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?

There is a staffing problem. Sort it out with provision for training in the UK. If you want to leave the Uk and work elsewhere there is a fee to be paid. I would not allow any healthcare profession university programs to allow foreigners while there is a huge shortage.

For current staff, I would look at processes and look to make GP processes much more efficient. Admin and management is currently absolutely shameful IME. Leadership roles are political appointments.

A better workflow management should be allowed where staff can have much more control over their shifts. If a nurse or doctor want to work 36 hours instead of 40, it should be easy to elect that. Training should be given for day and night staff. So yes, you work nights 3x a week, you attend training at night, not during the day when your sleep patterns are going to be absolutely messed up.

Finally I would look at sorting out procurement. Get Tesco procurement team in to help set up systems. Give them a 1% discount on their tax rate for every £100m they save as compensation.

Sadly I agree with EnthusiasmIsDisturbed - why are we trying to save a system that doesn't work. It's not a choice between NHS or USA system. We have family living in France and the system there does seem better.

But we're stuck with the emotional tie to the NHS, as if countries without it have no access to healthcare for those who arent super rich...

The issue with charging for appointments is the doctor had better make a diagnosis otherwise there would be hell to play from some people.

How would it stand in dps case where he had in excess of 15 appointments at the GPS only to be diagnosed on a trolley in A&E.

If a GP can't make a diagnosis or gets the diagnosis wrong would you get your money back

Bring in rigorous assessment of Band 6 & 7 managers, particularly non clinical. The vast majority can't manage, are ineffective & no idea regarding service improvement. Then I'd sack the Band 8+ managers who continually back them in order to save their own backsides.

No IVF.
No vasectomies.
Decent clerical staff- you'd have no chance of running the NHS with just doctors.

I don't agree with charging for missed appointments as in my trust a lot of them are because people have had to leave due to waiting so long. I got a stroppy letter once when I had to get back to work over 90 minutes after my appointment time. Um. No.

I love the NHS but it’s desperatly failing. They’ve messed up routine surgery on me, missed the diagnosis and caused long term issues which all could have been spotted easily by 6 drs. They saved my sons life, but sadly also missed his symptoms which led it to be life threatening. Its so overstretches that it doesn’t work, and it’s dangerous.

I know we all love it but I think it needs to move to an insurance based system.
I don’t think it can Be saved in its current model unfortunately, makes me desperately sad.

It's not fair and reasonable to charge all for appointments. Those with lifelong and chronic conditions can be in the doctors at least once a week.

So you would have to make those on limited incomes, and those with chronic and long term conditions, and those with disabilities exempt, and the elderly, and kids. So you would end up with the same situation as you do with prescriptions, where only a fraction of people actually pay. I think it's only 11% of prescriptions are actually paid for as most people that have lots of prescriptions are exempt.

So in reality charging for appointments won't make that much difference and may just discourage people going. We know men tend to avoid the doctors until its too late as it is.

And to the people saying stop cosmetic surgery - how would you feel if you were disfigured in a car crash, or had acid thrown in your face, or were born with facial deformities?

Get rid of the umpteen layers of managers.

I've been to our local hospital a number of times recently with sick elderly relatives, and the thing that struck me most was the sheer number of people who looked like managerial office staff striding about bedecked with lanyards and clipboards. The corridors are full of them and they seem to outnumber medical/porters/cleaning and clinic reception staff by about 5 to 1.

Do we want highly-paid people sitting in meetings and focus groups or do we want that money to be spent on front-line staff treating patients? Guess which lot decides what the money gets spent on?

Hmm. Sack the managers and administrators. This thread is going the same way as every thread about the NHS and just shows the absolute lack of knowledge and understanding of most people about how the NHS works.

Including some people who claim to work in it.

And yes, I have.

Still, looks like Tory rhetoric and Daily Mail frothing is still a popular line.

I agree with you leigh.

Joined up budgets. No constantly trying to shift someone onto another service to save one service money.

No private services like Virgin, they say they offer good value but at the end of the day their aim is profit, it will never run well for patients or staff when profit is the aim

Put more money into social care, prevent patients ending up in hospital and stopping the elderly bed blocking where they acquire infection or complication that could of been avoided

I saw something about trusts being encouraged to create their own bank which is a good idea, less money poured into agency

Some how great staff better and retain them

Place a high focus back on hygiene, from staff not traveling into work in uniform to everyone staff being more aware of hygiene. The amount of times I’ve seen staff put on sterile globes, touch non sterile items and then go back to sterile things. Makes you wonder what else is being contaminated

Better nutrition, no microwave meals full of crap. Our local hospice has feeding volunteers who come in at meal times and make sure their assigned patients are fed or gently encouraged to eat and drink to free up nurses to get on with what they need to do.

Stop waste, make everyone aware of wastage and find ways around this. Look at the appeal by one hospital to return crutches saying it will save money and yet everyone is saying they tried to return but were refused due to sterilisation (guessing new crutches that sit in a cupboard are hardly germ free). If your a healthy person with a broken ankle in a boot, do possible germs on crutches to use in the community really pose a great threat yet we have all seen stuff like blood or spills on a floor that are there days later.

