To think its time to reform the NHS

[ScreamingLadySutch]

There was a brilliant post on a dog who is telling H there is something in his abdomen, but I didn't want to derail it.

But someone talked about access to the GP: "Good luck. We get the Spanish Inquisition from the surgery receptionist whenever we try and book appointments. You could tell them you have blood dripping from your arse and they'd still be reluctant to give you an appointment. I'd love to see how they'd respond to "my dog keeps sniffing me"."

• which is why the NHS needs to be reformed. The NHS is a socialist construct. Therefore, the provider 'decides' which supplicating peasant is worthy. That is what socialism does (The State will Decide), and it doesn't work!

If the provider is linked to the consumer, then the whole system gets more responsive. In capitalism, if a service is not provided, the provider doesn't get paid. Its forced altruism.

I don't know why the British treat the NHS like a religion (Do Not Question God!!!). It is complete brainwashing. Reforming the NHS to create this link does not mean privatisation (I was hospitalised in Germany and the whole thing from X-rays to overnight stay cost me Eu37 - and they don't have the NHS structure). Nobody longs for the days when there were waiting lists for telephone lines before BT, do they.

I am sure that those of us who have worked in the NHS have seen examples of shocking waste and mismanagement. It is very difficult to get things changed.
I worked in the community for years. There were many things that could have been done by carers/ HCAs that local policy insisted had to be done by RNs, and, conversely, things that really should have been done by RNs that were delegated to unqualified people.
Usually because policies were written by unqualified people. It is very difficult to get things changed.
PFI funding for new hospitals was an absolute scandal.
As for NHS supplies and procurement. I could write a book.

@codenameduchess

Charging for elective surgery would be disastrous, that would simply lead to people being forced to wait until their condition is an emergency. Not only would this put their life at risk, the surgery would cost more, be more risky and require a greater amount of after care. How are the elderly supposed to pay for their joint replacements?

I have had one elective surgery due to a knee problem, I was also due an elective appendix removal, it took so long to get the appointment I ended up with a ruptured appendix and needed 6 days in ICU, 3 in HDU and 4 on a general surgical ward. My elective surgery would have required around 12 hours of care on a surgical ward.

People are not given get NHS c sections because they are to posh to push. People may have psychological reasons ( mine was to some extent - previous unexpected stillbirth) but they are valid reasons.

It's doesn't need reforming, it needs funding. Proper funding.

You are 100% right. Try telling the British that. They genuinely believe that the NHS is the envy of the world

It also disadvantages younger people as it is the 25-40 year olds who are most likely to need it, aka the people actually paying for it now.

I didn't realise working people over 40, the ones likely to be in senior positions and earning more, are exempt from tax!

Don't think you actually understand socialism. What you described is closer to communism. They may have roots in common but they're not the same thing.

Added to which is the fact that yes the Nhs is a socialist entity - being operated by capitalists who would rather it didn't exist!

"Nobody longs for the days when there were waiting lists for telephone lines before BT, do they." Dreadful example to use! The telecoms industry is very poorly regulated and overcharges massively while providing poor service usually!

t needs reform in the shape of proper funding, removal of bloated bureaucracy in favour of streamlined administration by people who actually understand healthcare and gaf about patients!

Waaaay too many chiefs - mainly from capitalist industries like banking (!?!) currently "running" the Nhs.

"And no politician wants to say “Sorry folks, no more IVF, replacement knees or bariatric surgery” or whatever, because it’s political suicide." They don't even care about that any more

https://www.express.co.uk/news/uk/1106201/NHS-prescription-medication-changes-no-longer-available-NHS-England

https://m.huffingtonpost.co.uk/entry/nhs-treatments-no-longer-offered-patients-riskyukk_5b372ddce4b007aa2f803e5a

Due to austerity there very much ARE people who can't afford 20p paracetamol etc

I agree those that can afford such things should pay for them but when we have food bank use, child poverty, homelessness, disability poverty etc escalating massively then yes it's unacceptable.

The corruption and overspending in procurement also needs serious investigation!

Back door privatisation too.

Personally I think complaints procedures need a MASSIVE overhaul especially in relation to primary care.

I started a thread a few months ago re GP's fobbing off certain groups of patients for discriminatory reasons (mainly women but also mentally ill, learning disabled, bame...) resulting in patients at best going undx and suffering for years even decades, at worst dying. But it's incredibly hard to complain about GP practices and GP's in particular with it being a very real risk that patients can be denied service and effectively "blackballed".

