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?

Silly sally, yes but that’s not an illness that’s costing the NHS millions, but obesity is, diabetes medication, blood pressure medication. After a certain BMI cut off- somewhere between obese and morbidly obese I guess

Life isn't that straight forward. What about if they can't pay? Then what then?

I think singling out specific groups is a really, really dangerous road to go down.

Llanali

I vaguely remember news reports a year or so ago about pharmaceutical companies setting their own prices when they were able to exclusively supply the product. Some items were priced at 3000% more than they previously sold for. I’m not sure if this like explains it. I might need to find something better.

www.bbc.co.uk/news/uk-wales-42506736

Councils need to have better care for the elderly including social things and this would stop all the doctors appointments and call outs that happen because they have no one else to care for them or haven't spoken to anyone else all week

Something needs to be done about hospital spending on consumables - no idea how it happens but they seem to spend more than they need to on items that are easily available and cheaper elsewhere.

I realise it's contraversial but I'd charge for a and e. Just a tenner and obviously not for people who don't pay for prescriptions. Would generate a bit of cash and also hopefully stop people using it for a sore throat etc which would free it up massively.

I'd stop politicians messing about with it. Every few years there are different initiatives and they just get going with it and then it gets scrapped when someone else comes into power. Ring-fence it and put doctors, nurses and cross political mps in place to run it, who still have to be voted for but with more medical people involved they may get to the bottom of what needs to be done

Get more cleaners - the mrsa compensation costs millions

Pass some law like they have for wonga loans to say that the pfi interest payments are ridiculous - apparently a massive chunk of NHS budget goes on the interest payments and this was all done to keep it off Tony blair's balance sheet. The interest should be capped.

Ultimately though it's been underfunded for years and if we want to save it we all need to be prepared to pay more tax. I personally would do this - if tax went up to go towards NHS I'd be happy as I do worry about the future. But I think any political party who had this in their manifesto would not do well.....

I wonder how much a no-blame culture would save? (I’m not questioning that it would save money - I genuinely have no idea how much legal fees/compensation/fighting blame etc costs the nhs - I would love to see numbers.)

We have had 2 major cock ups from the NHS - 1 was when DH was misdiagnosed with something non serious when in fact he had cancer. We have never blamed anyone for this. I genuinely believe that if the GP wasn’t so overworked and pushed for time, and if there wasn’t such a hesitancy to refer to the hospital (also overworked as short staffed) she would have spent more time checking DH, would have listened to his concerns and would have been more proactive in seeking a resolution. It should never have happened, but I don’t blame the gp - it was just one of those things.

We had one other major cock up with DD in A&E when she was 4. I can’t say what happened because it was so rare (docs said they had never seen it happen before in 20+ years of practice) that it would be very outing, but suffice to say that it was human error on the part of 3 separate staff which should never have happened. The first two were absolutely in the wrong and they both tried to cover up their mistake afterwards, but the situation could still have been salvaged without harm if it wasn’t for the 3rd staff member who was all out wrong and in all honesty should have been seriously reprimanded as a result. (She also tried to cover up and lied outright about what happened.) There have been long term effects on DD both physically and emotionally. The amount of people who told us that we should sue the hospital was unbelievable. It never entered our heads to sue the them. I have no problem with people suing if they end up with serious medical costs/substantial loss of earnings etc due to human error, but the idea of suing the hospital and taking MORE money out of the nhs for error just seems completely counter productive to me.

(We did lodge a formal complaint and there was a formal enquiry (which was a waste of time) but we didn’t push things ultimately precisely because we didn’t want to make things worse for the hospital.)

I’d love to see how much the nhs spends on legal action/dealing with patient complaints/investigations and enquiries

Get health and social care to be co-ordinated and don’t outsource social care

Make a nominal charge for appointments

Stop the ludicrous backwards and forwards business. GP makes a referral and all tests are done there and then, privately this is what happens. It’s an utter waste of time and money to keep dragging people backwards and forwards for appointments

Get rid of FAXES and use a uniform online system to share patient records / test results etc.

