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.

@endofthelinefinally I agree there is a lot of expectation of patients to organise and manage their own health admin, especially when it's done at different hospitals that don't talk to each other. I've talked to some very vulnerable people such as those with additional needs who live in the community or have mental health issues who struggle to cope with it. They seem to get a much poorer service when they can't stay on top of it and keep chasing things.

I don't understand people needlessly going to a&e. Why, it's really not a complicated system. The clue's in the name. Who wants to spend their day waiting around a hospital.

I know these people exist because I've been at a&e with ds on a Saturday and seen kids there with tummy ache and sore knees.

Expectations are incredibly high and people will actually lie in order to get the service they want

That attitude is part of the problem.
The NHS are so caught up on stopping people getting things they don't need, the people that require help can't easily access services.

The amount of cost wasted with red tape trying to stop people "abusing" the system. We're not all hypochondriacs and the system is hugely complicated and stressful for people in genuine need .

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
How is this different from the Health and Social Care Act 2006 which put commissioning responsibility into the the hands of GPs?
This is just more of the same.

I thought you were talking about STPs which are looking at the consolidation of specialist care into fewer centres while devolving some acute functions like blood tests, xrays etc. into community locations to focus on primary care rather than emergency medicine.

The changes your suggesting have been in place for 12 years and have if anything made things worse.

GPs don't need to be in charge of commissioning services that's not their skill set and and takes them away from the work they are actually trained for.

What we need to do is close hospitals and put the money back into the community but that's unpopular.
It's safer for patients to have a few dedicated centres of excellence for elective care than lots of local hospitals, look for example at the dedicated stroke and trauma centres in London. Where previously patients would go to their nearest local hospitals now they go to a single highly specialised unit and the death rate has reduced because the unit has a singe function and the opportunity to practice all the latest technology and guidance.
It's not cost effective to provide all services at a local level and smaller hospitals don't see enough volume of procedures to allow their consultants to keep their skills up to date.
Suggest you're closing a local hospital though and everyone goes up in arms. We need politicians who are prepared to be brave and face public censure in order to move the NHS forward and focus on prevention and community treatment. Too many people with chronic conditions (asthma, diabetes, epilepsy) end up in hospital when they should have had their condition managed before they reached crisis point.

@Firstimpressionsofearth
To be very honest it is convenient in some ways

Go to work all week and use A&E evening or weekend, do not have to worry about not getting paid at work, have a babysitter, don’t have to battle to get a GP appointment in 3 weeks, also you get given the answer all in one go to put your mind at rest so it is seen as easier to wait 6 hours than wait 3 weeks. People usually just respond they couldn’t get a GP appointment. No they probably have to wait. And they don’t want to wait

@gamerwidow
It’s a devolved budget that aligns with STP’s

p.s. I do agree that we need to encourage self care more.
Would be good for all school kids to do a first aid course as part of PHSE.

PookieDo I still don't agree the budget sits in the right place with the GPs. I don't think most of them have the skills to use it properly.
They are extremely clever talented people but their expertise is medicine and that's what they should be concentrating on.
To be honest the whole commissioning business is an economy in itself. As an acute trust we spend a lot of money each month arguing about who is going to pay for what. That's a lot of highly paid people doing a job that wouldn't be needed if every hospital just got a block contract and had to manage it. We have 10 people on salaries of £40k and over sorting this out every month. Making bits of the NHS complete against each other for money is a false economy, ultimately its the same pot we're squabbling over.

In capitalism, if a service is not provided, the provider doesn't get paid.

Except if they are banks. Then they get bailed out with taxpayer money, nobody gets prosecuted and they get to continue with the knowledge that even when they fail the taxpayer will prop them up, trebles all round. Heads they win, tails you lose .

I’m a retired hospital doctor. When I qualified, 39 years ago, administration cost less than 5% of the total NHS budget. By the time I retired it was over 12%.
The head of an NHS trust earns nearly double the prime minister’s salary - for considerably less responsibility.
Any reform of the NHS needs to focus entirely on cutting expensive and useless management posts and hiring more clinical staff.

My gp growing up must of had 2500 to 3000 people on his books 1 secretary , the surgery was twice a day and it was first come first seen , he used to do home visits in the afternoon, if you had been in hospital the day you came out he would come and visit plus he was on call over night,

The gp practice now is a complete shambles

I don't think the GP system works very well for working people or with hospitals. A lot of the time a hospital patient will be told to say see their GP a week after discharge for a check up, the GP can't fit them in at that time. The two systems don't work together and patients can be left feeling bounced between the two while no one wants to know.

