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?

Sorry facts bear out that NHS remains one of best health care systems in the developed world despite being under funded. Lowest % of GDP, highest alcohol related spending (way above obesity spending) but waiting lists much reduced nationally.

No figures about outcomes or satisfaction there cherry. Try putting the MH waiting times into that equation.

Sorry facts bear out that NHS remains one of best health care systems in the developed world despite being under funded.

Not arguing with you but do you really think it’s sustainable? Aging population. Advances in medicine that generally results in higher costs including ability to treat more people (oncology populations for example), advances in tech such as new gen MRI’s, new medicines that don’t come cheap etc. so many things that mean that costs are only going to go up.

I don’t think spruiking that any system is the best in the world (again, not refuting) is what’s called for. Things have to change in any system to evolve with the rapidly changing healthcare landscape or that system just gets left behind. That’s what people are saying on this thread, even though it may still be ahead the system is slipping and not looking well placed for the future unless changes are made. The question is what changes are needed to achieve a world class system with the challenges it is currently facing and those that we can predict for the future.

There’s a lot of reform work already going on - STPs are evolving and looking at system wide changes and hopefully undoing lots of the harm putting management of funding mainly out to CCGs - many of whom are verging on bankrupt.

I can supply the figures but it makes for dull reading. Mental Health is a huge issue but that certainly has to be one field where austerity has had a huge impact.

cherry, that first one rates the nhs as the worst for absolutely everything against the EU and it’s most developed nations. Apart from having far fewer hospital beds in Sweden because they tend to treat people at home.

The Commonwealth Fund report is notable bunkum which congratulated the NHS for having clear procedures and being accessible, but completely ignores the fact that they’re not very good at healing people or keeping them alive.

And the other chart shows that waiting times have been consistently low under the Tories whilst they were consistently high under Labour.

Which also explains CCGs going bust - because of Labour PPI schemes which are bankrupting them.

STPs may be positive, but it’s difficult for them to get much done when the left constantly blocks reform. For example the Naylor report suggested turning the NHS’s old, creaky, unsuitable expensive to maintain buildings into cash by selling part of the land they cover to housing developers giving the NHS money to build modern, state of the art, much larger multi floor buildings which only take up half the space. So the half sold isn’t needed. The left blocked implementation of this by screeching about the Tories ‘selling off the NHS’ and misrepresentating it.

This week I have seen several Labour leaders whinging on about how the NHS is stuck with old, creaking, unsuitable, expensive to maintain buildings and blaming that on ‘teh evul Tories’ not building new NHS facilities and the left blocked them purely for the sake of scoring political points and not wanting the Tories to have a successful hospital renewal scheme which would belie Labour’s claim to be the party of the NHS.

It’s fucked and it’s going to stay fucked because the Labour Party who claim to care about it won’t reform it and they block good, sensible reforms because they don’t want anybody but themselves to look good re the NHS. They couldn’t give a fuck if people die as long as they can keep the vote winning nonsense they care about the NHS hobbling along.

Not sure that first set of graphs is anything for the NHS to be proud of @CherryPavlova. I’m amazed at the last graph about waiting times - it represents elective care. I’d love to see one for outpatient waits as all I hear from anyone in the UK who is waiting for an OP appt is that they wait for months.

And @Gingerrogered this is what I was trying to say about taking it out of the hands of the governing party. They only have their own interests at heart

A complete overhaul of admin. Obviously a huge task but there are just so many ridiculous inefficiencies.

Unfortunately, I think it will eventually have to mean that some (more?) treatments aren't available on the NHS. How you choose which ones is of course hugely contentious, but for example, people who can't have children naturally may have to accept that. Just because it's possible to help, doesn't mean the state should do it. Obviously in a perfect world it would but "we" will need to accept the NHS can't do everything.

The biggest change I'd make is a complete change to a more holistic view in training doctors. They still treat symptoms rather than causes. E.g. they treat the diabetes and the bad knees rather than the obesity (which imo is often a MH issue)

Obesity needs tackling in primary schools through well funded Public Health policies. Prevention of obesity is a much better and cheaper way of dealing with it. The PH funding of weight management programmes also needs to be increased to enable the public to access effective treatment. None of this really requires medical input.

www.chorley-guardian.co.uk/news/crime/virgin-health-contract-union-blasts-terrible-decision-1-9402905

Patients taking responsibility for themselves.
Educate before it becomes a problem.

And YY obesity needs tackling in Primary. I see so many overweight children (and their overweight parents) usually driving to school.
There was a thread yesterday about a Yr 11 who was over weight , 90% of the answers were "No don't tell her" " What good would it do, it'll harm self self esteem"
I'm sure she knows she's overweight , she must have a mirror !
So many people ignore and the consequences are heart, joint, circulatory, diabetes,some cancers not to mention self esteem.

Take the advice offered.
If I went to my GP and said " My fingers are sore" Why "Oh , I keep opening and shutting the door and slamming them in it"
The answer would be Well take your fingers out of the door frame and it won't be a problem .

Yet I get patients coming in with poor footwear complaining about their corns, their toes, that nail.
Explain about the shoes
They have the treatment , wear the same shoes , same problem comes back. Same conversation.........

Same with smoking , the advice and help is there.

Non-attendance I don;t think you can fine for unless you do a complete across the board . If you make exceptions like someone being admitted you'd need proof. What if it's the spouse or child admitted?
Unwell ? The number of people I phone who have missed their appointment and will argue it's tomorrow/next week. Till they find out it was today ..."Oh , I'm unwell today " (Not when you were calling me a fibber you weren;t)

Yes the NHS needs an overhaul. Many NHS staff do work in excess of their hours . If we all worked to rule , it would collapse .

