To think the NHS will eventually have to be privatised ?

[Felixsmama]

When the NHS was founded 1 in 2 people died before the age of 65. It's now 1 in 8, the last 10 years of people's lives can be spent with multiple co-morbid conditions which are expensive to treat and keep under control. The NHS wasn't designed for what it's not having to do, we have an aging population. Shouldn't we start to have conversations about what going forward our health service should look like? There's multiple models not just the US one.

Antenatal care. The appointments were booked for 1.30pm every time (no choice of time). I never waited less than 3 hours. I had to get cover for my classes every time - cover that wouldn't have been needed if they'd been honest and said the appointments wouldn't happen till 4.30pm!

In balance, I also waited two hours to see a private gynae a few months ago - she was very apologetic when she finally got to me but it was evident she's flooded with business (she also looks to be years over retirement age!)

Anecdotally I've found waits much longer in London/SE than Kent/the North. I guess it's pressure of population and high living costs deterring staff.

I'm struggling to think of a time where I've been seen within a couple of hours of an appointment time in NHS outpatients clinics (and we know what A&E departments are like so lets focus on the more predictable workload).

In effect, a hospital appointment is at least half a day out of work. You might think that would be more predictable in an era of phone consultations but no - the window offered was a date, not a time. So sitting by the phone for as long as it takes, hoping to gods you are not in the loo when the sacred call comes.

Or take the case of a friend of mine who due to a condition of birth needs a minor procedure every six months. He goes in so that a nurse can flush a tube - takes about ten minutes in the relevant outpatients clinic.

You would think that the sensible thing to do would be to make the next appointment when he is there? No, he can't make an appointment at all. He has to be issued with an appointment by the system He then has to reorganise work and life around that but if he really can't (eg the date of his son's graduation) then he enters the hell that is "choose and book". He has to phone first to cancel the appointment. When he eventually gets through the admin can't actually give him a new appointment on a suitable date - no he will be issued with a new appointment from the system. If that is a date he can't make eg he has holiday booked then he is flagged as two missed appointments and goes down the snake to the beginning of the game and misses out that half year appointment.

Its kafkaesqe and every one of the little fiefdoms has its own arcane appointments system because gods forbid that one fiefdom might actually learn from another let alone other industries.

Look at the antique business systems run in most health organisations with large parts of records still on paper/printed out and a level of manual data entry which is frankly terrifying and explains a lot of the records problems in health. That isn't a problem a cost its decades of "we can't learn anything from outside" and a fiefdom mentality. It does however cost money, patient time and well being.

@C8H10N4O2 We ve been mainly to Derriford, Plymouth, eye and vascular departments, yes i agree its half a day out, travel to hospital, park, walk to dept but we have never waited more than 30 mins, the time in dept varies but rarely more than 1 hour.

FiL went in for an op yesterday, quick and efficient admission, pre op checks done last week which was for a total of 3 hours, so hopefully these visits will stop.

Its not as if Derriford is a highly rated hospital either and its huge, covers Plymouth plus a large area of Devon and East Cornwall.

So yes it can be done within the NHS and under current structures.

Totally agree, AE is a mess, not least because of poor discharge rates on the wards into the community, lack of care packages.

Look at the antique business systems run in most health organisations with large parts of records still on paper/printed out and a level of manual data entry which is frankly terrifying and explains a lot of the records problems in health. That isn't a problem a cost its decades of "we can't learn anything from outside" and a fiefdom mentality. It does however cost money, patient time and well being

Upgrading a very large non structured cabled building to cat6/7 is extremely expensive & disruptive, then you need all the hardware and s/w to run electronic note keeping plus all the GP surgeries have to all have joint access, then you need all the network security firewalls and staff to run it all.....

Derriford uses paper records (in the main building but electronic in the smaller off site departments) and was built long before ethernet.

I have been in and out of outpatients in ten minutes. Nearly caused a riot in a waiting room once as people were waiting for another clinic for hours. I walked in with my DP a bit early. Got called in within seconds, and back out five minutes later.
I have also waited a while to be seen, but never that long. The issue is that Consultants covering outpatients can get called away for an emergency in another part of the hospital. So patients just have to wait.
It is about not having enough Drs who can only do outpatients and not have to be on stand-by. But even then the unexpected can happen. I have seen people admitted from the hospital at what should be a routine outpatient clinic.
I wish they would do the check-in appointments that do not need a physical examination, over zoom if patients want it.

Lots of big IT projects in the NHS have cost a fortune and failed to deliver. It is far more complex than people realise.
There was an attempted plan to link up GP surgeries and hospitals, but so many patients opted out of it through submitting a form, that it was shelved. They opted out because of fears the Conservatives were going to sell health data to US companies to make money.
No point building a vastly expensive IT infrastructure if a sizeable number of your patients opt out of allowing their data to be shared within it.