Reopen minor injury units. All the MIU’s in my area are now shut, you can’t get an appointment with a GP for weeks, pharmacists are very reluctant to say that you definitely don’t need medical attention and that OTC medication will suffice and if you phone 111 they will almost always say ‘it sounds like you’re probably ok but I’d recommend going to A and E to be sure’. It’s not surprising people turn up to A and E with a broken finger/ fever/ rash when there is no way of seeing a professional or getting any kind of genuine help the same day.

Also, get GP’s to offer a full service. Mine doesn’t even take bloods. Taking bloods takes 2 minutes but no, they give you a form and you have to go to the walk in clinic at some hugely inconvenient hour to have bloods taken. They then go back to the GP. Just do everything at the same time. It will have taken probably 3 people to take my bloods: appointment with GP, receptionist to make blood appointment, phlebotomist when it could all be done by a GP

@dontfeellikeamillenial I partly agree with this but maybe people who attend a&e that could have gone elsewhere for treatment should be charged £50 rather than people that actually need to be treated.

Convalescent homes.
A temporary middle ground for folks not ready to go home.
They used to work well. The repeat falls going back in soon after being discharged for infirm patients is a huge waste of money.

We have stripped out all other support systems so the only thing people fall back on is the nhs.
We can’t fix it in isolation.
Bring back proper health visiting teams
Bring back funded sure start centres where nervous parents can check on things without having to rely on a go appointment
Social care has been strippped to the bone

We seem to be relying on schools and doctors more and more for support. It isn’t sustainable

I think it needs a top-down restructure and patient care should be put back at the centre of it instead of selling off contracts to the highest bidder. There's too much inefficiency.

Increase taxes with ringfence for NHS
Completely rebuild how services are financed - have a budget per patient that travels with the patient, not a budget per service. And get rid of STPs.
We’re increasing overall life expectancy but a large proportion of that extra time is poor quality and highly medicalised. Have realistic discussions about end of life expectations for everyone some time around 75 years of age.

@user139328237 the reason prescriptions are free in Scotland is because that is devolved to Scottish Government. Their spending priorities mean they decided charging for prescriptions was inefficient due to admin costs.

Charge people to visit GP
Have to prove you're eligible for free prescriptions
No paracetamol etc on Perscription
Pursue foreign nationals or those who aren't eligible to use the NHS for payment
2 ridiculous hypochondriac incidents and a period of ineligibility to use any NHS service

I’d sack 90% of the admin and clerical staff and start again.

I’d change the sick leave/sick pay policy as it’s currently abused by loads of staff.

I’d get rid of a whole layer of middle management and loads of “project manager” jobs.

This - most wouldn't last 5 minutes in a commercial office

They should be able to turn you away from A&E if you don't need to be there.

They do this where I live. My local hospital has A&E (including a seperate children's A&E), out of hours GP, and minor injuries/illnesses unit all in the one department. You book in at the desk and are triaged by a nurse practitioner within 20 minutes of arrival. If it's something he/she can diagnose and prescribe for then they do that and you're immediately discharged. If not then they assess where you need to be and they will book you into either A&E, minor injuries/illnesses, or the out of hours GP. If they feel it's something that can wait until your own GP is available then they give you care advice and send you packing. It's very streamlined and a much better way of doing things, in my opinion. I had to take DS at the weekend, triaged into children's A&E, he was examined, x-rayed, diagnosed, and treated all within two hours.

Offer more telephone appointments for minor ailments. My GP operates a "doctor first" system. You call up on the day you want to see the doctor and the receptionist takes your details. A GP calls you back and has a telephone appointment with you, they will then advise over the phone, prescribe if they feel you need something prescribing, or will ask you to come in for an appointment that day and will book you in. It saves a lot of appointments as a lot of patients can have their issue dealt with over the phone without having to use up a face to face appointment so there are more face to face appointments available for those who do need them. Physiotherapy, podiatry, chiropody, SALT, and midwife are all dealt with in-house and are self-referral using a form available from the reception desk, simply fill it in and drop it in the box, they assess it and contact you as appropriate. Again, it saves GP time as appointments aren't used up by people asking for referrals.

They should allow pharmacists to prescribe on certain conditions. If I have a severe sore throat with pus-filled spots, high temperature, etc and suspect tonsillitis why can't a pharmacist examine me and prescribe as needed? Ditto a UTI, why can't they do a urine dip and prescribe? Allow pharmacists to do medication reviews so that GP appointments aren't used.

