I think the NHS could be fixed, AIBU?

[Dreamer14]

i am inspired to write this thread after two events:

1. my kid needs to see a doctor for a face to face appointment. A part of her body needs examining, in person. I have tried the virtual GP service. They were useless. It’s also not possible to get a face to face appointment in my GP surgery without first doing a stupid phone appointment.
2. my relative has an infection. She’s had it before and knows she needs antibiotics. No one will help her. 111 say go to GP. GP say no appointments.

Surely we can do better than this?

Ideas I have;

• give people more choice about appointments… if it is inefficient to do a phone one let’s not force people to do it
• we need to open up more GP surgeries and hospitals
• We need a separate service for elderly people -so many don’t need to call 999 but have no choice as there is no help elsewhere
• we need to help mental health patients before crisis (watching Ambulance the other day, so many people calling 999)
• We need to get with the times… stop sending letters and start Emailing people. Or texting. The NHS IT systems and processes are shameful.
• payment for some services (I’m happy to pay a small amount to my GP)
• attract more people to NHS jobs. I’d love to work helping people. But I’m a mum of 3 and I can’t afford to retrain. Some of these jobs could be done on the job and salaried. I’m not gonna pay £30k to go to uni for 3 years to be a biomedical scientist.
• sort salaries out. How much do execs earn? How many woke jobs can we do away with?
• I think we should pick a few areas in the uk and trial different things In Each one. Then we can scale up if it works.
• strip it back to only crucial services. Nothing woke. If you want something doing that is beyond the list. You pay for it.
• I’m a supporter of people that want to pick when and how they die if they get given an awful diagnosis. There are many people that get diagnosed with terminal diseases and don’t want to suffer.

ultimately we need the government to spend more but we also need the nhs to spend better.

@ITUnurse

Yes. I know.

I just think it would be a slippery slope but that's the way it's going anyway

On the degree front it's funny you never hear anyone saying oh, we cant recruit doctors

We should make the medical degree easier /scrap it. There's lots of people who could do it if it wasn't so hard

🙄

I agree it should be a degree but not passing someone because they didn't do the correct Harvard referencing on their research proposal is harsh. I had a fellow student who attempted suicide because she failed an essay three times due to that.
In the grand scheme of things are essays and dissertations really needed in the course to be a nurse/midwife when the NHS is suffering?!

If they just charged people for missed GP appointments that would save the NHS £216million pounds per year.

It would not, because issuing fines in itself is costly - there aren’t magic admin fairies who sort out fines for free - it would require paying for a whole new system and employees to manage them. Or should the already busy receptionist, who can barely cope with answering all the phone calls they receive daily, add it to their workload?

I agree it should be a degree but not passing someone because they didn't do the correct Harvard referencing on their research proposal is harsh. I had a fellow student who attempted suicide because she failed an essay three times due to that.

In the grand scheme of things are essays and dissertations really needed in the course to be a nurse/midwife when the NHS is suffering?!

To be brutally honest - yes. I’m sorry for your friend’s experience and I hope she’s in a better place mentally now, but nursing requires a high standard of being able to do things with accuracy. People’s lives can depend on it. Harvard referencing is a pain the arse, but not so hard that you fluff it up three times in a row or even two. Most students, of all subjects not just nursing, manage to get it right the first time. If she couldn’t get her head around that I’m not sure I’d want her to be administering my child’s medicine or writing down important information on his medical notes.
The NHS is suffering yes - but dropping standards is not going to improve things. That’s just asking for big trouble.

I agree. AHPs also have a far lower % vacancy rate than nursing and all have degrees.

It is a slippery slope but the public can't see the wood for the trees. Fantasising about matrons and nurses being handmaids. I don't know how it will ever be fixed, some shifts I wonder is this it? The end of the NHS

My failed name change 😂

I think we need to look at how it works for eyes. On the whole it seems to work, you go to the optician, you get a free appointment in certain instances, otherwise it costs about £20. If you need a referral they can make one. While you might wait a while/ages for things like cataract operations, other services seem to run smoothly and appointments come through quickly. For example, my husband had laser treatment for glaucoma/ocular hypertension last year and only waited about 4 weeks on the NHS. While his appointments tend to be a little less frequent than they are meant to be, they do happen(eg doctor says see you in 4 months and it will be 5-6 months).