Derriford may not be highly rated, but I'd agree that it's generally well run and organised in the departments that I've seen most, which are breast cancer clinic, dermatology and oncology -- with the proviso that it can be very slow to get the care process initiated in dermatology. Once I was inside the system, my treatment (phototherapy) was incredibly efficient: twice a week, in and out in under 15 minutes, with reminders by text and a direct line to the nurses booking aand running the clinic. Oncology appintments often run late, but it's not inefficiency as it's mostly down to the complexities of each patient's needs. Brilliant, but I am retired; it would have been much more difficult during my career.

A&E is reputed to be mostly at critical though.

However, the loop back to the GP is always erratic. I have a procedure next week that requires blood tests 48 hours before, but the surgery won't make an appointment without a letter from the hospital, and that hasn't arrived by post yet. The appointment system tried to email it, but the message couldn't be delivered because the GP email is migrating to a new platform. Fingers crossed!

Oh, I forgot the eye appointment that took 7 hours. I became increasingly worried about an elderly patient waiting at the same time with no-one to advocate for her (I tried, and I also complained to PALS afterwards and they told the dept they must provide a whiteboard with approx waiting times on). It is worth telling PALS. Departments and experiences vary a lot.

I had a long wait for an eye appointment, although not seven hours! But the same Dr covering the clinic was also covering emergencies. So not surprising. I do not know if that was always the case or if they were just short-staffed on that occasion so he was making the best of a tough situation.

I think whatever the situation, most people will understand but it is really vital to tell patients how long approximately they may be waiting. I was so hungry as I didn't dare leave the room as I had no idea how long it would be, wasn't sure whether to dash out and get more car parking, not sure if I needed to get someone else to pick DD up from school etc. I thought a £1 whiteboard was an excellent solution but it really shouldn't have been up to me to point out the need...

I will also add for fairness that the private service where I waited 2 hours or so was also crap at communication, but at least they had a reception, even if it was staffed by unpleasant people. The NHS service, I had to follow a HCP down a corridor and into a room to get an update on wait times! This is no joke when you have an eye injury!

But that is because the government keep demanding that administration in the NHS is cut as it is "wasteful". That includes receptionists.
The reception in our local hospital is staffed by volunteers.

@AndreaC74

Who waits hours after their appointment time? is that common?

Yes, some NHS depts still operate the "give everyone the 9.30 appointment time and let them wait in turn for the consultant". So some are there from 9.30 until the morning clinic finishes at 1pm. I'd have expected that kind of nonsense to have been stopped due to the infection risks (covid etc) of having loads of people sat around waiting for long periods in small waiting rooms, but apparently it's still done!

I had to wait with my OH for his oncologist appointment a few weeks ago. Waiting room absolutely jam packed full at 9.30 (his appt time) and we finally saw the consultant at 12 noon, and we watched as most of the others in the waiting room went into the consulting rooms over those 3 hours, with barely anyone new arriving. And that was oncology, i.e. loads of people probably with compromised immunity due to cancer treatment! It was absolute bliss during the covid restrictions when they had proper appointment times and there were usually only 1 or 2 people in the waiting room.

Look at the antique business systems run in most health organisations with large parts of records still on paper/printed out and a level of manual data entry which is frankly terrifying and explains a lot of the records problems in health. That isn't a problem a cost its decades of "we can't learn anything from outside" and a fiefdom mentality. It does however cost money, patient time and well being

My OH got referred to a different hospital for a potential bone marrow transplant, and we were gob-smacked to see him with 2 computers on his desk. One was an old one, with old fashioned green lettering, which looked like an 80s/90s DOS computer, which he used to view blood test results, then went back to the modern windows one to look at x-ray and MRI scans. Frightening stuff if they're still using DOS machines! That means they're having to use duplicated networks, probably a Windows based network and a Novell network for the DOS systems.

(By the way, the consultant needed his own blood tests, x-rays and MRI scans done in his hospital as he wouldn't accept the ones done by our own hospital oncology despite them being in the same local NHS trust - so that was a massive waste of resources in duplicating a whole suite of tests that had already been done by a different oncology dept - I wonder how many hundreds/thousands of pounds that cost!)

People have explained on this thread why very expensive private sector delivered IT projects for the NHS have failed. There have been several attempts to tackle this issue. It is a far more complex issue than is often realised.
The NHS now includes state-run hospitals, different private sector providers, charity providers and small businesses. Incorporating them all into one IT system is a nightmare. It is why my ex-GP had to fax a prescription to my new chemist in Scotland before I had managed to register with a new GP. The Scottish and English IT systems are not compatible.
Every attempt to change this has been scrapped as governments realise the vast cost of doing this.

