The NHS is falling apart

[Hold34]

I know there are many wonderful caring staff out there working in the NHS.

But overall, it's a bit shit isn't it? It's (mostly) not the fault of the staff. It's just underfunded and can't deliver what it needs to meet demand.

We all have to pretend it's great but it's not.

What stupid remarks from posters

Care to do better?

Anyway.

People who receive substandard NHS cats should absolutely complain, otherwise things won't improve.

Privatised medicine - profiteering from ill people - is evil, imo.

Totally agree that it's mismanaged. We spent a fortune on huge screens for a computer system we stopped using a couple of years later. And so many trained nurses sitting in offices doing gif ones what.

It’s under funded As medical knowledge improves there are more services to be funded but the pot doesn't necessarily get any bigger?

Although I also think that people don't take enough personal responsibility for themselves and misuse it [e.g I had the misfortune to end up in A&E after a fall and the guy in the next bay pee'd over himself (or over the floor, not sure which, could only hear it) because he was so pissed.

A&E is falling apart here. I had to go in with a suspected pulmonary embolism and they did their best, but honestly it was a nightmare for them. They had one doctor for A&E and he kept being dragged off to resuss. A pregnant woman fainted as there was no water, all taps were non drinking and vending machines were empty or broken. The nurses couldn't help as two were involved with something serious and the other was having to wheel patients for tests as the porter hadn't turned up for his shift and they were waiting for another one to be sent over. I saw one of the nurses crying when I was having my obs checked and saying to another she couldn't cope.

The doctor told me it is always like that now and he is terrified someone will die soon. He asked me to report it. They had run out of painkillers. The waiting room was so full people were sitting on the floor and all partners were asked to go back to main waiting area which was so full people were sitting outside.

They closed the minor injuries unit, you cannot get a GP appointment for a month and emergency ones fill up too quickly. 111 had to tell my GP once that I had to see a doctor that day and the poor GP had to stay late. I think there is a definite connection there

The trouble with charging for missed appointments is that I suspect a large percentage of those that do may have mental health issues, addictions or not actually able to pay so imo is it worth the additional time & money to try & get that charge paid?

Same with charging drunken people who fill up A&E on the weekend, where do you draw the line? Do you charge the extreme sports lover for breaking his leg or the driver who looked at their phone & caused a crash? If it free, it needs to remain free.

However I do think think things like paracetamol shouldn't be free particularly as I can probably buy it for 25p & the one the NHS has are likely to have cost them a £1 due to awful procurement. With an ageing population should prescriptions for the over 60s be means tested? I can totally see how we are bad at diagnosing conditions, I'm in my 30s & I just don't go to the doctors as I can never see the same one & it's such a wait for an appointment.

I'm conflicted because of my own experiences.

DH ended up going private because despite presenting with the same problem 5 years in a row, the GP thought pain killers were more of a solution than investigation and proper treatment. In the end nothing would have changed the outcome; his problem is degenerative, but with proper treatment and understanding he may not have deteriorated so quickly. It may have helped him hang on to his job for longer, or could have prepared him for a job change. As it turned out his job was whipped from under him which aside from all the practical problems, gave him mental health issues too.

DD broke her leg, we drove her to A&E and had an X-ray and a temp cast on, referral for fracture clinic in the morning OMG and we were back in the car within an hour and a half.

Obviously I have lots of in between experiences, but I think it can and does work well, but not always.

One of the biggest issues I found when DM was in recently was lack of communication. It was incredibly hard to speak to a doctor and when I asked the nurse all she ever said was I needed to speak to the doctor. Doc came at 9am then 3pm on that ward so I was never there due to school runs an hour away, they also came round at 9pm when i wasn't allowed to be there!

I have had 2 DC referred to CAMHS for autism assessment. One had presented with signs from a very young age but was sent to the paediatrician who 'kept an eye on things' for a time before sending the referral forward. DC was 9 before being diagnosed. The other was referred by the GP straight to CAMHS when they were 6. He was also 9 when he got diagnosed. That's not good enough. People are struggling and fighting and needing help but not even getting a diagnosis for years. It's a failing.

Mental health services are stretched to bursting point. People are suffering.

I do think a lot of it is down to money. It's all very well saying they pay too much for paper clips, but the bigger picture says even with no paper clips, money is short.

Which evidently is what you are promoting. Private health care.

