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!)

Spoken as a true middle manager 🙄

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...

How are you defining "manager"? In my previous role I had "manager" in my job title but at least 50% of my day to day job was hands-on provision of a clinical technical service.

It definitely should be improved but who pays?

We already pay for it, even though it is a private sector now, we pay for it by tax and national insurance and VAT and council tax and every other type of tax we pay, the Government decides how much of that tax goes into which pot.
Historically the NHS provided elderly care in long stay wards. These were all closed down and the financial burden was largely placed on local councils via social services.

Okay I will define for you: in my department there are band 6 managers who, when I politely enquired what their job entailed, informed me that they “print off the reports from the Medway system to collate and take to meetings about waiting lists” ——- do you seriously need a “manager” to undertake a task such as this??

Obviously better funding would help, but I do wonder if part of that funding would come from better procurement processes and less unnecessary wastage of current funding.

Of course, the government would be keen to tax us even further, because they think it’s the answer to everything.

I would insist that any senior management or procurement position must now be taken by people from outside of the NHS with experience in either private sector, not from within, so there is experience of having to streamline processes and spending.

Okay I will define for you: in my department there are band 6 managers who, when I politely enquired what their job entailed, informed me that they “print off the reports from the Medway system to collate and take to meetings about waiting lists” ——- do you seriously need a “manager” to undertake a task such as this??

Of course not, if that's really all they do. This just further illustrates why we need proper effective management. What are they supposed to be doing? Who is directing their work and why are they not dealing with the lack of productivity? I completely agree that NHS management is a shambles in some areas, but I would suggest that's a result of lack of good management, rather than there being too many managers. Sacking the managers will make it worse, not better.

Band 6s are not managers in my field - they are generally technical specialists or newly qualified professionals.

But prescriptions are already paid for and cost over £9 most working age people. Are you talking about introducing a £1.50 charge for pensioners only?

I believe 9/10 prescriptions are not paid for. Is that correct?

I've heard this too. Must waste so much money checking whether people are eligible for free prescriptions

But employment is at record highs?!

Nothing will fix it now/return it to the better days of recent. It’s too fucked up through lack of funding, planning, building, staffing etc for the rise in the population/increase in the elderly (with more complex medical needs). Nothing short of bankrupting the country would make the NHS world beating imo.
On a daily basis there are at least ten ambulances waiting outside my place of work waiting to handover patients. To say the system is officially broken it’s now correct. It has come to fruition so to speak. So, where do we go from here? There are no more quick fixes. No capacity to eke out in the system. The days of goodwill of staff to ‘go the extra mile’ is over. Why work under these conditions when you could just leave and have a job with much less stress and shoulder the financial drop for a happier life. The pandemic is changing the way workers think, valuing a quality life over the continuous bullshit that’s called ‘the rat race’.
I for one am in a fortunate position to be able to retire early in a few years time, and I can honestly say I can’t wait for the day. I’m saddened for what has become of the health service and what is to come.
Only a drastic change in our national ethical ideology and expectations of healthcare in this country will make the service fit for purpose once again, but at a human cost. This to me is the elephant in the room that I doubt politicians will want to debate for the good of the service

Lot of excellent insight in this thread so far. Perhaps Mumsnet should use this to make a submission to the department of health, since they can't work it out themselves.

Something that has not been mentioned so far is malnutrition. This is entirely preventable (with the exception of very advanced chronic disease), and contributes significantly to poorer health outcomes in the elderly.

For example, a malnourished individual is far more likely to experience sarcopenia (Muscle loss) which leads to frailty, falls, hospitalisation, and death.

Malnourishment costs the NHS a lot of money every year, easily comparable to obesity, and just as preventable. More education directed at people in their late 50s onwards on best practice health management as they age, on how to prevent/delay ending up in a care home would be very useful, as a way to save money.

