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.

I think people should be given tax breaks if they chose to go private. There NHS is a huge bureaucracy that is good in dealing with some things eg acute issues with treatment options (cancer, heart disease) etc but absolutely appalling at dealing with chronic or life enhancing stuff.

The problem I have with GPs is that they are often gatekeepers and people don't get referred on soon enough and issues that could be well managed tip into crisis. GP refused to see my elderly dad because of Covid, didn't even ask to see a photo of the issue and just said chilblains, nothing to be done.. He's diabetic and his foot problems, developed into really bad infections, stopped dad walking and accessing other health services he needed. He ended up being under the care of the hospital podiatrist for 6 months, needed two appointments per week. How much did that cost the NHS? Surely more efficient all round for a GP to actually see my Dad in first instance?

Likewise, I am now on fourth phone call to GP re a skin issue. Have tried 3 different medications, no improvement - not entirely convinced diagnosis is correct as no one has viewed my skin directly, been working from photos. GP laughed when I mentioned dermatologist and said you'll be lucky, we don't refer unless critical / suspected cancer

@GelatoQueen Dermatology is a hard nut to crack, and their waiting lists are long -- four months' minimum here. Even with an urgent referral from my cancer surgeon, it was six weeks. If you can afford it, a private appointment would get you a proper consultation, diagnosis and treatment. It was the best-spent £180 of my life, and it opened the doors to the treatment I needed.

I think people should be given tax breaks if they chose to go private.
Only if they give up using the NHS completely. You can’t not pay the tax for the NHS and then expect to use it when you need it.

@Discovereads

Which is of course not possible.

Not today, but if government departments ever properly started to share information they could conceivably make a list of people who don’t pay NIC tax or claim a tax rebate, and so would be marked as private pay patients for anything/everything if they presented at an NHS hospital/clinic. To discourage this, could make it law that if one parent opts out, your children are opted out too and you need private insurance for them from birth to whenever they started working and could choose to opt in themselves.

R walker, well put.

@Discovereads

I meant its not possible to completely opt out of using the nhs.

Hope your treatment goes very well.

I think we would use the same Hospital, Derriford, 3 years ago, my DD had a skin issue, in out and operated on in less than 2 weeks from seeing the GP.

How things have changed :(

Re the tax breaks issue - my DH is waiting for a procedure on a skin lesion. If he didn't have to pay tax on the procedure he would go private thus meaning the NHS waiting list would be reduced. He would not be taking up NHS consultant time as the staff in the clinic that has been recommended by the NHS don't do any NHS work. I really don't understand why this isn't an option. FWIW his first dermatology appointment with the NHS was actually delivered by a private provider. the NHS and private companies are in partnership and have been for quite some time to keep waiting lists slightly manageable - it's not a Covid development.

I work in health - it's brilliant for some things and absolutely diabolical in the 'not life threatening but improves quality of life' sphere eg I think it is wholly unacceptable I can't access certain menopause medications (Scotland) and am actually now going to see a private consultant.

@GelatoQueen

Because your ohs tax is unlikely to even touch the sides of what your family will use from the nhs over your lifetime?

So its not as simple as not paying tax and then self funding 1 procedure

You're missing my point. I'm suggesting that for simple / one-offprocedures people should be given the option of taking a financial incentive on the cost of that treatment simply for opting out of NHS treatment and going private. Obviously we would still pay into the NHS via national insurance / tax.

NHS should focus on the things it is good at frankly. No amount of money will fix the NHS as it is a lumbering bureaucracy and money is wasted left right and centre, it's too inefficient, systems are poor and there isn't the right level of investment in posts at lower levels. It's very top heavy managerially. I work in health and it is very hard to make change.

@GelatoQueen

So basically you want the nhs to pay for your private treatment?

@GelatoQueen
No amount of money will fix the NHS as it is a lumbering bureaucracy and money is wasted left right and centre, it's too inefficient, systems are poor and there isn't the right level of investment in posts at lower levels.

This isn’t the case at all. The root cause of all the problems in the NHS is chronic underfunding. This is actually a situation where proper investment will fix the NHS. It was running fine when it was adequately funded..,so we know it’s not a problem caused by inefficiency or wasting of money. In addition, numerous international studies have been carried out comparing the NHS to other wealthy nations healthcare systems and the NHS is always in the top 7 worldwide as far as health outcomes and always #1 or #2 for most efficient/cost effective system. It’s cut the fat long ago, the problem is the chronic underfunding is now causing cuts to the bone.

