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!)

*No fertility treatment. No cosmetic surgery. No breast reconstruction, no gender realignment surgery. No gastric bands, no acne treatments.

The majority of this is done privately. Acne treatment is usually medication and weight loss in the long term is a health benefit so the nhs wins.

But heart bypasses, every sort of cancer and it's treatment, lung disease, hip fractures. I'm sure these are the drains on finance and can't be avoided.

Tax-payers.

The 'who pays' line is always presented as a gotcha, but polling shows that brits are happy to pay more taxes for improved public services.

(I've also said elsewhere on the thread that you need to sort out the housing crisis to get 20-30-somethings having more children to prop up that tax base. But the 'tax more to improve things' is not fundamentally unpopular.)

I think the main issues stem from wanting to centralise services and control. I'm pro localisation and distributed power/ control in most things. Closing community hospitals in particular was a terrible idea.
Human nature is that we will always do more and work harder for those close to us. The nhs has become too abstract a construct that's it's hard to care.

I’m happy to pay more tax to improve public services but I would like to see higher employment rates. These days, it pays better not to work & I would begrudge paying more tax for many people to sit on the benefit system. I completely understand that we need a benefit system as not everyone can work but there are many people sitting on benefits that can work & there needs to be tighter restrictions to receiving benefits.

NHS dentistry is certainly terminal. I’m a dentist so can’t comment on the Health Service overall.
For Dentistry there are 2 options as I see it.
One would be completely private, so everyone even kids. This will lead to a lot of problems in the less well off, also children.
Even wealthy people seem to resent paying privately for children’s teeth for some bizarre reason! (Don’t have more children than you can afford to keep!)
The other would be to stop lying to everyone and fund a minimal core service for children and people on benefits.
Exam, simple scaling, fillings, extractions, plastic dentures and root canal on front teeth only (3-3).
All orthodontics, crowns, bridges, metal dentures, molar and premolar root treatment, gum treatment beyond simple scaling would all be private only. No stupid units of dental activity, the above would be provided in state run clinics, by dental students and newly qualified or by independent practitioners at their hourly rate.

Agreed there is only so much you can do if parents do not want to but I think it is important to be honest with parents as to how much support you can offer in event of them becoming less able. So many families expect hospital staff to say to our patients that they are no longer willing to do this or that. They are difficult conversations but it is so much harder when someone is admitted to hospital and the family declare they are exhausted and can no longer provide the care they have been because those patients then become marooned in a hospital bed. If those conversations happen earlier and private care is arranged or referral made to social services in good time then these delays might be avoided.
Often it is about money. Patients will sit in hospital awaiting a few weeks of short term care until they are seen by a social worker and means tested and then have to pay anyway. If they know they have the means to fund their care, they should be sourcing that as soon as medically fit for discharge and could then leave hospital a month sooner. ( although in many areas the carers are hard to find whatever the funding) I understand the desire to get what you can free, but people seem to not understand how risky it is to stay in hospital. They also need to understand that whilst they are sitting there enjoying their NHS hotel, someone else is stuck outside A& E waiting for someone to leave the hospital to allow them to receive emergency care and whilst that is happening, someone else is on the floor at home with a broken hip, awaiting that ambulance to become available.
Sorry.... this is obviously not about your parents, but as an NHS worker, I am very frustrated with the whole situation at the moment and I feel like the NHS is under the spotlight but society also needs to look at their responsibility and Social Care needs a massive sort out or needs to be reattached to Health. Back to DEPT of Health and Social services.

For the tiny bit of the NHS I'm familiar with, a national education campaign on what to do yourself at home, what to call 111 for, 999 for and GP for. So many people calling for 'an emergency ambulance' when they don't need one at all. All adds to the load. A long serving colleague said to me the other day " for some people, its like we've become the NHS Uber service".

No, there needs to be better pay in this country. That is the root of many of our problems.