That's an outright lie. I'm promoting no such thing. I'd like free healthcare that works properly and is a similar standard to other part privatised systems. Evidently you simply can't stand to hear criticism of the NHS without assuming that anyone who's experienced and recounts serious problems with it wants to introduce privatisation. That's ridiculous and utterly counter constructive.

Charging for MISSED appointments is not privatisation by the back door. Ask anyone who works in the NHS about missed appointments and wasted resources and you'll quickly understand that something needs to be done to reduce it.

I think a lot of people who live in London or other major cities often don’t have a clue about the lack of services in the average town. In our fair sized town we don’t have a walk in centre, and most of our hospital services have been moved to a city hospital to “centralise” services. We are about to lose our A&E.
GP appointments are on average a wait of 3-4 weeks.

I think a lot of people who live in London or other major cities often don’t have a clue about the lack of services in the average town

I'm the OP and I live in London! Although my nearest hospital is a certain East London hospital which has been in the press a lot over the past week for all the wrong reasons. Maybe it's better in central London.

I worked I the NHS for over 30 years.
Before I retired I had so many elderly people coming to my clinic with letters about appointments in other departments, many times the letter confirming the appointment would arrive in the same post as the letter cancelling the same appointment.
The choose and book system is a nightmare.
I have a serious, chronic condition.
Getting appointments is so difficult and the choose and book people have no medical training at all.
I have twice ended up in the wrong clinic due to choose and book. The system wouldn't let me book the correct one. I tried to explain over the phone and they had no clue what I was talking about.
In the end I just attended the wrong clinic because it was the only way to get transferred to the correct one.
Luckily the doctor I saw was somebody I had worked with. She said it happens all the time. What a waste of appointments.

I think it's a perfect storm of things:

Really dire procurement practices which have them over the barrel unecessarily for many things, and paying over the odds for off the shelf goods. Also Labour's PFI deals which are still leaching money now for no benefit, yes we got shiny new stuff at the time; but we are also still paying it off now, and by the end of the term will have paid several times over what it is actually worth.

The uncertainty with Brexit etc and change in training (eg bursaries, removal of the diploma option for nursing) leading to staff shortages, those that are left are expected to pick up the slack which leads to more (understandably) leaving. Either the gaps are left or pricey locums brought in.

People have greater expectations.

People are living longer, and equipment etc is much more advanced; which is great for patients, bloody expensive for the NHS.

Chucking more money at it won't help, reconstructing it from the ground up would. Educating people, making training more accessible (not lowering standards though), more robust procurement processes, treating staff better to make it a place people aspire to work, and utilising the estate they own better.

It's such a complex problem & I don't know how it can be fixed.

Definitely underfunded but also wasteful.
Excellent staff & some that shouldn't be there.
Bad procurement
Too many middle managers & costly initiatives that tend to not go anywhere.
Lack of GP availability
Cuts in other areas eg social care, mental health.
Lack of cohesion & communication between depts.
Society's lack of personal responsibility.

and often huge big buildings that cost a fortune to heat & keep cool as the widows don't open for example.

Agree that private hospitals are t all they are cracked up to be. One of our spinal surgeons started doing scoliosis repairs in the new local private hospital. The hospital was desperate for our ward staff to go and look after the patients as theirs had no experience. They also had no specialist back up if complications arose. Fortunately he now doesn't operate there anymore.

GP appointments are on average a wait of 3-4 weeks

I also live in London and it's exactly the same. My GP has several excellent long-term doctors but seems to have to plug the gap in demand by using locums who frankly are nowhere near as good.

I’ve had many positive experience’s in the NHS. Even this week I got an appointment with a consultant and scan within two days of asking for one. I always get a same day GP appointment. My life was saved a couple of years ago with emergency surgery quickly Diagnosed and I’m currently pregnant with an ivf baby funded by the NHS.

We've had good and bad experiences too. My husband has had great care for chronic breathing problems and being treated with an expensive drug which has improved his quality of life. In my job I come across cancer patients who pretty much always say about how wonderful the care is and who are being given new immunotherapy treatments which are hugely extending their lives. I also come across others who have had their symptoms dismissed for months and then end up with a serious cancer diagnosis. My teenage son has been waiting over a year for a simple small operation which is greatly affecting his self esteem and relationships. I myself was admitted to a surgical assessment unit a year or so ago and the care was truly shocking and disturbing .There is good and bad. I mainly work with cancer patients, there is enormous pressure on the services, people living a lot longer, new treatments extending people lives, difficulties recruiting staff and staff at breaking point.

