try to improve it as Tory and Labour Governments have done over the years.

I would cut back a bit on what is provided but I would not change teh concept and that is despite paying a small fortune into it every year in huge amounts of income tax and in direct tax whilst just about never using it! I have had one 5 minute appointment in the last 12 years.

WitchyMcWitchface I think you’ve misinterpreted the earlier post by the consultant who was talking about allowing people a dignified death and not striving too voraciously to extend natural life span through intensive medical intervention but how difficult some families found this concept.

That is world’s apart from ‘easing people out/murdering/ euthanasia get people who lack capacity to make that decision.

One thing I thought was that it seemed that people with no savings might be shoved into care homes as the family know the state will pay. Whereas if Granny has a large house and savings perhaps family try harder to keep her at home.

It's a good idea that people care for their own relatives where possible. But the government need to support carers better and pay them an amount of money that's actually possible to live off.

How many people can afford to give up a £25k a year job to care for their mum for £60 pw. Looking after granny is just not an option for most.

If people hard carers at home they would probably bed block less. Some old people are in hospital waiting for care in the community to be allocated because there is no one to help feed and clean them at home.

I think we can all agree that there is huge wastage in the NHS and room for improvement in the management of many Trusts and hospitals.

Australia has a partially paid for health service. I don't see hordes of people begging for money for their hospital appt when I visit. These countries must have a way of dealing with poor patients.

It’s called Medicare. Paid for out of a levy on taxes. So you pay tax, then you pay an additional % levy on top, obviously the more you earn the more you contribute.

However, there is also the private health ‘saving’. So if you choose to shell out for private health you don’t need to pay an additional levy again. If you don’t have private health you pay that levy also. It sounds odd but it’s not. Put simply a high income earner with private health insurance will STILL be paying more for the Medicare levy than a low income earner without private health. People on benefits contribute jack obviously. Our system is seriously strained and the levy needs to be raised but that’s never a popular vote winner.

So ‘poor’ patients (words of poster above not mine) will only use public services. They will also be joined by people with ideals that there should only be a public system and that a private system should never have been allowed to occur.

If you can afford private health then it would be anticipated you would use the private system where possible. It’s mainly for routine stuff that can be scheduled. While there are rare private hospitals with A&E’s the vast majority of emergencies will be treated in public hospitals whether you have private insurance or not. Also, complex matters tend to be treated in the public system as we have tertiary hospitals with great expertise.

I have had operations in both systems. For one operation I had absolutely no private options. Husband has been treated in the private system. One child (young adult) has been treated in both. Other child (older teen) has extremely complex health needs and will only ever be able to be treated in the public system. Basically you use the system that matches the skill set/facilities that you need. Waiting time for routine matters that are not immediately life-threatening tends to be quite long in the public system (years for some things) whereas it’s relatively quick in the private system. If you have an immediately life-threatening situation you will be dealt with quickly in the public system. Our system is by no means perfect, can be improved no end but basically works.

As an former A&E Dr who worked in the NHS at the beginning of my career and in our local system for the remainder my suggestions for sustainability would be to increase funding via tax payers on a sliding scale. Then charge those fuckers that come into A&E when they don’t need to be there, I have a never ending list but things like ‘I need my child put under to remove a splinter because they won’t let me do it, no don’t hold them down, they don’t like it, wait - we need to ask them for permission, don’t stress them AND we had an unreasonable wait time’, because obviously the heart attacks and critical patients who should be there like road and machinery accidents who are flown in should come after little Sally’s splinter. Yep, charge some people a million dollars for attending, others completely free depending on common sense used.

*Waiting time for routine matters that are not immediately life-threatening tends to be quite long in the public system (years for some things) whereas it’s relatively quick in the private system

This is what I like about the Australian system, bearing in mind I’m not native to it either. We have private health insurance, when the oldest DD needed and ENT procedure instead of waiting months and months to be seen and then a long time to have an operation it was all sorted within about 6 weeks. When people go privately for essential but non life-saving surgery like grommets and adenoidectomies it also means that they’re not contributing to the public waiting lists.

It’s also only the surgeries and admissions that are covered by private health, the actual specialist consultations need to be paid for, although Medicare pays a decent chunk. Lots of people choose to see a specialist privately (for continuity of care and so they can see the same person) but have their procedures and arranged admissions in public. This isn’t at all discouraged and again takes pressure off the public outpatient list.