We have lots people in work who are earning so little they need charity handouts and government benefits to make ends meet. It is not that benefits are too generous it is that work does not pay as pay has been deliberately restrained for over a decade.

I'm guessing you are a Tory voter? The only options you can see are to take even more away from the poorest.

@sequin2000 that is interesting. I contribute considerably more than I get back. But that is to be expected as I am very healthy and child free.

But I am very aware that can turn on the head of a pin, which is why I support the concept of the NHS. My dad after a life time of barely bothering the NHS was a very heavy user in the last year having been diagnosed with rhematoid arthrotis and having a stent fitted. However I am getting to the point where I see the NHS model is not working for longer term healthcare and preventative medicine.

I am lucky I have some private medical proviaion through work so use that for annual health checks and things like physio and dental treatement.

No, there needs to be better pay in this country. That is the root of many of our problems.

yes pay is shit!

There has been zero growth, 30k in the early 00s is the same as 50k today but many jobs still pay what they did in the 00s

Improve pay.

Stop treating the NHS as a business (i.e. one dept paying another to do a job!) and get rid of lots of top managers.

Bring back Matron!

Maintain hospitals to avoid closures. This would accommodate so many different types of clinics.

and then you are paying more tax on it!

Well for a start there should be less managers than actual staff, which isnt always the case especially in departments like HR, organisational development, corporate comms teams...

Indeed. I've lost 5 staff in the last 6 months. All of those staff were closely involved in working with services in the community to improve the service for patients. Because they have left and because we are going through yet another re-organisation due to the whims of one of our previous Health Secretaries we cannot replace them, the rest of my team are trying to cover their workload, but failing and I now have 2 of them off on sick leave due to stress and also battling through for too long with long covid.
The services that they were working with in the community are closing at the end of March because without their support they cannot improve and so the ICB will not continue to fund them because of the massive risk to patient safety.

As usual on here there is the usual blaming of old people for being old, childfree/childless people for not giving birth to future taxpayers, NHS management because let's face it no one really knows what we do, but by God they would soon realise if we weren't there (see above example).

As usual there is the "sack all managers", "hire more nurses", "reform", "make people pay" as ill thought out solutions by people who either don't work in the NHS, don't understand the structure and how it works or just know about their own little corner of a ward and don't know what goes on elsewhere.

The solution is actually very simple....
Stop voting Tory
Stop re-organising the NHS and allow us time to do our day jobs without threat of losing those jobs
Stop believing the shite that the Daily Mail and its ilk publishes.

@vdbfamily I agree with you, it's a mess. We are fortunate to live close to both families, we consciously made this decision despite preferring to leave London so we could help as they get older.

Also, get rid of the dead wood - people constantly on the sick and getting paid for it.

It definitely should be improved but who pays?

more than do now. Wealth tax to even out intergenerational equality. Means test prescriptions for over 60s.

@cptartapp same, I don't understand why it isn't means tested?

I'm pretty sure it is, life expectancy has increased but healthy life expectancy hasn't it. People are living longer with more conditions.

Life expectancy has increased for some of the population, although the average has only increased by about 10 years over the course of 50 years. For the population as a whole it has plateaued and in some areas it has decreased.
A lot can be put down to the use of simple medications, such as antihypertensives, statins and medication to manage diabetes. As you say people are living longer with these 'conditions' because they are being managed with medication.
Dementia is the difficult one because there is no really effective treatment to speak of currently. It would be interesting to know the figures for the number of hospital admissions for people with fractures following a fall, who also have a dementia diagnosis, both from their own home or a residential setting.