I couldn’t afford it. I’d be dead by now, if not from an asthma attack then an emotional wreck without pain management courses and genetic counselling, no longer able to work and claiming benefits, bringing up my children in poverty. That’s much more capitalistic, is that what you’d prefer?

Gamer they are all around the table. CCG, GP’s, community, social care, adult mental health, pharmacy, diabetes, respiratory, acute, specialist services. They are making decisions together based on data and joint working approach. What does this area need? Ok how are we going to do this?
It is not a room full of GP’s with a few million making any old decision

Some CCGs are a lot better than others.
The one in my area is still arguing over a particular service provision 10 years on. Not one of the people on the committee has a clue about the service in question.
Imagine if you were a cardiology team wanting to set up a community based service to improve patient access and reduce costs. Then the CCG doesn't invite you or any of your staff to any of the meetings. They make decisions based on the opinion of a local pharmacist, a representative from a surgical team and a hospital administrator.
You try to communicate with the right people but they all keep changing roles every few months.
Yet in some areas the CCG works very well. It is all a bit hit and miss.

YABVU - the NHS needs to be sufficiently funded.

But you are doing exactly what the plan is for people to do. The downfall of the NHS has been planned since the 1980s when the conservatives began breaking down the huge interlinked behemoth that the NHS used to be. Initially by contracting out cleaning services, then by introducing hospital trusts. the whole thing has continued ever since, with increasing services being run by private providers.

As it now is, the NHS could be privatised tomorrow. All that would be needed would be a law handing over national insurance to private providers. But then there would be a national outcry. So to make it palatable, the NHS is being run into the ground by consistent and deliberate underfunding. To cause an outcry of 'this can't go on! It's not working!' 'We need to change the system!'

Of course, this current NHS is a really costly way to run things. I remember the days pre-Thatcher when someone would phone up and say a person local to us had been injured 300 miles away, was now recovering, and could we arrange a transfer? the answer would be yes, and we'd get on with doing it.

Nowadays, to do the same thing involves the 'receiving' trust billing the 'sending' trust - that's if the transfer is even agreed, which will usually involve a meeting. And of course all the paperwork

In the past if I wanted a piece of equipment, let's say a sleep system at around £500 (I use the bare minimum), I would have ordered it and it would have been provided. Now I have to write out a full clinical reasoning for the need for it, a reasoning of why each component is needed, and the reason I want a particular supplier. This then goes to a panel. Why a panel is thought to be more knowledgable about sleep systems than a specialist physio, I do not know. The cost of the paperwork and manhours involved (we wait MONTHS for special orders) in this probably totals over £500 anyway, so it doesn't even save any money. And meantime the patient's body symmetry continues to deteriorate.

So yes, the NHS needs to be reformed - it needs to be renationalised. Taken back to being fully interconnected, and all run by the state, not by private providers - who are looking for a profit, which the NHS never was looking to do.

the NHS and healthcare can only be reformed when the public accept that it has to become a 'needs' led service rather than a 'wants' led service.

for example:
yes you need a GP to see you about your on going back pain and arrange for a physio appointment BUT you want that straight away as soon as you ring and you dont want to wait 2-3 weeks and you dont think you should have to..because it is your right to see the GP immediately

*the NHS and healthcare can only be reformed when the public accept that it has to become a 'needs' led service rather than a 'wants' led service.

for example:
yes you need a GP to see you about your on going back pain and arrange for a physio appointment BUT you want that straight away as soon as you ring and you dont want to wait 2-3 weeks and you dont think you should have to..because it is your right to see the GP immediately*

It is precisely because of this attitude that the NHS needs reform - that patients should be grateful for what small crumbs they get, as and when its convenient for the NHS, regardless of the opportunity cost to the patient of waiting days, weeks, months or never for treatment! Ime, most adults have to do a combination of working to earn the money to pay the bills, and care for children or other vulnerable relatives. If a mother has back ache and has to wait 3 weeks for a GP appointment, never mind the waiting time for physio, is she supposed to say to her 3 children under 5:

"You will have to get yourselves dressed, washed and fed, because I am in so much pain, I can't move for the next three weeks!"

Or, the adult who has taken time of sick twice in a year, due to an ongoing condition and is told that if they take time off again, they will get a disciplinary; two disciplinaries and they are out! There seems to be a lack of comprehension among NHS professionals that people in full time jobs cannot take weeks off work these days, if they want to keep their jobs and a roof over their heads.

I would love to have a needs led service, because I don't see anyone in my family getting that, never mind wants led! How does a patient say to a cardiologist that they want a stent for severe coronary artery disease; or a gastro-enterologist that they want a scan done of their intestines because they have gone from a size 14 to 10 due to loss of appetite, nausea and vomiting; or I tell a consultant neurologist that seeing DD once a year is not enough, when we are calling 999 and she is being admitted to an acute ward every week - it would be cheaper all round to see her and revise her emergency protocol every 3 months instead?

