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.

And how are the poor - those most likely to BE sick and disabled and need to visit Drs the most - meant to find £10?! Don't be ridiculous!

Agree with PPs who say that constant reorganisations waste money.

The competitive market is not appropriate for healthcare because like trains journeys, people do not have a large choice in their hospital - it is based on location. You might have a choice of maybe max 3 hospitals for your elective operation and most people choose on distance. Sometimes for heart surgery there is only 1 realistic choice as it is the only specialist unit in a large area. It’s not like picking your brand of orange juice at the supermarket.

You could introduce competition by over-provision (ie 2 or 3 specialist heart hospital per area) - but then you could alternatively spend that money on more staff/equipment etc which would improve existing service.

"PaddyF0dder

Ok OP. So what are you suggesting? Which model would you go with.

I’m a hard working NHS consultant, and I really despair at this sort of bollocks NHS bashing. For what it’s worth, I also despair at the poor funding and constant politicising of the NHS by those worthless ogres in government. So don’t worry, I’m an equal opportunities despairer.

I’m of the view that the NHS is an absolute, fundamental good. It’s a social leveller, a moral absolute. It is, in Britain’s rather chequered history, the best thing Britain has ever done.

I don’t dispute that, in many ways, it is really struggling. But I do dispute your solution. Our politicians could chose, in a moment, to adequately fund the NHS. But instead they chose to fritter away untold billions on nuclear weapons, finance, brexit etc.

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"

Yes yes yes!^^^ this! Well said!!
You can NOT mix the NHS and businesses that make profit. Its quite depressing how many right wing NHS bashers you get on Mumsnet. Thought it would be more well informed than this.

www.kingsfund.org.uk/publications/articles/big-election-questions-nhs-international-comparisons

UK has lower numbers of doctors and hospital beds per capita than France or Germany.

How about increasing these BEFORE undergoing a costly re-organisation?

PUblic Private partnerships used to build hospitals are ridiculously expensive in the long term. BOTH labour and conservatives have used them. Basically they give a shiny new hospital for the next generation and future govts to pay for.

Understand that vulnerable patients are expected to manage complex sets of appointments/instructions etc BUT the doctors are expected to see a huge number of patients (of greater complexity now people live longer and have more medical problems) and do lots of admin. Shouldn’t the answer to be to get more staff so the existing ones aren’t spread so thinly? I work for nhs.

I've had treatment in the US and I have to say, if you have the insurance, it is excellent. You are treated as an equal by the staff, not a 'love' or 'm'dear', not looked down on like a nuisance. Paying for your care DOEs have some advantages in that respect.
But the answer is always to tax someone else to pay for it. Usually the rich. When in fact we all need to cough up more - money that is!!

To be honest I think that the most vulnerable people with additional needs, severe mental health issues or dementia probably need some sort of key worker who can go over their appointments so they know where and when they need to go and chase things up on their behalf. These people get a raw deal if they aren't able to manage their own health admin.

Hospital staff do what we can but it's never enough and we can't control what other departments or other hospitals do or make every single person in a hospital aware of Mr Xs dementia for example.

The NHS has been subject to ruthless and fairly constant reform for decades.
We spend far less (as proportion of GDP) and have fewer beds per capita than most European countries.

There is already a large portion of care provided through contracts with private providers - elective low risk surgery by BMI and Spire, investigations and scans by Alliance, GPs are mainly private businesses, rehabilitation, community care and prison healthcare by Virgin. That’s before considering PFI contracts and inpatient mental health being dominated by Priory.

I think when people make sweeping judgements about reform of the NHS, they don’t really understand what the NHS is and what the alternatives are. The US system is fine to have your gall bladder out if you have insurance. If you need a lung transplant assessment your insurance might not cover you for listing and you die. If you need ongoing drugs for life saving treatments your insurance might not cover you either. If you have no insurance then life becomes a challenge if you are ill.

The NHS remains one of the most effective and efficient healthcare systems in the world. The DH has a whole section set up to garner money from other countries by allowing them access to our system to learn and develop their own country’s healthcare. It does remain the envy of the world. It’s not perfect but if you are seriously ill, there are few better places to be than England.

Are you Brexit party by any chance? Testing the water for Farage?