And oral nutritional supplements (ONS) such as Fortisips or Ensures, should NEVER be prescribed outside an acute setting without full assessment and recommendation by a dietitian. Then ongoing re-assessment until patient can be weaned off ONS. They should never be used as a food replacement, should not be prescribed simply because patient or family ask for them, and they will not bring a dying person back to life.

To put the cost of ONS into perspective, one serving per day costs upwards of £400 per year. There are far too many patients in the community, who are on 4-5 servings per day, and have been for years.

it all comes back again to individuals taking more responsibility for maintaining their own health as far as reasonable. instead of relying on the NHS to fix something that they broke.

I think this is automatic now. I bought a pre payment certificate online this morning and picked a prescription up ten mins later. The pharmacist knew I didn’t have to pay and there is a code on the name label on the drugs which says something exempt.

Obviously you have far more insight than I do but reading your post it occurs to me that woefull health care for the poor will cause huge problems for the Tory government, we have a labour shortage... not enough people available to do the work that needs to be done!
tories need the poor to be fit and healthy and that means good medical care surely?

My sister in law works in the NHS. Here's her list of fixes:-

1. Scrap the internal market which takes up massive amounts of manpower, administration and management time and results in expensive/inefficiency decision making.
2. Bring back smaller hospitals, cottage hospitals, etc to deal with the routine, run of the mill, simple procedures that don't need the "all singing, all dancing" high tech super hospitals doing the complicated stuff.
3. Scrap all the different, competing trusts, to stop the damaging fragmentation of the NHS into so many different trusts, all doing different things in different ways using different systems.
4. Make more services directly accessible instead of having to go through the "gatekeeping" role of GPs which often just wastes their time and causes delays. I.e. in the same way you make your own appointment with a dentist or optician, let people make their own appointments with departments like podiatry or audiology or physiotherapy where it's blatantly obvious that you need an audiologist for hearing loss or a podiatrist for an ingrown toe. If they think you need a specialist or treatment from a different dept., they can refer you, just like a dentist can refer you if they suspect something else when checking your teeth/mouth.
5. More convalescent/step down wards or homes for people with no medical need to stay in hospital but still need "care" on a temporary basis until ready to return to their usual home.

@vdbfamily "elderly patients enjoying their free NHS hotel". I'm sorry but that statement leapt off the page. I have never stayed in an hotel where I have had to share a room with 5 others, share a bathroom, usually dirty, with randoms, had men swanning around, been awoken by noise throughout the night, spoken to as though I am a decrepit idiot, served tea in a plastic cup and poor quality like warm food.

If asylum seekers were treated as described above there would be a public outcry. A key problem with the NHS is that those who work in it think the above description is acceptable vis a vis prevailing standards.

I think we could be heading back to the time before the NHS whereby big employers provided health/convalescent facilities for their workforce, partly from a sense of responsibility (i.e. Cadbury, Quakers, etc) and partly from a simple need to get workers back to the workplace as quickly as possible. There are lots of "large" old buildings which are now hotels or apartments, but which used to be convalescent homes built/paid for by big employers.

It's been noticeable for a decade or two that larger employers have been providing private healthcare, initially for more senior workers, but which is being slowly extended down through the ranks and some now provide it to all workers, and smaller employers are starting to offer it too.

I agree but, this is difficult and demanding work which few people have a genuine aptitude for, and for those that do the pay is so low that you can't have a decent standard of living. If the pay was high enough to incentivise those with an aptitude for this work well ....we just wouldn't be able to afford it surely?
Many of these traditionally female jobs relied on women being subservient and willing to work for low pay and bad conditions, that ship has sailed, women want to be treated as equal humans now, if healthcare won't treat them properly they will walk and work elsewhere.

Thanks for your response, I see what you are saying, it looks as if this is happening almost by default or as a kind of organic thing?

The Tories don’t care. Privatisation for them will = money for them and their cronies who own/run private health care. Or money from selling parts of the health service to companies such as Virgin Health etc.