When I was pregnant I had some back pain so was referred to physio. The appointment was a group appointment because it was more efficient to give the same advice and exercises to twenty people over the course of thirty minutes than offer twenty individual thirty minute appointments. It was a bit like a PE lesson! The physio explaining it to everyone then all of us doing the exercises at the same time with the physio moving around the room and correcting/assisting/demonstrating as needed. This model could be applied to many types of physio, rehab, and OT as well as other areas of the NHS.

Teach first aid in schools, year seven (11yo) onwards, incorporate it into either the PE or PHSE curriculum and make it compulsory. One lesson a month for whole of secondary school so that eventually you will end up with almost an entire adult population trained in first aid, trained to know what they can deal with at home and what needs medical attention.

Bring back sterilisation on the NHS, that had to be cheaper than antenatal care surely?

I would let it go

So many things are wrong and start looking at the French health care system

You start charging at point of service it’s no longer the NHS

So much money is wasted

And look at the areas that are doing well with private health care it doesn’t mean we have to become like the US system

Lots of good ideas here re limiting cosmetic surgery/IVF, clamping down on health tourism, not prescribing stuff like gluten free bread or paracetamol and streamlining management. I'd add that nurses shouldn't need a degree - we should go back to having vocational routes as well. That's how my mum trained, straight out of school at 18, starting with changing sheets and cleaning the wards and working up, and she's a bloody good nurse. I think we'd have less trouble recruiting.

And the OP's question is what YOU would do - so what I do is:

• exercise and eat healthily to keep myself as fit as I can and not be obese
• pay for over the counter medicines if I need them
• for anything like a sore throat/cough, go to the pharmacist first and only go to my GP if that doesn't clear it up
• never drink so much that I lose control of myself, never take drugs and never smoke

We all have a responsibility to look after ourselves so that the NHS is there for those who need it most. Perhaps it's being the daughter of a nurse, but I would be so ashamed of myself if I went to the doctor to be told it was a cold and I should go home, keep warm and keep hydrated.

I haven't rtft so sorry if it's been mentioned. I've just started a job with the NHS, today I've been given an iPad, not sure why! Also, my uniform for training will apparently be shredded and I'll be given a new one

Tami Thankfully none of yours ended in death.

We have 2 deaths and years of pain and years when people haven't been able to work because of NHS refusal to correctly diagnose even when the patient was telling the doctor what was wrong.

Doctor I think I am having a heart attack.

Nonsense there is nothing wrong with your heart. Prescription for indigestion tablets given.

A&E

I think I am having a heart attack. Dr gave me indigestion tablets.

Well give the indigestion tablets time to work.

A few hours later ambulance called but it arrived too late.

I live in another EU country and our family’s first port of call when we have minor illnesses is the pharmacy. The pharmacists are excellent.

People need to take more responsibility and stop using it gratuitously.
My neighbour, living in a house worth £1mil, loaded, has an nhs appointment for her dc literally every single week.
Coughs, colds, eczema (1mm of red), pigeon toes, sore tummy (from rolling over a gymnastics bar), on and on.
I'm not sure if anything would make her stop, but if she were charged £50 a visit, at least there'd be extra money in the pot.

I agree about sorting out procurement. The NHS should appoint headhunters to find the toughest, nastiest, most aggressively bullying take-no-prisoners supermarket buying executive in the world and make her/him and their team a financial offer they can’t refuse.

They would be tasked with using every dirty trick in the book to screw every NHS supplier to the floor for every product and service the NHS buys. They would be offered an uncapped financial incentive package which would allow them to keep a proportion of every pound they save the NHS. If they made millions for themselves, the NHS would save billions.

But if you start charging for appointments or visiting a&e then it is no longer the NHS I

It’s another health service that charges at point of service

I think we should be charged but then needs to be managed so every is able to seek medical care and that is where an insurance system works. Not everyone can afford £10 or £20 to visit a GP

I do agree about many admin staff who do the bare minimum and middle management the endless meetings and discussions over the most insignificant little issues for there then to be another meeting taken up to discuss why it’s its such an insignificant issue ffs it’s takes forever for any changes to take place