So what's good about eyes and how is it working reasonably well? Can the model be used for dentists? Can it be used for GPs?

Is it simply that people like to work with eyes so there are no staff shortages? Or it is the model that works?

It's not perfect but it does seem to be much better than other areas of medicine.

It does need fixing but this isn't a quick fix. Money needs to be put into recruiting, training and retaining staff. Not just medical staff but admin as they're stretched too. The funding needs to remain especially as we have an ageing population.
IT systems aren't great (I had a consultant have a brief moan about them). I agree about the use of email/texts away from paper but patients need to have choice as I know my elderly dad prefers a letter. Overhauling processes within such a huge organisation is a massive task. I've dealt with 3 hospitals recently and they all work differently. Where to start? This needs money as the people who would need to do this will need to be paid as they would in any organisation. It does need to be more efficient though.
What is classed as essential? I think this is very dodgy ground and don't agree with only treating certain things as where would it end? I had breast cancer, as part of my treatment I had a mastectomy and implant reconstruction (in the same surgery). Is the reconstruction essential? I have also been given the option to have symmetrisation surgery as my other boob is obviously less perky than the implant side. Is that essential? Yes, I am very conscious of it and won't wear a swimsuit as I look wonky.
From my own experiences of the NHS in the last 18 months, a lot of it is great but I don't think patients should have to follow up when they haven't heard about appointments. I chase up or query but not everyone does. Our GPs use enconsult and I find it works well but this varies so much between surgeries.
Paying for appointments, no as it will stop people attending. I've also been questioned by someone (a supposed friend) about me qualifying for free prescriptions and how it's unfair they don't qualify.
I could go on......

whose that? How much will it raise? How will you enforce it, etc.

If they just charged people for missed GP appointments that would save the NHS £216million pounds per year

pre covid I would have agreed with you, but people don't get the face to face appointments to miss these days

(you can't fine people for missing phone calls)

Perhaps it would help if people started taking some personal responsibility for their health. Apparently almost 50% of cancers are caused by lifestyle factors, smoking drinking obesity etc. I’m sure it’s the same for other illnesses.
Unfortunately people want the NHS to fix them rather than doing anything themselves.

agree with a lot of your post op. I also think there is a lot of scope to get rid of public health people and similar. There are a multitude of them doing very little but getting paid a lot. Never ever made redundant either nor are jobs externally filled. It’s corrupt. no need for diversity consultants either but a competent hr system would help a lot. Maybe even these functions should be outsourced.

Administration is terrible too. That would sort a lot and save a fortune if that could be fixed. And we need much more drs, nurses and dentists.

I think we do need to have some sort of conversation about what is essential and what people should be asked to pay for, or at least contribute towards or pay insurance for.

I would not put breast reconstruction into the category of non-essential as it's a clear consequence of having cancer. Neither would I put breast reduction into that category as it is much healthier to have smaller breasts, better for your back etc, and it will reduce the need for healthcare in the future.

But there are other things that should be paid for/insurance used for. However, I suspect that most of the things people think can be done on the NHS and shouldn't, are already excluded. Maybe we need to think about requiring people who indulge in extreme sports to take out insurance. While I wouldn't describe cycling as an extreme sport, I am a member of Cycling UK, which provides insurance for various things. Maybe it could provide insurance for healthcare needed for cycling accidents at a slightly higher membership fee. If you run, you could pay a little more to UK Athletics to cover physio for running injuries etc (to be honest I think most runners pay for their own physio anyway). Just examples of thinking around the issue. The NHS can only really do A&E and life threatening conditions properly - I think we need insurance/affordable self-payment for quality of life issues.

The NHS is always saying it can’t recruit doctors.

I do think though there is a point there. For example creating physician assistant roles like in the USA. Upskillling more nurses and so on. But we do need to train more drs too.