I suspect 100,000's of appointments could be freed up if GP Practice hcps didn't fob patients off, meaning the SAME patients with the SAME condition going untreated and necessitating repeated appointments.

There's also major issues with financial disincentives for referring to specialists, incentives for "encouraging" certain treatments (mirena coil in particular) which can be "lost" if the patient reverses the treatment (eg patients "discouraged" from having coil removed within a certain time period even if they're experiencing distressing/harmful symptoms)

"As controversial as it is, I also believe that ivf should not be offered as an nhs service, anyone wasting nhs resources should be charged for it (as in missed appointments, hoax 999 calls), the 'free' medicine for children should be scrapped and any elective surgery be made chargeable." I'm torn on this between "it's a slippery slope - do we trust them to decide correctly who's worthy of treatment" and "getting a boob enlargement or nose reduction (purely cosmetic treatments) on Nhs is bloody ridiculous!"

"The reason people can't get GP appointments is because there aren't enough GPs." Definitely an issue. Partly due to so many who go into general practice only wanting to work part time (but get a bloody good salary and pension for doing so!), partly poor recruitment numbers.

Interesting you say about nurses too. Practice nurses especially nurse practitioners are perfectly capable of doing many of the tasks GP's currently do. Yet at my practice there's only 1.5 nurses but they're constantly trying (and failing) to recruit more GP's (I suspect due to the model of how GP practices work which I believe includes GP's "investing" in the practice which nurses don't)

There's also very rarely ime healthcare assistants in GP surgeries who could absolutely cover things like dressing changes, simple diagnostic testing (uti dips, pregnancy testing, blood draws), minor burn and scald treatments etc

"There were many things that could have been done by carers/ HCAs that local policy insisted had to be done by RNs, and, conversely, things that really should have been done by RNs that were delegated to unqualified people.
Usually because policies were written by unqualified people" doesn't surprise me in the least! This is why it needs to be medically qualified people that decide on such policies.

GP's should never have been allowed to remain essentially private companies paid by the Nhs to see Nhs patients.

"I don’t think healthcare is ‘free’ any where else." I believe there are actually quite a few countries where healthcare is free at point of use. Especially in Europe.

"Why are people opposed to private healthcare ?Or a system like Germany ?" Personally - I absolutely would not trust this govt not to take us into USA style privatised hell! I do not trust them to ensure the most disadvantaged - who tend to be the ones most in need of healthcare - are properly and fairly cared for!

And the 'free' medicines for children costs a lot (think of the admin alone) a bottle of own brand kids paracetamol is £1." And how are families who are on the bones of their arse (thanks to austerity policies, benefits cock ups and a poorly run economy) meant to afford that?!

"Introduce the privateer vultures into healthcare and you won’t get better healthcare. You’ll just get profitable healthcare. And I’ll be damned if we start making decisions on healthcare based on profit." HEAR HEAR!!

"Ivf is a one off cost of thousands. A child adds a small amount to your monthly expenses. Just Caz you don't have £5k to drop on ivf doesn't mean you can't afford a child" it has a very low success rate is my main issue with it. MANY of those needing to consider ivf have had symptoms of gynae and other conditions affecting fertility ignored & dismissed for DECADES before they even get to this point. Addressing THAT would save not only heartache for the patients but I strongly suspect a LOT of money.

I also well remember seeing dr Robert winston on tv saying that many couples referred for fertility treatment haven't addressed, nor been advised to address, really basic areas that could have improved their chances prior to reaching that point - more frequent sex (particularly around ovulation), healthier lifestyles (obesity/ED, smoking, excessive alcohol use, poor diet, lack of exercise, less stress...) apparently he used to go over this kind of thing with couples first, find areas where improvements could be made and Iirc 2/3 of patients then fell pregnant "naturally". Of the remaining 1/3 the majority of them Iirc (it was a while ago) most had conditions (usually gynae) with clear symptoms they'd reported for years and primary hcps had left untreated.

