To be very frustrated in A and E just now.

[changeitatanytime]

I'm in Scotland, was advised by my doctor to go directly to A and E as have been having shortness of breath for few weeks and today I had an episode of chest pain.

Arrived at A and E at 4 pm. Was told to stand outside as shortness of breath was Covid symptom. Then brought into own room so I'm isolated (negative LFT). Was seen by doctor fairly quickly and was told would get bloods done, an ecg and a chest X-ray.

Had my bloods taken at 5 pm and chest X-ray at 5.10.

I have now been sat in this room alone for 1.5 hours without anyone even popping their head in to let me know what is happening. And no one has done an ecg.

I understand that they are very busy but someone presenting with shortness of breath and heart pain not being checked on for an hour and a half? Surely that's not right.

I'm not the most patient person and can feel my heart rate going up and blood starting to boil.

Am I allowed to just walk out the hospital without saying a thing? Do you think I'm being unreasonable? What time should I give them to until leaving?

People don't want to hear that the structure is wrong, bad management, out of date processes, inefficiencies everywhere, bad procurement contracts.

They just love to stick it the labour gospel mantra of tories are underfunding it and it needs more money and its all the tories fault

Thats it, anything else like the actual truth is ignored.

I think it needs a complete reform from the bottom upwards, to be honest.
Massive savings could be made if it was run more like a business would be - for instance, the pp who spoke about letters and stamps.
My daughter has a hospital appointment on Tuesday. It was rearranged from August. Why in the letter telling us it was rearranged did we need another set of maps and FAQs? As the pp said, invividually it's coppers, but aggregate that against the number of rearranged appointments every week and you have a decent saving.
Another one. I was waiting for my booster jab this week and the queue was through outpatients. There was no fewer than five receptionists sitting doing nothing as the patients dribbled in for their appointments.
We are a small community hospital, so most procedures are dealt with at the bigger, county hospital. There were only 12 seats in the waiting area!
It's not the staff's fault, but there is so much waste, it makes you want to scream.
Another one - everyone waiting for their jab had to take off their masks and wear a NHS supplied one. What's that all about??
Anyway I am ranting now.

@Dreamstate

No, the truth is the NHS is massively under funded and thus under staffed and under equipped with too few hospital beds for the population.

You are only to happy to demonise the NHS staff as wasteful and lazy and that the structure is “bad”

The NHS has been studied countless times by independent bodies comparing it to other countries health systems and these studies say the truth. The NHS is actually one of most efficient and least wasteful of all health systems. It gets better outcomes per £ spent. The problem is the Gov spends far too little to cover the population we have. The supply is too small to meet demand.

U.K. is still #10 in the world overall. So the NHS doesn’t need a complete reform. It just needs to be better funded to get higher in the rankings. And it’s not a Tory vs Labour thing. Everyone’s been complicit in underfunding it.....they just justify it by lying to you about how it’s mismanaged. It really isn’t.

worldpopulationreview.com/country-rankings/best-healthcare-in-the-world

ceoworld.biz/2021/04/27/revealed-countries-with-the-best-health-care-systems-2021/

This article is from 2018, but it’s actually gotten worse in terms of resourcing for the NHS, so it’s still very valid today

www.theguardian.com/society/2018/may/05/nhs-lowest-level-doctors-nurses-beds-western-world

Our A&E has a wait of around 6 hours just to be seen initially, then if bloods are taken you wait for the results anything from 1-4 hours before the doctor will actually see you. If those bloods show anything and ylu need a scan, another 1-4 hour waif for a slot amongst inpatients needing one etc. If you are out of there in less than 12 hours consider yourself lucky. If you want to be angry with someone, be angry with the Tory government not the under-resourced hospital 😑

@MalbecandToast it's attitudes like that that I am talking about.
Don't blame the hospital. So it's the Tories fault that massive amounts, are wasted in admin? It's the Tories fault that te receptionist couldn't be arsed to phone me? It's te Tories fault my dad was directed to A&E NOW by his GP then has to wait four hours to be seen and another two hours to be collected, is it?
Of course it isn't - it's decisions made locally that could be changed locally but aren't because it's easier just to blame te Tories

@Katyppp I'm sorry your dad had a bad experience but if an A&E department has 139 patients patients in it ( like mine last Tuesday) snd only 2 registrars to cover these 120 of them not in the majors department, what do you actually expect them to do?! If they don't have the staff, what are they supposed to do?!

Actually in your case the time frames don't seem that bad, but my dad nearly died in an NHS hospital recently - taken by ambulance with a known to that specific hospital life threatening chronic condition, the paramedics told A&E what he needed yet he was left pn a stretcher for 7 hours before fairly simple life saving treatment was administered and he was admitted.