I think the problem with the NHS can be boiled down to this: no government will ever be able to fund it adequately. Some might be more generous than others, but basically it's not going to be possible to do all that is now expected of our health service.

When it was set up in the 1940s, it was there to mend broken limbs, do necessary surgery, issue specs and dentures, give inocculations etc. Now we expect it to do an infinite number of things, and it just can't.

Mental health services - it will never be possible to fulfill what's required on the NHS. MH problems are chronic, often open-ended and complex, and very time-consuming sand therefore expensive to deal with. Very few people are going to say: 'Thanks for my 6 counselling sessions. All sorted now!" It's often a lifelong issue, and realistically can't be dealt with satisfactorily. I just think we need to be honest about this! Therefore MH provision will surely only be for the most acute cases. Otherwise the policy has to be prevention as far as possible. I we want it to be 'all things to all people' we will have to find other ways of funding it.

I hope the NHS will always be there for serous illness but when I wanted a funny mole removed from my face, they checked it out and since it was non-malignant, I then had to decided whether to fork out to have it done privately, and that's absolutely fair in my view.

@CulturePigeon

I kind of agree.

I think we definitely need a culture shift in terms if expectations of what the nhs is capable of funding.

At the moment people want it to cure every single ailment and minor concern. They even want it to be responsible for personal care.

They want it to keep every single person alive for ever, no matter the cost.

They even, it would seem, want ot to fund private procedures.

And when its pointed out that's not possible and certainly isn't possible on the underfunding its had for that last 10 years plus you get a load of guff about waste and inefficiency.

Healthcare and health promotion are expensive

We need to massively up funding. Hugely increase wages.

Focus on health promotion and prevention.

Seriously rethink elderly care.

Stop trying to force care in the community when there is no money for care in the community.

My friend was given a TWR referral 8 weeks ago and still hasn’t been seen.

Lump, inverted nipple and strong family history of bc.

First fuck-up: GP sent the referral via “the wrong system” which friend only discovered after 2 weeks, chafing the breast clinic and multiple phone calls to GP surgery in which receptionist and practice manager insisted it was the clinic that had lost the letter.

Second fuck-up: the breast clinic wrongly put the referral in the “soon but not urgent pile”. It was another 2 weeks before friend found this out because she’d been told in no uncertain terms that her TWR referral wouldn’t get any priority because the GP had fucked it up.

Third fuck-up: there aren’t actually any appointments to offer her. She is constantly told that they are trying to set up a new clinic but are “really behind”. I appreciate this is resources rather than human error, but there is surely a better time to communicate the “actually no appointments anyway” message than when the patient has already waited twice as long as they were expecting and is exasperated.

Only one of those things is actually about funding. The other two are just poor systems and processes (and people who cba to do their jobs properly).

If the GP or hospital only got paid when they saw the patient, you can bet your boots the service would be better. We need a model in which the money follows the patient.

Although GPs are funded by the NHS essentially they are their own businesses really and so there's so much variation. Myself and my child have been able to get face to face appointments (including smear test and imms) throughout covid and without issue; always on the same day aside from routine stuff which has always been a week or so.

What idiot designs a process like that? It's a joke

Nobody designs the process. That's the problem. The NHS is expected somehow to run efficiently with a much smaller administrative infrastructure than any private sector organisation.

There is no time to address quality of services - everyone is just firefighting the immediate catastrophe with inadequate resources, on unpaid overtime.

Thank you @Alexandra2001 for your kind thoughts. I'm all sorted for the time being, and have an option to self-refer back to dermatology if there's a recurrence. And yes, correct hospital. Extremely efficient once the motors warmed up.

Can't comment on that case, but I know locally a psychiatric hospital was due (and had been for many years) to close, there was an audit report on it and the Health Board were told in no uncertain terms that the fact it was due to close was no excuse for the state it was in and work needed to be done to maintain standards while there were still patients there. So yes, money can be spent even when it's known somewhere is going to be closed because certain standards are expected to be maintained as long as there are patients there.

@x2boys I remember being at Stepping Hill hospital about 14 years ago. I was in a surgical ward so ancient that it had pull-chain toilets, one of which was in the same room
as the shower for 12 patients whose bowels were in various states of disrepair. Meanwhile they were spending a fortune refurbishing the sweeping entrance to “Trust HQ” which they had thoughtfully installed the staff car park. The reason? Well the budget needs to be spent or we’ll get less next year!

Anyone who signed off on those budget priorities needs to be fired, frankly. It’s Orwellian stuff and far from unusual ime.

This was also mental health, however the wards were not due to be closed at all ,just refurbished and then closed down less than a year later ,it makes absolutely no sense .