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.

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?

I agree, this would be a real dilemma.

I would be dead without the NHS, my parents moved to the UK when I was a child as they couldn’t afford strips, a tester and insulin. A few year ago I had emergency surgery, the care from staff was largely excellent, I have also received almost ten years of support from the ED team and I’m finally well enough that I have been discharged.

People have no idea how much things really cost, when I needed a new epi-pen in the states I had to pay $360!

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.

I agree with this point. (Answered your first question before absorbed the whole of your post).

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

A fair number probably are. Even if it reduces by ten percent, surely worth tackling. We've heard from some NHS workers here about the lax attitudes they've encountered towards appointments. Similarly though, plenty will be mistakes and poor administration, which is a huge element of waste by all accounts and obviously requires tackling. As far as figuring out who is vulnerable goes, this should already be an established principle in many different aspects of NHS work. Again, ALL of this should be dealt with.

This must be a local thing. Part of me includes memory issues. Regardless of the nhs service, I use I get text reminders the day before with all the details needed. When I encounter a new service when booking I always ask if they do this. Some also send appointments out via email.

But again it's down to communication. Had I not specifically asked I would not have known

Surely if someone is vulnerable it will be on their medical notes even if only at the gp surgery? Certain health conditions would also be an indicator if they were just taking the piss or not.

As far as figuring out who is vulnerable goes, this should already be an established principle in many different aspects of NHS work. Again, ALL of this should be dealt with.

Very blunt instrument whatever it is. Doesn't replace proper compassion. Just puts people into boxes. Funnily enough whilst undergoing cancer treatment I was probably considered vulnerable. In one way I probably was however in another way I feel it takes great strength to go through this and keep it together by en large. For this reason I don't want to be labelled. It feels awfully reductive. I do like people to be able to exercise compassion and consideration though. IMO we all need this,

Surely if someone is vulnerable it will be on their medical notes even if only at the gp surgery?

I would certainly hope that vulnerability assessments are inherent to all aspects of a person's medical care. If they're not then they sure should be.

Yes, it’s under funded deliberately so we complain, the they take it away and say “see, this is what you wanted!”

Surely that’s obvious?

I once missed an appointment that I never received. They were really snotty about it and didn't believe me. I am really careful about appointments and everything is put straight in the diary, the letters go on the fridge in date order. I book my own blood tests in good time to make sure the results are available before my consultant appointment. I keep a separate symptom diary to maximise the time available in the appointment.
I plan my whole life around appointments, but so many get cancelled at short notice it makes life difficult.
I have a supportive partner who comes to all appointments with me and I work very hard to keep organised, even though some of the meds I take cause awful brain fog.
I cannot imagine how somebody more ill than me and unsupported would be able to navigate the amount of stuff I have to.

It’s not necessarily underfunded, but over staffed at management level and above. Big businesses have looked at profit margins by streamlining activities and how processes are done, particularly on the admin side, these needs to be done, I had a mole removed, sidpgned up for a virtual clinic, so they would phone or send a letter, ended up having an appointment that lasted literally one minute and a waste of everyone’s time, but especially the doctors. Things like this could be done via a letter freeing up clinic time. They need to charge funds for overseas visitors who should be paying, upfront. They need to charge for missed appointments, they need to listen to the staff on the floor about getting things done quicker and better but they don’t. Procurement savings could be made if they went back to a central point, imagine the deals they could get. It’s well known about the cost of medication such as paracetamol being cheaper to buy via Aldi than direct from the manufacturer. The real issue is that no government is prepared to take the challenge on because none of the unions are prepared to agree, that’s the unions for the doctors , nurses, admin staff and all the rest

I would certainly hope that vulnerability assessments are inherent to all aspects of a person's medical care. If they're not then they sure should be.

Really? I would like every person to be treated with consideration and compassion without an assessment. You don't need an assessment for this. Yes, know about how various conditions affect the way people will behave and function but there is still a need to be aware of issues or potential issues which an assessment might not cover or which might have arisen since the last assessment.

This is much easier when punitive measures are not in operation. There is much less need to find 'exemptions and exceptions' to a rule if punitive measures are not in operation. And the consideration is much more likely to reciprocated when people feel valued and understood. I would say stop trying to make NHS staff into judge, jury and police officers and start letting them behave like the compassionate health professionals the health service needs.

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

I agree with this 100%. This constant rhetoric of how amazing the NHS is, how grateful we should be and politicians saying ridiculous things like it’s ‘the best healthcare system in the world’ - when it definitely isn’t - reeks of brainwashing. It’s not fit for purpose but we’re all encouraged to not saying anything/pretend it’s fine and if we state the opposite we are seen as unappreciative or ungrateful for not wanting to put up with inadequacy.