In the country I live in care is also free to everyone at point of use and nobody I know has ever waited more than a couple of hours - far less in life threatening situations or intense pain.

The NHS is a sacred cow, but a beoken one, and lots of countries have a social model of healthcare (nothing like the dodgy US model) which costs more for those who can afford it but covers everyone and works better than the NHS at point of use.

broken not beoken!

Not many countries, sadly, have free healthcare at the point of contact.

It makes me sad that the NHS is just battered, and in places it is broken, but that politically it’s a football getting kicked about. It is the Tories, it is years of under investment, it is also other political parties who haven’t negotiated well with the British Medical Association (Labour), it’s a lack of any long term secure thinking. So yes I”m not surprised a lot of staff are weary, sometimes not great, there isn’t a lot of good quality training etc.

But it really isn’t as simple as ‘bad management’ and huge admin costs that could so easily just be swiped away. In fact every government seems to think it knows best and the NHS has been chopped and changed, restructured so many bloody times. THAT in itself has been damaging. Tories are though, pretty toxic to the NHS, particularly now. Not everyone has been. The ones that leave it alone were the best!

@UntilYourNextHairBrainedScheme what country are you talking about?
And the reason the NHS is underfunded is that British people keep voting for low taxes. They don't want to pay more for healthcare either. I think they are wrong. But that is a big part of the problem.

Im not being funny but A&E is incredibly busy and stretched at this time of year anyway. They have to prioritise and for all you know there could be someone dying in the next room.

I also really worry, particularly in A&E and ICU, that Covid has stretched everyone. It really is in crisis. They just aren’t allowed to go public and say this. The covid case rates have been too high, for too long, and the hospitals are not coping. That on top of everything else.

@C8H10N4O2

But the NHS is bad because of bad management is a mantra that has been around for decades, and it just doesn’t hold up

But it does hold up that is the problem. Yes its underfunded but even in periods of good funding huge sums of money are wasted and its not always government initiatives.

There is no other sector I work with where senior staff actually boast about never having any other experience even within their own sector, let alone in any other sector. And gods forbid you suggest that possibly, just possibly there are some processes and practices in other sectors they could learn from. Every little fiefdom is run like a petty fiefdom. And we should all be "grateful" because its free. Patients are treated as if they should be grateful rather than accessing the service they pay for.

During the pandemic for the first time ever in my working life the fiefdoms collaborated because they were forced to - suddenly they had to play catch up in areas where they had refused to modernise just a few of their costly and dated processes and really dreadful employment practices. As soon as the first wave passed it was back to fiefdom mentality. There is no excuse for this and they get away with it because of the sacred caste status and mentality of the NHS.

All my life I've voted to support public healthcare financially but I've reached the point where the need for structural change and probably a model change is the only way forward to challenge that fiefdom mentality and the treatment of patients as supplicants who must be grateful.

All of this.

Until we are a grown up enough society to have proper conversations about keeping people alive indefinitely, properly funding care and restructuring the NHS we are screwed.

The current situation in the NHS is terrifying. We should not have to be grateful for receiving scraps of medical care in a first world country. The fact people are even saying that shows how terrifyingly dysfunctional our healthcare system has become and how worn down we are.

@C8H10N4O2 Honestly I’ve never seen any convincing data that the NHS is in a state because of bad management. That’s not to say there are not small examples, but I’ve yet to be convinced this is the main problem.

In periods of ‘better funding’ and let’s face it, it’s never been a river of cash, there are usually huge debts and backlogs to pay off.

On top of that, there are always new treatments, new machines and a rising elderly population so the costs are rising greatly year on year.

I worked within the NHS for 15 years for several trusts. They were all very well managed and saved money each year which went to a major hospital which was struggling. However things like the cost of prescriptions were ridiculous, drugs cost so much money and that is in the control of the doctor and patient which is very hard to influence from outside as management. So things like over prescribing for antidepressants we tried to reduce, but in no way was this ‘admin’. Admin takes up a minute part of the costs overall.

@C8H10N4O2
suddenly they had to play catch up in areas where they had refused to modernise just a few of their costly and dated processes and really dreadful employment practices.

Lack of modern processes and IT capabilities are due to lack of investment in future planning and upgrading to spiral in advances in technology. “Fiefdom” mentality is true, but again, that is caused directly by not enough funds to go around and so all the Trusts are competing with each other for table scraps. Everything you listed is a result of inadequate funding for operations and investment. So, no it doesn’t add up the bad management is the cause of NHS issues, it is actually a symptom of the chronic decades long underfunding by successive governments from all parties/coalitions.