I have a question about the "woke jobs." Black women are 5 times more likely to die during childbirth. I contributed to and was part of a study that looked specifically into the experiences of Black mothers during their hospital stay/treatment - a lot of them reported being treated in a condescending manner, being told they are 'strong black women' thus pain relief wasn't forth-coming and when asking questions would be told they're being 'difficult' or told they had 'attitude'. I wonder OP, do you agree that training for HCPs on areas such as this is a waste of money? Is it too woke? I suppose so because the lives of Black mothers is of course just a bit too expensive. I'm with you! Cancel the 'woke' services!

A registered nurse absolutely does need a degree. It is a highly specialised, skilled role and requires advanced scientific training. My argument is that a paid apprenticeship is a perfectly good way to get this degree to make it accessible to more people. I have a few family members who did paid apprenticeships to get exactly the same degrees that their contemporaries got into a massive debt to do. It takes a bit longer, but at least they got paid a wage along the way.

Right ambition, wrong execution. There’s a lot of wastage in the NHS, but it’s depressing you went for the word ‘woke’, as your tone suggests you’re outraged by it but only because you read it somewhere that told you to be outraged. Please do give your own definition of this woke problem, and one that is grounded in reality rather than a strawman. Bet you can’t! Frankly I’ve never met anyone who uses the word ‘woke’ that way is able to give their own definition, or indeed one that reflects reality in any meaningful way.

Public health is a vital service, staffed by properly qualified people. If enough extra funding and clerical support had been put into local public health services to do the contact tracing for covid we would have been a lot better off. Instead they put that ridiculous Dido person in charge and wasted an absolute fortune.

@Fairyliz as someone who has had cancer I find your comment very insensitive and a load of bollocks too. What is your source of 50% being caused by lifestyle?

Perhaps it would help if people started taking some personal responsibility for their health. Apparently almost 50% of cancers are caused by lifestyle factors, smoking drinking obesity etc. I’m sure it’s the same for other illnesses.

Unfortunately people want the NHS to fix them rather than doing anything themselves.

I think in many ways it can be more complex than simply taking personal responsibility. For example, so many children are now obese and for them to ever get out of that cycle of eating too much and not exercising - which is all they’ve ever known, their brains and bodies are not wired to feel what’s ‘normal’ - is going to take more than the average persons’s will power once they are adults.

But more efforts - which include education, policies, money and yes absolutely personal responsibility - should be aimed at preventative support and measures where possible. I think we are trying to do this, but clearly not to the extend needed to make any difference. I think it was mentioned in a thread just the other day that, where focus on childhood obesity was a big thing just a few years ago it’s barely mentioned in the media anymore. It’s like we’ve given up or forgotten about the problem as a society at the moment. Healthy eating and lifestyle initiatives quickly come and go and they are always a bit half hearted in my opinion.
So we in fact with a more American model which focusses on cure and medical management rather than any prevention, but without the money and facilities to be able to do so.

@MsPincher

Its already happening.

ANP roles have been common place for around a decade

I love that these threads are full of great ideas that will fix everything, except the vast majority are already in place

@Vinorosso74 Im so sorry you are going through this and it wasn’t meant as a personal attack on you. But would you be totally surprised if somebody who smoked got lung cancer?
This is American research so the numbers could be slightly different for the U.K. but the general sentiment is the same

www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/

@ITUnurse i think we need to be honest about the fact not so many will be as intelligent and highly trained as you. Whilst your work is highly specialised (and needs to be) - your nursing is world’s apart from the counter-leaning, patient-escorting types propping up the dermatology day clinic!

Problem is there is still an assumption that most cancer patients made a lifestyle choice which caused their cancer. Most didn't and this doesn't help. The percentage isn't as high as is often quoted. Some cancers have a higher risk with lifestyle choices than others. Most smokers won't get lung cancer, yes it increases the risk of other illnesses too.
There are so many questions over why some people get cancer and others don't.
As people live longer, the risk of cancer becomes higher.

@BuenoSucia

Presumably the nurses propping the desk in dermatology will be highly skilled in dermatology?

Although tbf I agree not all clinics need s/n but that's not argument against nursing being a degree course. It's an argument against clinics not all needing s/n