Private hospitals have the choice of contracting out, and do so if it makes sense financially and operationally, and it's reversible. The NHS hospital doesn't have this choice. Every single contractor bids and takes on a service if and only if it makes enough profit for their owners. Back at the ranch the NHS has also spend on "buyer" capacity to manage those contracts they had to contract out. Does anyone think this might have something to do with costs apparently rising above those in comparable economies, or is all to do with NHS waste?

It needs looking into properly, however since it is not in politicians' interests (given what voters are baying for) and everyone has some outrageous story to share about patient and hospital behaviour, do the adults in the room give people what they ask for, or ignore them? Such as culling populist-labelled "dangerous" dogs, when vets have to say no way are we culling perfectly innocent animals following a tragic event that is not breed-related.

@maryso Agreed. Contracting out costs money. Managing those contracts costs money. It is a political decision.
And the cleanest wards I have been in and with the best food is where this is done in house, rather than contracted out.

At my last eye appointment, we went in at 3pm-ish and didn't get out until almost 7pm. It was mostly waiting around.

Audiology / ENT aren't quite as bad thankfully.

Thing is that you don't need to integrate it all into a huge single IT system. That's where they have gone wrong. A single huge database is nonsensical and there's simply no need for it.

It's the data that needs to be shared, and that can far more easily be done by data links between systems. What you need is "common" tagging of the data and a common method of identifying the data, with a suitable "data highway" that transmit data as required between the different systems.

That's the direction of the NHS databases these days. Different "providers" or departments can access the data they need (and only that) from other connected systems. It's very slow progress.

Early stages were as simple as there being a database of pharmacies, linked to GP surgeries, so the GP surgery can select a patient's preferred pharmacy from the list, and then establish a data link so that future prescriptions can be "pinged" to the pharmacy rather than walking round or faxing a paper prescription. That's a very simplistic example of data sharing, and took a long time to set up, but it's been a revelation. Pharmacists don't have access to your GP records, but have access to specific data they need, i.e. the prescription!

That kind of data linking is happening across the NHS. It's a shame that so much time and effort was wasted on a super NHS network linked database, but years ago, it was thought to be the "right" way to proceed, but now we have better software, better internet, etc and means of data transfer is completely different compared with 20 years ago!

@Kazzyhoward

No one uses DOS based networks, that hardware, let alone the s/w is unobtainable.

What you might have seen is specific program run in compatibility mode or DOS box.

My old company did loads of IT work for the NHS, they ve had a massive upgrade to Win7 and now Win10, they use thin client, which won't run on older operating systems..... but what is surprising is two major (private) supermarkets still use XP to run their tills......

@maryso

Private hospitals have the choice of contracting out, and do so if it makes sense financially and operationally, and it's reversible. The NHS hospital doesn't have this choice. Every single contractor bids and takes on a service if and only if it makes enough profit for their owners.

But NHS trusts are also free to bid for services against the "private" contractors. I have diabetic eye tests. They used to be done by my normal optician, but the local NHS decided that it would save THEM money by contracting out the photography of the eye and let the regular eye tests be continued to be done my normal opticians, funded out of a different NHS budget! (The NHS pseudo open market at it's best that costs the NHS more overall by putting higher costs through different trusts - clear that - not!).

Over the years, the diabetic eye screening has been done by lots of different NHS trusts, never by a private contracted firm. Sometimes by a neighbouring NHS teaching hospital trust, sometimes by an ambulance service NHS trust, sometimes by our own nearest hospital NHS trust. Heaven knows how much the procurement, bidding, set up, disbanding, etc costs are - it must cost the NHS a hell of a lot more by constantly changing the different NHS trust to contract out the work to. They even buy different equipment, a different van, etc each time the contract is awarded to a different trust, alongside different premises - sometimes done in the GP surgery (presumably they rent a room), sometimes in a health centre, sometimes a clinic, sometimes the hospital out patients. It's all nonsense to try to save a bit of pretend money but it all costs more and all paid out of the NHS total funding!

@Kazzyhoward so basically there's no profit in these services for private contractors, however the NHS is forced to continue with this game, not of their choosing, and still get accused of waste. Surely if it's so easy, some company in the market (including HCPS who are always looking for opportunities) will do it fo cheaper?

Or the trust could just do it in house without contracting it out at all, thus saving all the time/cost/waste of regular changes in "supplier". The NHS "internal market" just seems to make things worse rather than better.

The NHS internal market was created so that private companies can pick off the easy bits and make lots of money from them.