And once a child is born people's circumstances can change (as can govt policy leading to many families being in poverty when they couldn't reasonably have foreseen such a change. I don't necessarily mean the welfare stuff either! There are many children of parents who've been put out of work, ended up homeless etc due to govt plain running the economy in a fucked up way! Then there's if parents or children are/become sick/disabled etc)

"NHS needs more investment. The government is deliberately driving it into the ground so it can find political justification to privatise it." Exactly (see attached pic)

"because there isn't the focus on prevention." Totally agree with this though! Preventive approach would not only be much better for patients but would save money too, it HAS to be cheaper long term to dx and treat ailments and conditions when they first present than waiting for them to get bad enough that specialists, in-patient treatment etc is needed!

"I don't know why people in the UK seem to think that the only alternative to the NHS would be an American system." It's not that the general public think this, it's genuine concern that it's the only alternative this govt is not only considering but actively researching and even several MP's have shares in USA healthcare focused companies (which is a conflict of interests in my opinion and a corrupt practice)

The "primary care network" stuff just looks like common sense dressed up as something special, and which SHOULD have already been happening!

I do think there's a major educational/knowledge gap for many patients in not realising just how much pharmacists, practice nurses etc can do and help with. I've 2 friends who are pharmacists, they're highly trained and extremely good at being to help with most minor ailments and even small injuries. They are of course particularly good on medications, side effects and interactions far better than many GP's in my experience.

Poor administration needs to be addressed too. Dd and I have on several occasions "missed" appointments because the letters telling us about them haven't arrived - and on a few occasions weren't even WRITTEN until AFTER the appointment date. EXACT same letters being sent in duplicates/multiples (even in the SAME envelope!) ridiculously wasteful!

"The new reform will put the money back into the hands of GP’s who know their population better than anyone and will put it where it is needed and have more control" really?! Then in my opinion we're fucked!!!! I've come across VERY few good, caring, altruistic GP's

And that graphic! How much did that cost to produce?!! Only to list the very common sense fact that There's different groups of patients with different needs - what was it produced for?!

"With basic licensing safeguards, such as a full SRN-type qualification" what do you think we have now?! Nurses are graduate qualified professionals, pharmacists are qualified to masters level MINIMUM many have further postgraduate qualifications, as do many nurses.

"People literally unable to think about alternatives before leaping to assumptions of 'privatisation' and getting emotional." Do you or any of your loved ones even have a chronic disability or condition that prevents them from working?

And yes several people confusing "elective" with "purely down to personal choice" that's NOT what it means!

I DO think people turning up at a&e who shouldn't be there, their issue could and should be dealt with by primary care SHOULD be turned away at triage stage. Again this is partly an educational/public info issue. More "adverts" explaining what service to use for which ailment should be run. And run at times/in ways that reach the most people not on tv at 2am in between shopping/gambling nonsense, greater use of sm for this too, clear simple posters in pharmacies, schools, nurseries etc

I have to say after 9 weeks with a broken bone, when my nearest pharmacy is 3 miles away; and I cannot walk for more than 5 minutes (and have only been able to drive in the last 2 weeks), it’s very annoying to have to keep asking DH to buy me more paracetamol every 4 days, because we can only buy 32 at a time! There are no pharmacies near his office!

Only yesterday the physio asked me who had told me to stop taking painkillers, and said I should restart them! It’s very tempting to go and ask for a prescription just to get more than 4 days supply!

Re the primary care networks they have to conform to many regulations to be able to qualify for payments per patient
They can’t just get all the money and waste it they have to apply for it, use business cases and evidence what it was used for.

Prevention is exactly where it needs to go. But they have been fighting fires for so long I think it’s just not been feasible. Much more focus now on identifying who is costing the most money (repeat admissions, frequent attenders) and directly targeting them

The graphic was one I remember seeing at a workshop last year I just googled it

People have no idea how much they can see a pharmacist for - but PCN’s are going in on trying to recruit them to do mediation reviews

A lot of practice nurses are very highly skilled in things like minor illness too so we use them as a more cost effective resource

Gosh Graphista, I do hope you're being paid to type all that Momentum dictated spiel by the minute. Children don't pay for Rx, if you're on your chinstraps financially, there's freedom to issue basics for free.

Compared to a country like Sri Lanka, where I have spent months, the NHS you deem niggardly, is actually a fountain of benificence. Same is true in most of Africa. Only well administered, usually developed, countries, with good tax collection systems and a strong central state provide medical services at or near cost. You don't want to read this bit, but because the people providing those services have trained at their own expense and want to make a living, they charge fees.