Charging for MISSED appointments is not privatisation by the back door. Ask anyone who works in the NHS about missed appointments and wasted resources and you'll quickly understand that something needs to be done to reduce it.

It absolutely is. A lot of people who miss appointments do so because they are vulnerable. Memory issues, mental health issues, unable to get to a clinic or surgery. Or simply because they have missed an appointment sent out by post which was not received in time.

The best way to tackle missed appointments is by supporting vulnerable people better.

I’ve seen some amazing dedicated staff who truly do deserve a medal and others not so much. Too much standing round chatting at the nurses station when they were urgently needed. To the point I had to go up 5 times to tell them a patient ( not my relative) but old man in sane ward really needed help as he was in a lot of pain. The nurse was reading a magazine at the time and eventually sighed and chucked it down

Even though there are cockups along the way, I still think they are doing an amazing job.
Last Friday I went to see my gp and several referrals were made. I've spent the past week either attending those appointments or making them. Some I have the results back already.

One of the bad parts is there can be a lack of communication within some hospital departments. In the meantime, you are stressing and trying to get answers.

And some staff members attitudes. Earlier this year a few of us put in a complaint about how a nurse treated patients, and/or ourselves. It was like Jekyll and Hyde - lovely during the day but during the night? Not at all nice. I've been back since and nothing has changed.

Other friends across the country are also having excellent care. But again lack of communication etc are a common complaint.

Yes, of course, there are bad apples. Every industry has them, unfortunately. This is where the focus should primarily start. Weeding those out. However, that could also lead to an increased shortage of staff.

It absolutely is. A lot of people who miss appointments do so because they are vulnerable. Memory issues, mental health issues, unable to get to a clinic or surgery. Or simply because they have missed an appointment sent out by post which was not received in time.

Clearly there should be avenues to absolve the vulnerable who have genuine reasons. The disorganised or simply forgetful people, of which there are many, definitely should not get away with being wasteful. It is not privatisation to charge for outright negligent waste. As usual on here, default is to leap to the extremes and claim that everyone is vulnerable, has special needs, or similar. Sure, some are or do - so deal appropriately with that. Many aren't and don't - so deal appropriately with them. There is no mutual exclusivity required there. You can tackle waste AND take steps to protect those most in need.

I’m a GP. For me, 2010 was the real turning point and it’s been downhill since then.

Andrew Lansley (Cameron’s first Health Secretary) actually did even more damage to the NHS than Jeremy Hunt, as far as I’m concerned.

He’s played a game of divide and conquer with the NHS, with each sector now competing not to have to pay for things.

For example, I am increasingly spending several hours on the phone each week arguing with hospital consultants, telling them that as they have told a patient they need a certain drug, they can flipping well prescribe it and pay for it, rather than telling them to ‘get it from your GP’.

And the level of mind-numbing bureaucracy has increased infinitely since 2010. Something that pre-2010 required you to fill out 1 form now requires 3 forms. Procedures that I have carried out successfully for 30 years I have been forced to stop doing as I haven’t been on a course and got the new certified qualification (because it didn’t exist when I was training)...

As usual on here, default is to leap to the extremes and claim that everyone is vulnerable, has special needs, or similar.

Nasty, insidious comment IMO.

The disorganised or simply forgetful people, of which there are many, definitely should not get away with being wasteful

Why so punitive? And you don't have to have a diagnosed condition to forget an appointment without being negligently wasteful. I have only ever once missed an appointment (dental) by thinking it was later. I was undergoing cancer treatment at the time and was stressed to the eyeballs. Thankfully the receptionist was very understanding and was absolutely lovely when I burst into tears on the phone on realising my mistake. I did not get charged. That makes me all the more keen not to miss appointments.

As usual on here, default is to leap to the extremes and claim that everyone is vulnerable, has special needs, or similar. Sure, some are or do - so deal appropriately with that. Many aren't and don't - so deal appropriately with them.

Do you think a high proportion of missed appointments are simply because of laziness &/or inconvenience? It just doesn't make sense for me as most people only book an appointment when they need one & then reschedule their life around it, it's more of a pain to miss & reschedule surely.
Do you think the cost of paying someone to work out who is vulnerable & shouldn't pay vs those who simply take the piss will be cost effective. I'm not sure & how do we chase up payment?

Do you think a high proportion of missed appointments are simply because of laziness &/or inconvenience

Put simply, no.