The NHS needs the privatisation the Tories have unrolled reversed and it needs proper funding and probably some reform. Socialist reform.

Fuck capitalism. Fuck consumerism. Fuck neoliberalism. Nae pasaran!

These people get a raw deal if they aren't able to manage their own health admin.

This is a massive problem, but ime more importantly they get a raw deal because they are regarded by some doctors (not all) as second class citizens and not worth bothering with!

MontStMichel it's kind of a double whammy and an additional problem is how some patients with additional needs struggle in the increasingly noisy crowded waiting areas.

It's quite common for clinics to be running late which is crap for any patient but we do notice those with ANs are more likely to give up and leave unseen because they can't face another 90 minutes in the waiting room or becoming panicky at the uncertainty of when they we be seen.

We get given guidance on how to accommodate such needs but it's a bit useless being told to find a quiet private room when every bit of space in the department is being used.

I'm guessing there weren't so many people with additional needs living unsupported independently in the community trying to access NHS services when it was first set up.

There is reform needed, but it needs to be from everyone.

I read a news story last year about NHS funding that said each CCG 'buys' it's own IVF and are paying anything from £3,000 to £12,000 a go but they could get it cheaper if the NHS procured it centrally as they would have better buying power.

It's not just the NHS but patients too. I think a lot do not realise how qualified pharmacists are and that you don't always need to see the doctor (our surgery has the receptionist now ask so you end up with the right person not just the doctor).

People need to stop using services when they don't need to. No doctor visits for a simple cold etc unless you have existing conditions being affected.

A friend had to go to minor injuries for stitches and there were two people there waiting to be seen. One fell drunk out of a car and had a sore ankle that she could walk on and one was seen by the GP for tonsillitis but went to minor injuries as the doctor hadn't given her antibiotics and she wanted to check if that was right.

"BOTH labour and conservatives have used them" NEW labour did ie tory lite, I don't think traditional truly socialist Labour would do this.

"or make every single person in a hospital aware of Mr Xs dementia for example." I don't understand why things like this can't be "flagged" on patient info. Both electronically and maybe big red capital letters on paperwork?

I'd like to see the same done for allergies, chronic conditions etc several times I've had GP's try to prescribe me meds I'm allergic to! If I also had a condition like dementia that could easily be very dangerous! A couple of times due to the name of the med changing slightly I've not picked it up and been VERY lucky that the pharmacist did - if it's clearly marked on pharmacist records WHY is it NOT clearly flagged on my GP Records?! (And yes I have raised it with the surgery and the response hasn't been great to be honest!)

"The NHS needs the privatisation the Tories have unrolled reversed and it needs proper funding and probably some reform. Socialist reform.

Fuck capitalism. Fuck consumerism. Fuck neoliberalism. Nae pasaran!" YES!!!

"This is a massive problem, but ime more importantly they get a raw deal because they are regarded by some doctors (not all) as second class citizens and not worth bothering with!" In my experience - and many others it's the majority of Drs unfortunately.

https://www.mumsnet.com/Talk/amiibeingunreasonable/3402449-Aibu-to-ask-you-to-tell-me-your-experiences-of-being-dismissed-by-medics-as-a-sick-woman-I-promise-to-listen

"people with additional needs living unsupported independently" totally agree with this observation - it's NOT "independence" it's lack of support! Applies to many mentally ill too.

I struggle with busy waiting rooms too - not least because my physical disability makes sitting in hard chairs OR standing for long periods painful! But also because of the anxiety it causes. I've been told off for making early appointments to offset these issues because "they're for people who need to be seen before going to work" also for walking around the waiting room to offset the pain issue. I've also seen other patients have similar treatment inc a man with a leg cast on being told off for not moving to the Drs office quickly enough!! - Delightful attitudes to patients anxious/in pain - not!

How have we ended up with so many medics who don't give a shit about patients? What's going on with recruitment assessments?

The NHS remains one of the most effective and efficient healthcare systems in the world If that were the case, why doesn't the rest of the world copy it then?

I'm in Belgium, and the healthcare is excellent and quick. A friend needed an xray - I drove her to the walk in clinic (in the home of the radiologist, not unusual , a portion of a property becomes a clinic), and the xray was done then and there. The results were available on line for her and the GP to access about an hour later.