There are so many pointless, 'management' roles in over bloated teams like HR, organisational development, equality and diversity, learning and development, corporate strategy, communication division...jobs in these teams are generally high paying and have more managers than actual workers. The actual overall impact they have on patient care is unknown. I'm not saying there isn't a need for some jobs in these areas, but there are far too many non jobs in these types of departments

I work as a paramedic, I think investing hugely in social care and mental health services plus standardising health care across the country would help. Every area to have 24 hr minor illness and injuries units that deal with the same type of patients, a community hospital run in tandem with every hospital and ambulance services that work to the same protocols and carry the same drugs and do the same training, have the same uniforms and the same shift patterns.
make it easy for people to transfer to other areas within the NHS.
When I’ve moved to different positions within the same trust I have to prove my qualifications, ffs if they’ve been employing me as an unqualified paramedic all these years then they’ve got big problems.
This will all take time and require investment good recruitment and retention. I am happy to pay more tax if it was ring fenced.

@Eleganz no I’m not a Tory voter, thank you very much. I am a struggling nurse trying to work to make ends meet whilst I know of many people that do not & have not worked for years despite being able to. I think our conversation goes hand in hand, yes people do need to be paid more, that’s exactly why they are on benefits because they are better off doing so. I’m not saying I blame them. I have to fork out over £600 a month for childcare just so I can go to work. I’m living pay check to pay check, despite actually working in the environment this very thread is about. Yet I know of a few people that haven’t worked since they were 17 with multiple children that they get free childcare hours for. The system is broken, not the people.

There are so many pointless, 'management' roles in over bloated teams like HR, organisational development, equality and diversity, learning and development, corporate strategy, communication division...jobs in these teams are generally high paying and have more managers than actual workers. The actual overall impact they have on patient care is unknown. I'm not saying there isn't a need for some jobs in these areas, but there are far too many non jobs in these types of departments

So you don't think that an organisation that employs many thousands of people should have an HR dept? Should not manage the organisation and have people who plan how it should develop? That there shouldn't be equal opportunities for all members of staff regardless of race, gender, disability etc.? That they shouldn't communicate with the public? With their stakeholders?

Righto.

1. Introduce a Continental social insurance system like in France, Germany, Austria

1. Give patients greater agency and let them hold their records except for key data. GP never scroll back anyway, letters are often incorrect.

1. The GP's are either in or out but either way they must be more accountable. If they are out, they operate as private physicians and patients reclaim, if they are in they are employed by the NHS and operate in accordance with local policies and procedures.

1. Every single individual undertakes customer service training where it is hammered home that the patient is the reason for their existence and the patient does not need to be grateful for sub-optimal care and that care is funded by the people for the people. The people are not a homogenous fick blob.

1. Pay all support staff in Greater London the London Living wage.

1. Whilst respecting everyone's protected characteristics, remember too that the bulk of the population are ordinary John's and Jane's and their individual needs for care, courtesy and kindness should not be overlooked whilst investments are made in rainbow crossings, chest feeding pamphlets and tick box diversity exercises. If the NHS were respectful to everyone there would be no need for this.

1. Stop covering up failures and start telling the truth.

1. Write off PFI debts or make them more reasonable.

10. Make people fully aware that the NHS is run by Sir Simon Stephen's successor and not the Health Secretary.

11. Stop NHS employees persistently complaining about their job/employer/the Conservatives. The Conservatives were democratically voted by the people aka their patients and it is offensive to half. Also if any other group of professionals did this, they would be dismissed.

12. Everyone should hold an NHS account that shows the total cost of services received throughout their lives.

13. Stop 28/56 day prescribing where it is not necessary; review prescription exemptions. For example: I have hypothyroidism, I do not need every other prescription free. DH and I are over 60 and we are entitled to free prescriptions - we both work full-time and earn good salaries.

14. Deal with the blame culture and bullying.

I think if you're starting with the premise that some positions must be lost you have already made up your mind about the outcome of a review. What if the review shows the inefficiencies are as a result of loss of positions? How many mad things are happening (like the band 6 nurse issuing appointment letters upthread) because Nelly, who used to do that before she retired, has not been replaced, and no one has given any proper though to the effects of that decision?

If we are to have change (and we must) we need proper change management. Blundering about making badly planned changes is destructive and wasteful.