This has been the Tory agenda for many years and many medics/HCPs have seen this coming.

Ironically for a lot of medics, private health will make them more money. But what people don’t realise is that most GPs don’t want that to happen, because we know the care people will receive via the ‘free’ health care stream will be awful. One of the things we want the most is the ability to provide the exemplary care our patients deserve. We can’t do it now because the NHS is dead. The moral injury that is causing is significant.

NHS Primary General Practice will end up like NHS Dentistry. Majority private with shit access to free/partially funded treatment.

Private work for GPs has always been traditionally quite minimal and looked on with derision by most NHS GPs, which is why I’ve always been baffled why people accuse us of working part time to just make more money with private work.

However a friend has set up a private GP clinic over the summer and I’ve just seen a tweet from another former colleague who is setting up a private GP clinic.

It’s terrifying.

@NameChangedAsOutraged I don't remember a better NHS when labour were in power. Many of today's deficiencies were rolled out during the Blair government. As GP fund holding was working it was ceased by that government and replaced with an horrendous layer of expensive bureaucracy called PCTs. PFI was rolled out at pace.

The previous Conservative government in the early to mid 90s did not dare Introduce reforms to bring in a Continental System. Thatcher tore up the paper.

Only two or three years ago the public were not allowed to breathe a word against the sacred cow turned behemoth. NHS workers unbranded us if we uttered a word of dissent and told us we were lucky and it was free. It was never free.

As far as I am concerned the NHS has been destroyed by its majority population of right-on leftwingers pedalling their socialist/Marxist principles in a way that is dangerously fundamentalist. Too many jolly nurses on the picket lines for my liking thoroughly enjoying a bit of socialist grandstanding rather than expressing concern about standards or their colleagues. Too many photographs of unlawful picket lines with more than 8 pickets too. I don't recall that being challenged in the press.

If the wealthy people go private it will free up services for the poor I'd have thought and ensure a greater share of a scarce resource for them.

Blame the Tories all you like; I blame the despicable lefties. Not a nice statement is it when the boot is put on the other foot.

My sister in law works in the NHS. Here's her list of fixes
Reading your list gives me an impression of a system which is deliberately & inherently adversarial and dysfunctional, or designed by people who hate the fact that the peasants get any healthcare at all, like they would rather waste money than spend it on benefiting the people.....
(The people, the ones who do the actual work that makes all the shareholders rich)

I think this is a large part of the problem. Public services are being used to plug holes that have appeared as society has changed. Families used to provide care for dependents, whether young or elderly - but that's now economically impossible for many, hence the massive demand for childcare and elderly care. As you say, no one wants to do those jobs, because they're difficult and poorly paid - perhaps the scarcity of carers will drive up prices to the point where it'll be more cost effective for people to drop out of the labour market and care for their relatives themselves (as it is with childcare). Except the state loses money this way too, through loss of income and paying out welfare.

I don't know - beyond improving the health of the nation, so that people can live HEALTHY lives into old age (through promoting lifelong exercise and education and massively cutting pollution - itself a massive cost commitment) or adopting a Logan's Run style system of killing everyone off at 50, there's no obvious solution.

I’m sure this has already been said but until the issues with social care are fixed the NHS will continue to grind to a halt. I’ve just read that there are 12000 people in hospital beds that no longer need hospital care but there’s nowhere to discharge them to. This means that people are stuck in A&E waiting for ward beds, which in turn means there’s 8+ hour waits to be seen in A&E and ambulances can’t offload patients safely, which in turn means people are waiting hours for ambulances. The whole system needs unblocking, but the blockage isn’t caused by the NHS and so can’t be solved by the NHS.

Unfortunately with rising operating costs I think more private care homes will close, and so the problem will only worsen.

Staff retention in the NHS will improve when they don’t feel like they’re fire-fighting every second of every day with no let up, no one can manage that level of stress and pressure forever.

I wish you were my MP-or even better-PM!