Physio is easily accessible too. it's a co-pay system here as in France (except if you have private health care via your employer).

@Graphista, some poor admin clerk in appointments who is just being told to ring Mr X to let him know about his hearing test next week is unlikely to go through his notes or medical record in order to do so. They are probably making 50 or more phone calls a day and don't have time to.

A specialist team he is under long term will learn to recognise the name and know to ring Mr Xs daughter because they have learnt from experience that Mr X will forget about it 5 minutes after the phone call but there is a move to delegate a lot of this sort of admin to big central teams and you lose a lot of that more personal touch. I do agree alert systems could help in some cases.

One of the hardest parts of my job was liaising with some of the high needs patients who were still deemed to have capacity. We aren't given specific training on this and some patients could be very hostile, some would threaten suicide, some you would talk to about the date of an appointment and it would become clear they didn't have a clue what month it was, some would turn up to outpatients at random times and wrongly claim that someone had called them and told them to attend and become aggressive when told no consultant is available.

You want to help but many secretaries, admin clerks, HCAs and receptionists are in situations that make them feel out of their depth. I know the social care budget is tight but if patients in this situation could have someone to help them navigate this then they could use NHS services much more effectively.

The NHS remains one of the most effective and efficient healthcare systems in the world

Efficient, my arse, as I already said upthread - MASSIVE unchecked wastage across the board.

"some poor admin clerk in appointments who is just being told to ring Mr X to let him know about his hearing test next week is unlikely to go through his notes or medical record in order to do so. They are probably making 50 or more phone calls a day and don't have time to" but they have to look up his number yes? So why can't it be flagged at that stage? Or if it's bad enough that the patient with dementia can't manage their appointments it should be someone else that's being called surely? In the scenario you describe mr x's daughters number should be the default number that's called - to do anything else is poor service and poor organisation. It's not acceptable.

Agree the main issue is that such patients are unsupported - as myself and a pp noted upthread

"Efficient, my arse, as I already said upthread - MASSIVE unchecked wastage across the board." Especially since it was denationalised and fragmented - ridiculous state of affairs!

It's difficult with patients who lack capacity , they are often the last people to admit their minds have failed. A family member has dementia, I'm not going to be the one to tell them they must not try to deal with anyone who phones, and then if calls are transferred to you ho w do you know if they've already booked the hairdresser or whoever. Phone them? but if they can't read the calendar/ don't know what day it is you are stumped.
It's only going to become worse with our ageing population. Writing letters is the only way to go.

Because the computer system for appointments tends to just be a basic name, address, contact details type thing that links to a clinic booking page and a letter generating system (some patients hide unopened letters from family) . I agree alerts would be good but try telling that to IT or management.

The specialistteam that know Mr X would just go straight to Mr Xs daughter, the appointments team won't know to.

I think if there is this move to centralised teams for admin it needs to be backed up with much better IT communication so that appropriate next of kins or key workers are flagged up for example. Moving to this way of working without consideration for situations like this is causing a lot of problems that disproportionately affect certain groups.

The old school system of each consultant having a secretary doing all the admin may be less cost efficient and streamlined but these people get to know and recognise the patients and all their quriks and needs. To a centralised team the patients are just numbers to be processed and the service can be a lot poorer in some ways.

@scaryteacher
So is everything free in Belgium?
Maternity care, mental health care, major ops?
Id love to know how other countries do it.

We have a second home in France. The French system wins hands down.

The NHS is not free. It is funded by the people, for the people and for too long the people have been brainwashed into bei g grateful for sub optimal care and sub optimal service standards.

As for PaddyF0dders commentz about the NHS being a marvellous social leveller, how? Because so many in it treat all the patients as scum? Tell me about equality in a system where one set of stakeholders are introduced with titles but think they may use first names without asking? And first names are a massive improvement on "love" and "mum" so beloved by the nursing stakeholders. It's paternalistic and wholly unacceptable.

@PrincessTigger the poster said explicitly that Belgium operates a cop-pay system.

err. co-pay!

I think I should run to the exit now.

Yes I think that it might be good idea, maybe keeping your thoughts to yourself as you go.