No not momentum staff at all what a ridiculous accusation to make

Nothing wrong with people wanting to make a living - but a living isn't salaries and pensions of £100,000's paid for by tax payers!

It's not the Nhs as an entity that's niggardly it's certain people working within it in certain areas that are. And that's negatively impacting on the rest far too much!

If someone works as a GP for 40 years, from 25 - 65, at a salary that recognises the years of study, the CPD, and the hours and stress of work, and retires with a salary pot that's worth a million or so, there's a reason. One of the NHS's current problem is that they are losing senior doctors prematurely to early retirement because their pension pots are full. If you can't put more in, why stay?

I'm laughing at the OP saying the NHS needs to be reformed. Worked for the NHS for 10 years and I've never seen an organisation more continuously reorganised than it is. It's been in a state of wasteful flux for years. And I mean decades.
It's had a massive reduction in funding and Brexit is making healthcare staff shortages much worse. It's a testament to the staff still in it that it is still functioning at any level.

Choose and book is another massively inefficient waste of money.
The number of patients ending up in the wrong clinic is ridiculous.
The staff running choose and book have no clinical knowledge at all.
I have been booked into the wrong clinic twice and had to be referred again to the right place. I knew it was the wrong clinic, but there is no way to change it.
I needed an urgent appointment but was just told no appointments existed.
Sometimes appointment letters and cancellation letters arrive on the same day.
I have had lots of appointments cancelled by text less than 24 hours before.
Having a serious illness is a full time job because I have to keep on top of everything. I have to organise, chase and monitor my own blood tests and results. I don't mind doing it but it is so frustrating and difficult. So much " computer says no" to deal with. It is exhausting. Especially when I already feel ill all the time.

I feel quite strongly about this. My NDN (and friend) bought equity GP in a very small rural practice (lots of elderly patients, serious genetic problems caused by a tiny community's inbreeding),ended up senior partner, and ended close to nervous breakdown as she tried to square the circle of seeing and treating patients, keeping up with the paperwork required with every referral, adding new services to her practice annually. She handed the whole lot back to the NHS after 18 months haggling, retired at 52 (on a seriously reduced pension) and is much happier and healthier. We, as a society, should not be imposing such immense burdens on the people who are the frontline of healthcare.

You appear to be working on the assumption that elective section is more expensive for the NHS Xingming. Why?

No way was the bill for overnight hospital stay and x ray €37 in Germany. Sounds like you paid the nightly top up fee for a hospital stay which is paid by the patient and reimbursed later by your insurance provider. The rest of your bill would be paid by your travel insurance or covered by your E111.
I live in Germany and I can tell you that if you are a pay as you go patient they won't admit you until you have proved you have the funds and medical bills are expensive.
The German system has got its problems- GP's hardly do anything on their own initiative, usually you get referred to a specialist for even quite simple things because they are all scared of being sued -no crown indemnity here. Alot of practice here is arse covering. Nurses here can't do blood tests or injections or anything much more than healthcare assistants do in the UK. Hardly anything is available OTC and medicines that are cost a bomb.
Oh and bedside manner is awful.

I agree that people really do need more self management as someone further up said.
So many things they could easily and safely do for themselves. Expectations are incredibly high and people will actually lie in order to get the service they want. For example saying they are housebound
There is a lot of pathologising entirely normal processes. A pregnant woman demanding an Occupational therapist visit her at home as her shoes no longer fitted her. Entirely normal pregnancy btw.
I have so many examples it's soul destroying
on the whole the staff we work with including medical staff are fantastic- I am a nurse
But I do think that some nhs problems are with some of the staff we have.
As someone further up said her maternity care was atrocious, I don't doubt this. Some places seem to have an almost toxic culture embedded in them.
We say 20 mins to get them in 20 years to get them out. When people are recruited there is no probation period they instantly have a permanent post. Disciplinary policies are horrendous and extremely time consuming to follow up on. Sickness and absence is diabolical,again the processes to manage this are terrible ( I'm talking about people who are very clearly not unwell enough to be off on full pay for 6 months)
I think abolishing the bursary for nurse training was actually a good thing as I think some people did it as a cheap way of getting a profession, the newer nurses coming through do seem to me to be of a higher calibre.
Probs gone a bit off message here but forgive me just in from a 12 hour shift