Waiting time for routine matters that are not immediately life-threatening tends to be quite long in the public system (years for some things) whereas it’s relatively quick in the private system

Not necessarily true - I got a slot for a knee arthroscopy within 4 weeks of seeing the consultant. I actually had to request a later date as I wanted it done in the school holidays. The key was that I was relatively young, no medical issues, and suitable as a day case. The day care units can get through many more procedures than if you have to go into the full main hospital and take up a bed overnight.

The wait for a hospital admission was running at several months.

As private hospitals are undertaking operations for NHS patients, several friends have had ops in private hospitals but funded by the NHS, perhaps we are heading towards the Australian system

Not necessarily true - I got a slot for a knee arthroscopy within 4 weeks of seeing the consultant.

Yes, very dependant on area and how that public dept is going at the time.

When one of mine required grommets/adenoidectomy there was a wait of approx 3 months at our local public hospital . Other locals had over an 18 month wait, very area dependant. The person who I wanted to do it was in the private system and their list was over a years wait, they were VERY popular and with good reason. So I had the local public system constantly ringing to try and get me to get my child in as they could be seen quite quickly yet I was telling them I was waiting in the private system. These things genuinely are anomalies in our system though.

Pacer142 A senior medical "professional" effectively blackmailing the NHS for their own personal reasons........But was is not reasonable is an attitude of "I'm working the hours I want and if you don't like it, I'm off in a strop" is quite frankly pathetic.

I am genuinely sorry that you see it like this. I'm afraid that I do prioritise my own health and the wellbeing of my family above patients my job. Because vocational or otherwise its still a job. Obviously I could work full time and do on calls and weekends, but I can guarantee you that after a pretty short period of time I'd be off with stress and probably divorced, which would in the long run end up costing the tax payer more........and IS costing the tax payer ££££ because hundreds, possibly thousands of NHS workers are off with stress on any one day.

Obviously I could work full time and do on calls and weekends, but I can guarantee you that after a pretty short period of time I'd be off with stress

So you can't see a "middle" way then of doing a little bit more than a piffling 2 days? Why would you think the alternative is full time, on call and weekends - who said that? It does you no credit to talk about such extremes.

Do you think that others do not have stress in their jobs/professions. What about the threat of redundancy in most areas of commerce. At least you can choose to only work 2 days per week. Most are on call 24 hours 7 days a week with emails pinging at all hours nowadays

Ironic that in the run up to Christmas when threads about Christmas/Boxing Day working pop up and its mentioned that people who work at places like Next finish at 12 midnight on Christmas Eve and have to be back in at 4 or 5 am on Boxing Day someone always posts....................well what about those who work in healthcare.

 Well  not  all  healthcare  is  24/7  for  those  who  work  in it   and  yet more  than  one  poster  always  comes  on to  those  threads  to  use  it  as  a stick  to  beat  shop  workers  with.

I'm a CFO of a fintech company. I totally back what weneed says about scheduling. My experience has been that when you give people control over their working schedule they work more. It might not be more hours in a week but they work more productively during the hours they are working and take a whole lot less time off sick. I've noticed employee turnover is lower too but I think that's attributable to more than one factor. We genuinely appreciate the work people do and make sure that's known via pay as well as other non monetary ways.

Kazzyhoward So you can't see a "middle" way then of doing a little bit more than a piffling 2 days?.

Your sense of entitlement is breathtaking. My ‘piffling 2 days’ is my middle way. The alternative being to find employment outwith the nhs- which wouldn’t be hard. You do realise that I’m a human being and not a robot? You (or the great British public) don’t own me. Are you really saying that because I’ve trained as a doctor I don’t have a right to take care of my own health or that of my family until I’ve worked a number of hours/days/weekends and on-calls of your choosing?

User145 of course I know that other jobs are stressful. Other people also have choices as to how to mitigate their stresses. I am able to mitigate mine by working less, so I do.

Want2b thing is that healthcare by its very nature needs staff to be present its not just "productivity" patients aren't car parts! The nhs needs staff present when the patients require - not just when it suits the staff.

Higher staffing levels are needed so that staff aren't having to work unpaid overtime but the cover has to be provided.

Weneedtotalk - genuine question - do you think before becoming a dr you had an unrealistic idea of what it would be like?

Because while staff shouldn't be working excessively it's been well publicised for the past 30 odd years the pressures nhs staff can be under.

Graphista When I talk about productivity I'm talking about quality as well as quantity of work. Generally speaking the better quality of work performed in the first place, more quantity of work is achieved also, albeit over a longer period of time.