Much of the problem is the long life expectancy - ops which were considered serious and requiring long recovery are ten a penny now eg insertion of stents in heart vessels. Now we live long enough to have major orthopaedic surgery like hip ops, heart ops and that's not counting treatment for obesity and diabetes.
There is much more excellent (and sometimes expensive) medication available. Many more emergencies due to the elderly falling etc. Many more prem babies kept alive.
More money is the answer.

Isothickithinkimclever - I'm an ex nurse myself and totally agree a major issue is it being SO difficult to get rid of bad staff. And I don't just mean low level lazy/imcompetent (though that's bad enough) but borderline abusive/dangerous! It's scary how hard it is to get rid of the bad staff. And I understand this is partly because we're so desperate for staff generally but that's again due to lack of funding - but i DO think doing away with nursing bursaries was a ridiculously bad move!

There were already problems with nurse recruits coming from certain backgrounds when it became a graduate role, removing the bursary compounded that issue. A friend of mine from nurse training is now a ward mentor for trainee nurses and she says a good 3rd of recruits think many standard nursing tasks are "beneath them" - even while they're still trainees! They have a chip on their shoulder that certain tasks & responsibilities are too menial for them to undertake. It's very much a "hands on" job, recruiting people who screw their noses up at dealing with bodily fluids or patients whose hygiene isn't the best because they're struggling to maintain it due to illness is unacceptable - that's the job!

"The changes your suggesting have been in place for 12 years and have if anything made things worse." Totally agree. I absolutely do NOT trust GP's who are essentially privatised hcps working on a contractor basis within the Nhs - based on decades of bad experiences with many different GP's all over the uk.

Not sure I agree with closing hospitals though - and you seem to be basing that on urban setups. I'm in very rural Scotland and hospital/ward/department closures have been extremely detrimental to patients.

Eg my local hospital no longer has a maternity unit, the argument has been that the next nearest is "only an hour" away BUT that hospital doesn't only serve my locale but populace even further away inc in neighbouring islands for whom even our local hospital was difficult to get to, so that now the nearest maternity dept for them is several hours away AND is often overwhelmed with the number of patients they're needing to serve - because they didn't receive enough additional resources to cover this! Plus the extra distance means mothers and babies are needing more treatment by the time they get there! It also means some women are being admitted as a precautionary measure with certain conditions who wouldn't be if they had a maternity unit closer by - that's GOT to be costly surely?!

Our local A&E has also had its opening hours reduced with nothing put in place to cover needs of patients outside those hours.

Local GP's KNOW that patients have little choice and are very strict on what they will and won't do and regularly ditch patients if they DARE question the service they receive - local MP and MSP I know have had a lot of complaints about this. The problem is it's a deprived arse end of nowhere place that cannot attract good quality hcps. This makes some less assertive/confident patients reluctant to use primary care - that's one reason why certain people use A&E around here at least. I've also known (and this was backed up on the thread I posted) of patients using A&E out of sheer despair after being repeatedly fobbed off by GP's or because of being fobbed off a condition has seriously deteriorated to the point A&E has become necessary! I've had that happen to me and A&E staff "tell me off" saying "why didn't you see your GP about this months ago?" And they've been apologetic when I've responded "I did! They ignored me and didn't help!" On one occasion it related to dds admission due to an infection not being taken seriously and treated as aggressively as it should have been and the consultant she ended up under on the ward wrote a strongly worded letter to the GP surgery AND the people that can discipline GP's and on that occasion we did get an apology from the GP Surgery and since then they've been a bit better with dd.

You say about primary care and community services - IF hospital/dept closures ARE to be considered these HAVE to be good quality, well resources and in place BEFORE the closure.

"Too many people with chronic conditions (asthma, diabetes, epilepsy) end up in hospital when they should have had their condition managed before they reached crisis point." Again - this isn't always the patients fault. My asthma after several years of no issues returned a couple of years ago (I suspect a new irritant introduced to my area in some way) but I ended up in A&E BEFORE I was taken seriously - why? Because I also have mh dx and the TWO GP's I had seen dismissed me - one actually laughed at me - and said it was panic attacks NOT asthma attacks DESPITE it being on my records I have a history of asthma AND without even listening to my lungs.

"Any reform of the NHS needs to focus entirely on cutting expensive and useless management posts and hiring more clinical staff." Yep! Too many bosses not enough frontline staff!

"The gp practice now is a complete shambles" totally agree! They don't want to do what patients need. My dads on oxygen and bedridden and even he can't get home visits!

