If you work in the NHS, how would you fix it?

[startingitallagain]

Or AIBU to think it can't be fixed and we're gradually slipping down the slope of eventually not having an NHS?

I do absolutely understand how many staff within the NHS are struggling to cope under the pressure, with many leaving due to their own mental/physical health issues that the job has caused.

This has been inspired by another thread where the poster can't get a GP appt for their father who has terminal cancer and can't keep food down (and hasn't been able to for a number of weeks). www.mumsnet.com/talk/am_i_being_unreasonable/4708090-to-wonder-what-my-gp-surgery-is-actually-doing?page=1

With elderly parents myself and having to occasionally battle for them to get care, I find the prospect of getting older in this country quite terrifying, so much so I think I'd rather plan for euthanasia if I was facing end of life and no care!

Is it funding? Is it lack of staff? Would more money solve the issue? WWYD?
(As an aside I remember watching the documentary 'Can Gerry Robinson Fix the NHS?' a number of years back - made interesting viewing about the issues then!)

This week I had a letter reminding me to book a COVID booster. 6 pages in colour with pictures and font 24. Totally unnecessary

I am a tax advisor. My colleagues advise NHS trusts in how they can recover VAT. We only work on big projects but there’s lots and lots on VAT what these trusts could be recovering from HMRC on day to day purchases that goes unrecovered due to the trust not employing a full time tax advisor. Employ one person, pay them approx £70k a year and they’ll save the trust over £1m a year. That’s what private companies do. The likes of NHS trusts don’t see this as a necessary job though so the money goes unrecovered.

I would work on removing the obstacles that prevent staff from working effectively. The beaurocracy, the micro-management, the excessive hoops we have to jump through to maintain professional registration, the meetings that could have been emails, the rigid and inflexible rules that govern recruitment, and all the meaningless non-jobs.
I'd also reverse the decision to outsource support services to private companies and go back to employing our own cleaners, porters, car park attendants etc. Then we can directly address shortfalls that prevent us from running an effective service. (Eg, Clinical staff having to remove themselves from busy departments to collect ward patients, due to a lack of porters!)

@OverTheRubicon I don't think there are many people who don't work & are in full health & receiving benefits (if you exclude pensioners). I also know people who work with chronic conditions who get that certificate thing.

I do believe children should get free prescriptions though as I think that's better for society.

I’m sure it’s still the case if your epileptic you get all your prescriptions free
of course epilepsy medication should be free but why do you get all your unrelated medications free as well pay for them like everyone else

This is a great thread with some excellent suggestions. If only the Government would conduct a similar exercise..

Yes there are problems in the NHS but it frustrates me so much that people are not talking about Social Care. The NHS would function far better if people were able to be discharged when medically fit. We spend so much time and energy on trying to increase discharges but it basically means encouraging staff to be able to accept more risks for patients on discharge and get them home without extra care where possible as there is no care available for them.
There are plenty more risks associated with staying in hospital and delayed discharges mean people then catch other illnesses from other patients, or become deconditioned and institutionalised to the point where they may never manage at home again.
Patients and families fight to stay in hospital because they feel safer but they really are not s safer.
This week we had one family member refuse to give her mother's front door key back because she thinks she should be in a home. This lady wants to go home and it's stuck in hospital whilst we are treating people in corridors in A&E. Another man needs his bed moving and his family cannot do it until next week and he refuses anyone else to go in and do it, so he blocks a bed for a week whilst there is nothing wrong with him. There are so many scenarios I could tell you, that is just 2 from yesterday alone.
The NHS needs the general public to also take some ownership of their health needs. There is great too much entitlement around.
Please all make a plan for yourselves and your elderly relatives where you can. Have discussions about the future. Make sure you downside and live somewhere sensible and manageable before you are unable to manage steps and stairs.
Get the GP involved to get DNARS in place and future wishes recorded and known.
Sort out power of attorney for finance and for health and wellbeing. But also understand that your elderly relatives get to decide what happens to them unless they lack capacity. You are entitled to say you will no longer run around after them providing care but you are not entitled to say they cannot return home.
I would say that several times a week in just our one hospital, we have family members who have moved into( or never left) their parents home, saying they will not have their parent home again. We ask who owns the home, always the parent. We explain it is their home and the relative can leave if they want but they cannot stop their parent returning to the house they own but we have had patients returned to the ward because their relative would not let them in to property. We have had to involve police.
We have husband and wives refusing to have their partners home because they don't like them any more. We have to explain they cannot stay in hospital but need to get advice re divorce but we cannot keep partner in hospital until that is sorted out!!
What I am trying to say is, yes, the NHS has problems but they are exacebated by a breakdown in society generally and a complete breakdown of social care.
I don't have the answers but if there were adequate sorry both formal and informal in the community, the NHS would be under far less pressure.