“Fiefdom” mentality is true, but again, that is caused directly by not enough funds to go around and so all the Trusts are competing with each other for table scraps. Everything you listed is a result of inadequate funding for operations and investment

Having been in the room and watched vast sums of money spaffed up the wall because the fiefdoms couldn't agree with each other on said IT projects you are confusing cause and effect. This wasn't caused by fiefdoms fighting for money or a lack of overall budget it was caused because all of them wanted to be top dog or resist any change and most of all were absolutely insistent that they couldn't possibly learn from each other let alone other health care systems or sectors.

We are not only decades behind in health IT, records management, digitisation and business processes in the NHS because of funding but because of the intransigent resistance to change and lack of patient centred business processes.

I've worked for the NHS on and off under all varieties of government and this has never changed. I've also worked for other state backed health care systems with a more patient centred approach and seen the difference.

Until the fiefdoms work together instead of insisting each of them is unique and special this will continue.

Oh just to add - I don't disagree that budget per head of population for health care needs to rise which is why I've always supported taxes for health care.

I remain however skeptical about the benefits, having watched budgets rise and fall with neither achieving a focus on modernising business practices and moving to patient centred care. I don't think its an accident that haven't watched the NHS shackled from day one by powerful vested interests, other state backed health care systems all chose a different approach.

But it really isn’t as simple as ‘bad management’ and huge admin costs that could so easily just be swiped away

I don't think many people would suggest it is that simple by any means.
However , there is so much waste and poor use of money that could be fixed so very easily, it is fair to say that all of those small things would begin to help.

@C8H10N4O2
I remain however skeptical about the benefits, having watched budgets rise and fall with neither achieving a focus on modernising business practices and moving to patient centred care.

In my opinion, the base NHS budget has never risen enough to allow for forward planning or investment into modernisation/patient centred care. Everytime the government does an ear marked increase it is put against long overdue maintenance or to pay off debts. The only exception is pet projects done by ministers...ie the Covid app thar wastes billions because the cabinet thought they knew better than the NHS executives.

The resistance to change I have seen is from a viewpoint that they cannot sacrifice day to day operations effectiveness (allow a higher body count, risk more letha mistakes), in order to invest funds into long term modernisation projects. Projects which could easily be defunded in a matter of months in the next budget cycle at the soonest or the next government in a matter of a year or a few at the longest. The government funding cycle of an annual budget to cover only what you need now for the way things are now, doesn’t allow for large long term modernisation efforts. That’s why you’ll never herd all those cats into agreeing.

I can meet you half way as I can see it’s a chicken and egg effect in a lot of ways. And it’s why fixing bad management won’t fix the funding issues. I do agree that both need to be done together at once.

Have not read all posts but re hearing - staff can’t wear a cardigans/jumpers - bare below elbows for infection control.
Hospital masks are more effective than fabric masks to the pp suggesting this is wasteful.

All staff leave over Christmas has been cancelled in my trust.
Most people are working as hard as they can (as in every profession - there are a minority who are not great).

Heating not hearing !

Yes of course leave it’s reasonable for you to leave with a possible heart condition

just don’t sue the hospital when you drop down dead because you were impatient to wait!

@julieca Germany

Actually there are a huge number of countries with universal healthcare - obviously its never (including in the UK) "free" because it has to be funded from somewhere. In Germany the deduction through compulsory state health insurance is much bigger than in the UK in terms of % of income, but it's covered by the state for those earning under a certain amount/ on benefits. In the end its exactly as free as the NHS.

UK citizens often seem to think that free at the point of use healthcare only exists in the UK, but for residents of any given country it exists in lots of countries. Perceptions are twisted by the dominance of the USA in the collective consciousness because of media, but the obviously terrible (for the majority, brilliant for those with the best insurance) US model is absolutely not the "rest of the world" model and only alternative to the mess of the NHS.

All huge/ national state run institutions leak money but at root the NHS is grossly underfunded. The number of doctors per head of population isn't at a first world standard, and problems are compounded by the excessively revertant attitude to doctors (only doctors, not other essential healthcare staff, which is always interesting...) and to the sacred cow of the NHS itself.

In other countries nobody would defend waiting times of 6+ hours just to be seen in an emergency. The fact that, as someone said up thread, there might only be two junior doctors staffing an emergency department with 120 patients waiting to be seen isn't defensible - its not a case of "be grateful they're doing their best, what do you expect them to do?" its a case of being outraged that the staffing is approaching third world levels!

Yes, the UK population has got used to expecting to pay very little for healthcare - ridiculously little. In Germany healthcare alone costs 15.5% of income, with all the other things UK national insurance covers being deducted separately in addition.

It strikes me a lot of people prefer to pay a nominal amount for a nominal service in the UK and just hope it'll impact someone else, rather than actively wanting a better service enough to pay properly.