Our customers need support during trading hours which is pretty much 24/7. We make it work but quite a few parents ask to work evenings and overnight so they don't need to pay childcare costs. We have one guy whose DW is the primary earner. He works a 75% schedule making 100% salary by working 3 nights a week. He has referred so many others to us for employment because we are somewhat flexible. It's a win win for all as far as I'm concerned.

The NHS tells people their shifts, time off and doesn't enable them to manage their schedules. They then wonder why the sick rate is so high.

The basic rate of Income tax should go back up to what it was under Maggie Thatcher
(26% by the way)
That would sort the NHS, schools, adult social care and the MOD

but going back to Maggie is too socialist for the government
(NB Company tax was 26% then as well but VAT on the poor was only 15%)

graphista I don’t think I had an unrealistic idea of what it would be like to be a doctor.....and I was happy to do the 24/7 thing until my mid 30s. I had an unrealistic idea of what it would be like to be a working parent and one half of a 2 -career partnership (DH is not medical). I dream of a day when I can feel on top of my life again (I’m suspecting there is a small window between my DC going to uni and having children of their own) and contribute in a greater capacity to the NHS, but that isn’t going to be for another decade or so.

I worked in the NHS in the 70s. Getting a patient over 90 was a rare thing worth commenting on. Also crap pay.
Now it is a heavy physical job, there is a constant stream of elderly distressed people on trolleys being seen , hip fractures, pelvis, back or strokes. The pay is better, we used to do nights all night say once a week and as there was not too much work of you worked all next day too - 36 hours but you got away a little early. Not poss now. There's too much work and it's probably illegal lay long hours. The job has changed, more investigations in type and number, more poorly patients. Less respect. So more likely to be done part time. The world has changed.

weneedtotakk my point was that other people who don’t work in the NHS or Healthcare do not have such flexible employers or can mitigate their stress by only working 2 days a week and giving their employer an ultimatum. They may also be the sole provider in their home.

Are you really saying that because I’ve trained as a doctor I don’t have a right to take care of my own health or that of my family until I’ve worked a number of hours/days/weekends and on-calls of your choosing?

This does seem to be the inference doesn’t it? That if you train as an NHS doctor you must be beholden to it forever. That includes sacrificing your own mental health, family and social life for your entire working life. You also shouldn’t be expected to care that overtime is unpaid.

Funny how so many NHS doctors are leaving, isn’t it?

I'm a prison nurse.

I have 50 detox patient, as of yesterday 28 needed twice daily physical observations, 5 needed dressing changes, 3 are pregnant, 10 of them got high, 1 had a seizure.

And guess how many staff we had?

Me and 1 band 3 HCA.

WE NEED MORE FUNDING FOR MORE STAFF.

I would raise taxes and spend more on healthcare.

NHS workers are leaving in their droves because we are worked like dogs and paid peanuts for it. We need to retain HCPs.

I am amused at the posts saying the NHS is one of the most effective healthcare systems in the world - is it not obvious this compares it to all countries including no third world ones. By continuing to believe that the failing NHS is effective is delusional. Brits have become so used to waiting ages for their medical care that it’s become normal.

And to think that paying an extra £2 a month will sort it is also delusional.

The NHS needs to somehow be removed from the governing party and be overseen by a non-partisan body who could implement what was best for the NHS in 2018 and in the future not just what the governing political party wants.

There are lots of good ideas on this thread but they are just stop gap measures - sadly the whole thing needs overhauled and possibly replaced with health insurance but any mention of that makes people’s heckles rise. But this is the reality - if you want proper healthcare you need to be prepared to pay more too it.

In Germany employed people pay around 7% of their salary towards health insurance. People on benefits have this paid for them. This then means that the majority of their healthcare needs are free at the point of care. The easy access to community based specialists also means that less people go to A&E.

An example is my son has a painful ankle from playing sport - I called an ortho practice, got an appt 10 days later, he was seen & had an X-ray & ultrasound within an hour and was referred for 6 sessions of physio. If that doesn’t help, he’ll go back to the ortho (I’ll call to make an appt), where he’ll go for an MRI. All free at the point of care for anyone with health insurance (which is most of the population).

Yes it costs a bit more than what people pay in NI in the UK but it’s worth every penny for knowing that the good care is there when we need it.

I completely agree with comeongordon. We have a second home in France. The two systems are incomparable.

Services at my local hospital are now so poor that the local uni no longer sends student nurses there. I would not go there. It is by no means at the bottom of the league tables. Even the ceo wants to transfer its acute services out. As dies every other stakeholder. The people who want it to stay - the MP and some of the public.