The GP we had when I was a child (70's) did home visits, made a point of getting to know patients (useful for knowing who the "cry wolf" ones are as well as just being better placed to assess need generally - now GP's seem to assume ALL patients are "crying wolf" until the patients prove otherwise!), communicate directly with hospital/specialists and followed up on patients recently discharged in person.

"They are making decisions together based on data and joint working approach. What does this area need? Ok how are we going to do this?" And they're all fighting to get "their" service the most money/resources because there's nowhere near enough to go around and there's ridiculous rules/systems that mean eg GP surgeries are penalised for referring patients to specialists!

it needs to be renationalised. Taken back to being fully interconnected, and all run by the state, not by private providers - who are looking for a profit excellently put!

Theredjellybean - why on wary do you think it's acceptable for a patient in pain to have to wait weeks to be seen?! Why should they be left suffering - and possibly unable to work in that time too?!

Needs AREN'T being met!

"There seems to be a lack of comprehension among NHS professionals that people in full time jobs cannot take weeks off work these days, if they want to keep their jobs and a roof over their heads." Absolutely! I would say this is mainly true in primary care. Though secondary care can be guilty of it too. Mainly because that's NOT a reality for them. They can take MONTHS off sick and still be getting paid and keep their jobs!

They're living in a protected bubble where they've no comprehension of life in the real world!

Conditions aren't being dealt with when patients first experience symptoms, that leads to not only the conditions worsening and more complications but patients become naturally more anxious and stressed which adds to many conditions worsening and can result in new ones needing to be treated. It's a false economy!

But it's not happening out of ignorance it's deliberate and ideological. We've had right wing capitalist loving govts for the last 40 years - this is the result!

@Graphista, I understand what and why you say, and not being a HCP cannot argue from knowledge. But when you have a patient present with pain that can't be solved quickly and simply, you prescribe opioids and create another crisis. We are only seeing the tip of the iceberg.

However, there's a species issue. Medical know how has advanced much faster than anyone would have believed possible in 1947. We live longer, there are fewer stillbirths, more disabilities and most people would agree this is good. But in evolutionary and ecological terms, it's disastrous. Darwin's selection of the fittest rule needs to operate, even when it's a personal catastrophe. When the developed world was small, it hardly mattered. But now

I agree out approach to pain relief is outdated and simplistic.

I speak as someone with not only medical training but a painful physical disability which is little understood (lack of research) but relatively common - though I was affected at quite a young age. But because sufferers aren't generally significantly affected until after retirement age it's not prioritised.

I've had investigations and medics are reluctant to do much except treat the symptoms (mainly pain).

As I'm allergic to many painkillers (NSAIDs because of the asthma, codeine) that limits what pain relief I can take to pretty strong opioids which I am resisting becoming a regular user precisely because of the addiction issues (family full of addicts - inc opioid addiction).

What little physio input I've had has been fairly generalised and ineffective, surgeons won't touch me as there are complicating factors.

But yes I agree, I'm hearing more and more from friends and family and seeing on SM etc people being prescribed/recommended opioids more frequently and imo with blasé disregard for the side effects, interactions with other meds and addiction issues.

Personally for starters I'd make codeine prescription only, it's a highly addictive powerful drug and yet people can buy it in bloody supermarkets! It's ridiculous!

On the "species issue"
I feel you're erring dangerously towards eugenics on that argument.

There ARE enough resources throughout the whole world for everyone to have their basic physiological needs met but they're hoarded by the rich and powerful for no reason but to FEEL rich and powerful! Totally illogical!

Nobody NEEDS to be rich far beyond what they could ever need/use in their lifetime but that's sadly the nature of certain humans - too many - and Twas ever thus and it's very difficult to know how to address this in a way that wouldn't just start more bloody wars!

It's heartbreaking and unjust.

I don't understand how politicians can pass policies creating/worsening hardship and then claim to be altruists.

People dont value it because there's no obligation to pay for it. Either link it to national insurance contributions or make people pay a fee for using it - £10 for a GP appointment etc. Free for kids only. Then people may be more responsible when using it.

We need to look at other countries like Germany and France and model our healthcare system on theirs and we need to pay more

The NHS will just slowly be ground down. It’s beyond replair as so much is already privatized

And the money wasted is criminal and the NHS culture needs to change far to many middle management many working ridiculously hard too many do very little it won’t change unless there is a complete change

I work for the NHS

Csaved me (breast cancer) saved my baby (leaukemia) saved my dad bowel cancer) NHS nurse and I say privatise it. Used and abused. Used as a doctors surgery, adults that won't take responsibility for themselves. Idiots booking in to a and e with coughs, colds, head lice, verrucas!!!! Privatises it now!