I know it's been mentioned many times, but I add my voice to chorus of people commenting on the attitudes of the staff (clerical, not clinical). I know a number of admin people working within different NHS trusts and, as someone who's worked exclusively in the private sector, I am absolutely staggered by the lack of work ethic, and the sense that it's perfectly okay to take the NHS for all that it's got. The number of sick days taken, the extended leaves with "stress" (and yes, the quotation marks are deliberate) and the virtual "work-to-rule" culture...I swear, if many NHS staff behaved the same way in a business, they'd be out on their ear. And quite rightly. Do I think working in a busy clinic can be stressful? Absolutely. But I don't think an admin job in the NHS is inherently more stressful than any other fast-paced environment. Frankly I'd clean house and start again.

yet I get patients with poor footwear coming in Swould stop peaking as someone who has been poor, and has size 9 EE feet, getting good footwear is not always easy. Not sure what the NHS could do about that though

I would cut out the agencies the NHS has been outsources to, and reduce medical equipment waste by reusing wheelchairs, crutches etc

none of this really requires medical input In some cases obesity is an eating disorder though @peagreenboat

Is there not a pill or some therapy or somebody who is orepared to cut out and treat the cancer at its core.

Oh yes, the admin staff and ime the nursing staff to an extent too. Amongst the angels, there are increasingly some horrors. Shouting, not listening, arsy if asked to correct notes because they weren't listening. Therapies that not only work 9-5 but refuse to see the first patient before 9.30 because that's the first slot. Is thst because they arrive at: 08.59m59s and then take off their coat, put on kettle, wee, make tea, log on etc?

My staff wouldn't get away with it but my staff don't think my customers "get it free". They know if my customers go elsewhere the business will fail and their jobs will disappear.

I agree that the attitude that NHS staff are all angels is nonsense. There are, as PP said, too many who think they're doing us a favour and not giving value for money. Is there a proper performance management system?

Restructure management team.
Reintroduce ward managers (matrons)
Stop outsourcing of medicines and products
Change type 2 diabetes care, to reduce need for medication
N.B. The last point currently costs the NHS £10 BILLION per year, and this could be greatly reduced if the start of treatment, at diagnosis, could, for those whose condition is caused by bad diet and lifestyle, instead be a sort of “boot camp” where the sufferer is shown how to cook the right foods, introduced to exercise and taught how to manage their condition.
Further access to diabetes medication should then be paid for, by the patient, at a reduced rate rather than free, as it is now, if their condition is caused by their lifestyle choices and they have chosen to remain eating the wrong foods and refusing to exercise and/or lose weight.

I’d cut down on the hefty salaries they pay much of their staff. I had a friend who was in a commissioning type role who was hugely overpaid for what she did. I fail to see why her work attracted such a high salary. Lots of pen shuffling, report writing and meaningless meetings just about summed up the role.

Anquin, I’ve never been in a hospital that doesn’t havevward managers - often called matrons.

Your point about changing management of type 2 diabetes probably applies to lots of other illnesses too. Maybe cold water swimming as management of depression ( proven to work better than antidepressants for mild depression). Maybe refusing to treat COPD - or indeed lung cancer - until person has stopped smoking? Refuse cervical cancer treatment if people are not in life long monogamous relationships? Ban alcohol completely or at least make it prohibitively expensive to get drunk? Dance classes free at point of access for everyone and compulsory before school or work in mornings? Ban second cars or make them much, much more expensive?
It’s not sounding like a nice world to live in, is it?

Justanotherlurker

You don’t know who I voted for at all! DH and I firmly believe in paying more tax, and he has paid £40,000 pa income tax for the last 30 years! We would reform the tax system, and increase funding for the NHS to the same percentage of GDP as the French and German systems!

Tackle the multi national corporations - stop company takeovers by burdening the company with debt, stop interest and intellectual property right payments being allowed for tax....Tax turnover arising in this country and abolish business rates!

Have a universal basic income (and eliminate all these different rates of income between pensioners, carers, people on JSA, etc), but then increase and amalgamate income tax and NI, so NI is effectively paid on all income; and align income tax with capital gains tax rates, so there are no advantages in taking capital over income!

Build council houses as an income generating asset for the country rather than throwing housing benefits at private landlords for squalid properties! Steep annual property taxes on foreign investors buying property here!

Tackle inheritance tax!

Close all British tax havens! There needs to be an international approach to tax - governments have not kept up with the multinationals, and ultra rich in their domestic tax systems!

I am borderline type II diabetes. In my case it is a result of a lifetime of steroid medication for severe asthma, which has also caused oesteopenia, resulting in a back fracture after lifting a cooking pot. So tell me what I am doing wrong I’m all ears.

Someone mentioned sick pay and skivers. The private sector finds that if you don't pay people when off sick (other than after day 3 for SSP) they tend to stop trying it on.

For lifelong conditions
ONLY the medication for that condition is always free not EVERYTHING

Someone mentioned sick pay and skivers. The private sector finds that if you don't pay people when off sick (other than after day 3 for SSP) they tend to stop trying it on.

The generous sick pay (which by the way is only 6 months full pay after 5 years service) is part of our employment benefits, very much like a company car, bonuses, staff discounts etc. All which exist within the private sector.
Do we really think that during the worst recruitment and retention crisis the NHS has ever faced a removal of one of the few employment benefits we have is going to improve the NHS??

By all means improve procedures to deal witg those who do take the piss (I'm not denying they exist) but dont shit on the rest of us.

And as for being back ward managers I've never worked on a ward without a manager so God knows where that's come from.

Afaik, there is no benefit to company cars any more!