I think there is, yes, underfunding, but it's also often really badly managed. And there's too much closing of ranks and bullying when patients complain or staff whistleblow.

I missed appointments because of domestic abuse (in the past) and/or having no money to get there (food and rent come first). GP knew but I was still told off for not attending. I've never just not turned up, always let them know even if on the day.

Admin don't always pass on patient messages. A while back I moved house. My GP moved a procedure to a local hospital. I called old hospital (weeks before the appointment) to let them know. Received a "you didn't attend" letter. Similar happened another time. I called to let them know I couldn't make it. No-one passed my message on.

I appreciate the NHS and DP is a paramedic, I think the issue is people exploiting it. No one works for the NHS for an easy life, but people constantly take advantage. I took my mum to a&e the other week and was furious at how many people were leaving because "it takes too long", DP went to a job the other week reported as losing blood to arrive to a nose bleed, not even a big one! It's not great, but I will continue to support it and you always have the option of private

I think we have more admin staff/management than midwives in our unit! The job titles are ridiculous.

It is underfunded and needs reorganisation but we’re very lucky to have a free service. DH is a GP and the NHS is not an easy place to work.

If we’re not careful we’ll end up with the US model of healthcare.

Really? I would like every person to be treated with consideration and compassion without an assessment.

Obviously yes! Why on earth would noting and considering a patient's level of vulnerability negate the need to be compassionate and reasonable to all patients? And why shouldn't the vulnerable be protected properly? I think you're probably over thinking the word 'assessment' there... It means being aware of, considering, in this context, and it certainly doesn't mean to the detriment of those deemed not to be vulnerable.

A huge problem for the NHS has got to be the sheer amount of people who go to the GP needlessly, or A&E because they can't get a GP appointment or don't want to wait when they can wait.

Just the other week someone posted on here about their DC being seen in OOH and diagnosed with a viral rash. She was going to go to the GP in the morning. Why? The child had been seen; had not deteriorated, there was no reason for the child to go to the GP.

There is a poster at least daily asking should they go to A&E? Sometimes yes, yes they should, but more often than not they are wanting to present at A&E because they couldn't get a doctor appointment/are not happy because the GP didn't give a referral or an antibiotic/A&E is closer (saw that one just the other day) - and a whole number of other reasons that are absolutely not reasons to present at A&E.

People go to the doctors with a fucking cold/slightest hint of sickness etc. Now in an ordinarily healthy person there is no need to go to a doctor with minor problems like this.

That's a huge drain on resources. One that drives me potty on Mumsnet every day.

Someone will come along and say 'oh you have been sick you might have some rare or tropical disease you must be seen' which just feeds the paranoia of the poster who in all likelyhood has a cold. It's nonsense.

Surely those that can't be bothered to turn up at an appointment who are then are presented with a £10 fine before they book another appointment are just going to turn up ranting & raving at the GPs, or claiming they now have a mental illness or will just go to A&E. I don't see how it's workable.

It is underfunded, to a degree.

BUT mostly it is mismanaged. In my job is get to know the senior management and practices of multiple NHS Trusts. The buck passing, refusal to make any decisions, abdication if all responsibility, etc. is mind-blowing.

Bullying is endemic, as is poor scheduling meaning staff get screwed around on their shift work, and the simplest of improvements don’t get implemented because management would have to ‘consult the union’ who, instead of simply approving the change, will bring up disputes from years ago and attempt to rewrite entire contracts...

I work very closely with NHS staff. They majority of consultants are incompetent managers with neither the skills or interest to manage staff or lead. Some of the nursing team leads are equally awful and responsible for high staff turnover and sickness. More money only papers over the cracks. The show is kept on the road by the staff that do try their best.

I absolutely believe that healthcare should be mostly free at point of use. But I don’t see how to transform the NHS into something fit for purpose.

To be honest I find it amazing that we have always got access to what we need when we need it. Of course there are issues but given how many people pay into it to how many that use it we can safety say it’s on it’s knees. It’s a shame because it’s something to be proud of. Of course you may get better treatment options if you pay private however if you can’t afford to pay private in my counties you’d be left needing, but here you’ll always be looked after

*many countries

The majority of consultants are incompetent managers
Errr... perhaps they are too busy saving patients lives you know like they are supposed to?
some of the nursing team leads are equally awful
Perhaps their morale is also at rock bottom from working in a shit environment where they are destined to fail?

I take it you aren’t clinical staff? You certainly don’t seem to have much respect for them.