I was so shocked when I found out how much is spent in contracts from the 90’s when new hospitals were built ‘for free’ and now the nhs is tied into paying insane amounts for a new light bulb from a certain company or repair from them

I have an under active thyroid. I get all my prescriptions free, not just my thyroxine. While I don't take the piss I bet a few do.

Obviously I'm going to get them all for free, but if I was told tomorrow they'd only give me the tyrosine free, I'd be fine. An under active thyroid is easily treated and unlike diabetes etc once it's diagnosed and treated rarely leads onto anything serious.

thyroxine

I live in OZ and we have a good system,
Everyone is encouraged to have private health, you get a rebate in your tax return if you do.
If your a high earner and don't pay for private health then you have to pay a levy at tax time (ie like paying a fee for the nhs, for those that can afford it)
We have Medicare which entitles everyone to 'free health care' but most who can afford it have private.
We have 2 types of GP, bulk billing (free), non bulk billing (small charge to see GP) generally non bulk billing gp's offer out of hours/ weekends - so those wanting convenience use them, at a cost.
If your taken into hospital in an emergency situation, they'll ask if you have private health so they can claim from your health fund. Provided your able to talk, If you don't Medicare pays. I vaguely remember this from being transferred from one hospital to another whilst being admitted eptopic pregnancy - if my health fund would pay for my ambulance (which it did)
Also - controversial, no IVF unless done privately. And I say this as someone going through IVF. It works, you shop around for the right clinic for you. They range from $1000 - $10'000.
I am sure there is more but that's all I've had access and experience of.

Leigh I understand your frustrations although I will say that there has been a great deal more suggested on this thread than just cutting managers and admin staff. However, I’d really love to hear your viewpoint. No daily fail frothing here - I love the NHS - I want it to work, but yes, I am frustrated that it’s currently not working. My family are lucky that we’ve never had a death or serious injury due to negligence, but at the same time we have had way too lengthy waits for important treatments and follow up care due to short staffed departments and lack of resources and funding.

What do you suggest?

£5 - £10 charge to visit the GP (unless on benefits). You pay to see the dentist and optician, I don't see why seeing the doctor is any different.

Stop putting ornamental structures and works of art in hospitals. Have a cap on staff costs at higher levels (eg top salary at each hospital can be no more than 1% of total wages bill etc). Work with local schools and other partners to improve health and wellbeing from a young age. Its all well and good promoting bf but obesity in kids is caused by a shitty diet once weaned. Shitty diets come from a lack of knowledge/skill/money to make healthy meals. Have a doctor led triage system when calling GPs. Have all GPs on the phones from 8am to 9am. GPs can then decide whether a caller needs to be seen after 9am that day, can be seen in a few days, or needs an automatic referral to another service. Take letter writing and file updating off GPs and give it to Reception/Admin.

Bed blocking in hospitals needs to stop - we had severe difficulty getting my gran out of hospital, and she was medically fit and wanted to go - it was just a matter of getting various agencies to actually talk to each other.

My mother, in a different area, was able after various admissions to recuperate in a cottage hospital - so not blocking an acute medical bed that could have gone to someone who needed much more than just supervision.

I spent 48 hours blocking a bed myself, because they wouldn't send me home to an empty house until I'd been fit and well for that long. I really don't see why I couldn't have gone somewhere else other than a hospital for that time, as really all I needed was someone to pop in and take my obs infrequently.

I forgot to say - the cottage hospital was GP led, so clearly it can be done.

Of course, first one must find the GPs... but maybe a hospital-based version of general practise would be more attractive?

Leigh I don't disagree with you. Admin and management are needed. Yes it's not run efficiently right now but you have to give people a chance to change and prove that they can perform. This isn't the apprentice where you get to tell people they are fired. These people know the system for good and bad. You have to learn what it is they do before you tell them they have to change. You have to listen to clinicians input on the current process and make changes based on both clinical and administrative input.

I think reality TV has an awful lot to answer for. These 'pseudo' workplace reality programs have done so much damage with all this 'you're fired' nonsense. A good manager makes sure their team is trained, their employees job descriptions reflect reality and said employees follow the job description in full.

Scrap the endless cycle of tenders and bids. It makes so many NHS organisations unstable, staff morale drops and performance falls off. My - management - department spends its whole time bidding for tenders. The cost is huge, the result is always uncertain, morale falls, sickness rises and staff are forever TUPEing in and out of organisations. It's outrageous. I'd take public health back from councils, they havent got a clue what they are doing where health is concerned and are making decisions from a place of ignorance.

I would get away from the CCG and CSU nonsense, and allow care to be led by a Health Organisation that bases care on evidence not money, moving back to something like SHAs/PCTs. Until all of this is sorted, trying to sort the rest of the NHS is peeing in the wind.

Oh and I strongly agree with putting health at the heart of education, from primary age upwards.

A lot of people have no knowledge of how the NHS works, but surely it is only common sense that the money should be chiefly directed towards front-line service and actually caring for patients?

The normal hierarchy in any organisation would be a pyramid-shaped chain of command, with the top handful doing the managing and the overwhelming majority doing the actual work. That is how it should be.

Leigh many are critical of management because when they are needed to lead they so often don’t, everyone ends up trying to cover their own arses and quite frankly get very little done

Time wasted is money wasted i see that too often at work and we see how money is drained from the NHS