What is missing in NHS management is good management skills! Most of them are crap managers and you see the Peter Principle in all its glory. Things are so inefficient and poorly run that you can't get rid of the crap and they get promoted out of the way and just compound the problem elsewhere.

Bullying is rife and it is a toxic environment all in all. One of the issues is that many/most NHS employees have never worked anywhere else. They see shit management and think that is how it is supposed to be. A well managed, motivated workforce who feel valued and appreciated has already won the biggest battle.

I know when I go on a ward and it's a dump, dirty, maintenance jobs not reported, staff shortages etc, that the senior ward staff will treat me like shit on their shoe. When I go in to a clean well run ward with happier staff I will be treated well. Good ward 2managers see everyone as a team with housekeepers, cleaners HCAs etc being treated as valued members of the team and it shows through the whole ward experience.

"Fire all the managers and hire more nurses" is the taboild opinion of someone who has no idea how the NHS works and what its problems are. It's amazing how prevalent that view still is.

@vdbfamily we have sorted wills, poa & funeral arrangements with parents & in-laws. However they both will not downsize & shut down any conversation. They talk about needing to do it & how the house is too big etc but never now. It won't happen if you go beyond a certain point.

oh & they are very against stamp duty!

I hate this frequently made comment too. See also 'fire all the bean counters' as commented by a PP.

I disagree with that. Prior to working in the nhs I worked for a very large national organisation with thousands and thousands of employees. We went through a restructuring process with external people brought in to make the decisions. A lot of middle management and specialist roles were lost/streamlined.

It worked, the company was just as effective and saved money. Obviously there needs to be finesse in the process but the nhs is currently at that pre restructuring stage and something needs doing.

And I’m not saying fire all the managers but it seems you can’t even have a conversation along these lines of there needing to be some positions lost without being accused of having that opinion.

There are less managers in the nhs than any other comparable business. Read the King's fund report and the research. It's one of the reasons for the problems. The nhs is a people business. Its not widgets.

I was thinking the same, I only work as bank as my workplace refused my flexible working request and there is no childcare that can accommodate 12 hour shifts and variable shift work. I get paid less than the normal staff and don’t get sick pay or full holiday pay.
I think most people are confusing bank staff and agency but even agency nurses don’t take that much more it’s the agency themselves that are making the money.
If workplaces were a little bit more family friendly and have a much better work life balance maybe they would retain staff and the reliance on agency would then decrease as well.

This falls down as land to build on is extortionately expensive - you can't compare us with NZ, Aus and USA.

This. PIL receive attendance allowance and have several hundred thousand sitting doing nothing in the bank. It's not means tested neither is their winter fuel allowance, free prescription, bus pass, etc etc like the abolition of my child benefit. Why?!
And this is 80 year old MIL claiming who paid very little 'stamp'. Gave up work at 28 to raise two DC and never returned.

Glibly saying we should improve social care - it really is a bottomless multi million pound pit.

Carers drive miles between cases round here, don't get their petrol fully reimbursed, spend usually half hour with customer, barely enough time to do anything properly. And that's when the client is not disabled or incontinent.

Your second paragraph sounds like a great reason to improve it.

It definitely should be improved but who pays?

Haven’t read the whole thread but the number of useless managers there are in my department alone costing £££ is unbelievable- they don’t seem to know or do anything constructive and they most defer to people of my level for advice on how to investigate/fix a situation- plus they don’t have a lot of decision power (I’m talking bands 6-8). So why do we need so many??

Yes! Total agreement with this.

www.gocompare.com/health-insurance/the-bill-of-health/
This is an interesting calculator to see how much you have cost the NHS