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!)

If most of these posts really are from those working in the NHS, it's interesting - though not surprising - to see so many highlight organisational / management / expectation issues rather than just the money
It would also underline the belief of many that there's simply no point wasting more on a system that doesn't work, not least because those spending it would be the same ones making the decisions now

Clearly we need a new approach, but while retaining current clinical staff would be necessary, we'd need to find a way of keeping this management mentality away from it - and how to do that I honestly don't know

@RosesAndHellebores Striking nurses and paramedics are expressing concern about standards and colleagues. That’s been one of the reasons for their recent strikes. We must be looking at different photographs. I haven’t seen any jolliness from my nursing and paramedic colleagues. I see exhaustion and anger.

Im not denying that there were issues with the Labour government re: the NHS. However the Tories have been in power for 12 years. If what is happening now was directly due to the Labour government’s policies alone, then the current government have have TWELVE YEARS to turn it around. They haven’t. They have let it die. They are responsible for what is happening.

Instead of sniping between right vs left, woke vs whatever the opposite is of woke etc there needs to be focus on fixing this binfire. However that will never happen, so I’m just going to carry on working, doing what I can for my patients whilst experiencing constant abuse and trying to avoid getting seriously burnt out again even though I’m having to admit people to hospital due to hypothermia because they can’t heat their homes due to the cost of living crisis (which I had to do during the most recent cold snap and it broke my woke, leftie heart).

Families used to provide care for dependents, whether young or elderly - but that's now economically impossible for many
I would argue that, as well as now being economically impossible it also relied on women being prepared to Sacrifice themselves, forgo their future earning potential so that the man could preserve his.
Women now have more opportunities, we are not prepared to Sacrifice ourselves nor should we, we have talents and abilities that are needed by society, we deserve to flourish and fulfil our potential just like men do

Point 4 suggests your SIL hasn’t got a clue about the role primary care plays in the NHS.

90% of constants for under 10% of patient funding.

The waiting list for hospital appointments are already at an all time high. If you remove the need for referral to a specialist then the waiting list will meltdown.

Using your example - ENT/Audiology are not going to want to see everyone with hearing loss, their clinics would be overwhelmed. Audiology won’t accept referrals without ears being examined to ensure the hearing loss isn’t simply due to impacted wax that needs aggressive olive oil treatment and that’s it. There are some hearing losses that need to be seen immediately, will the average lay person know what that is? Or will they wait on a waiting list for months whilst their hearing declines and the serious underlying issue deteriorates?

It’s not straightforward and self referral should only be used in very specific circumstances such as Podiatry (in my area) is self referral already and I agree that should be the case nation wide.

Doctors leave university after 5 years with £85k debt and the princely sum of £14 per hour. They pay all their postgraduate exam fees (essential to get into training), GMC and indemnity fees, conference fees (have to publish papers for competitive training). Most hospitals charge for parking and don't provide free accommodation.

It takes 5 years med school + 2 years foundation training + 3 years core training + 3 years specialty training to become a consultant. This sacrifice and dedication is not reflected in pay or conditions.

I do feel sorry for GPs, have just been to pharmacy as we are advised they can help. They were insistent that I phoned GP today. I have done so but feel a bit of a fraudster tbh.

Off topic ( a bit), but what a brilliant thread this is.
Informative, with differing views, but generally respectful.

Only wish more threads were like this😁

As a GP I want to ensure all patients who contact us - please don’t feel like a fraudster for accessing help you need.

I hope you get better soon.

Thanks, it's for my little one actually, constipation. I've been through it with my older one so not overly concerned but the pharmacist made me feel like a bad mum so now I am bothering a GP when they are busy with more urgent matters.

I’m sorry the pharmacist treated you like that.

@Soothsayer1 · Today 13:47
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 present system was designed by Conservative government health secretary Andrew Lansley in 2012.

The last labour government spent a decade undoing the damage wrought by the Major/ Thatcher government, only for the Tories to get back into power and continue their project to dismantle the NHS, social care, and local government.

We have gotten really bad at letting nature take its course especially at the end. We have really good pain relief strategies, people aren't planning for the future or making advanced directives. When I have dementia , I probably will get it as I'm female and it will be the number 1 cause of death. I want to be given pain relief and midozalam , no dysphagia assessments , no artificial nutrition , no Antibiotics, if I fall pain relief no CT. Just let me die peacefully drugged up to the eyeballs. I have nursed numerous people with the condition and that's what I want to die painlessly not kept alive for years on end.

That's OK, I'm quite thick skinned so no problems. GP has already phoned me back. I did apologise which I think she appreciated.

@Hongkongsuey in all fairness DH and I are 62, still working full-time, and plan to do so for another 3 to 5 years. If we need care in our latter years we expect to pay for it and will do so from our pensions and investments. We do not need to downsize to fund our healthcare needs thank you so don't generalise. Further, we wish to elect for minimal treatment in our dotage to ensure quality of life.

MIL 86 with Parkinsons, a widow for 18 years, has carers daily, paid for by DH because despite teaching for 40 years, her needs do not meet the bar and yet she was raised on cradle to grave lie and thinks that if the NHS doesn't think she's ill enough to pay for the carers she isn't entitled to any care. The foundations of the NHS were disingenuous from day one.

For the previous poster who said th Tory's have had since 2010 to sort out the NHS. Actually there was a Lib/Con coalition from 2010 to 2015 and as a sop to the libs Cameron put in charge Blair's former health adviser Sir Simon Stephens, a man who knew more about privatisation than anyone in the UK, having spent several years in the US.

In 1997 when Blair came to power he was handed a very healthy economy. In 2010, the economy had been absolutely wrecked. And wrecked again in 2020/21 through lockdowns for the sake of the NHS. It doesn't take rocket science to work out that there has been little money for investment.

Ultimately healthcare must be taken out of politics and politics must be taken out of the NHS. However for as long as the NHS tells me the Tories are stinky crooks I shall tell them that the lefties are stinky woke ne'er do wells puffed up on their personal moral superiority. We really must sort out the Dr's annual pension allowance though because despite being high earners they shouldn't be subject to the punitive tax rates faced by others. It's not only Dr's affected by the annual allowance but of course they should get specialist treatment. Just like the soviet communist regime afforded its leaders country dachas and other privileges. It's all a bit too two legs good, four legs bad for my taste. And that is where the rot began.

@RosesAndHellebores lol. Do you write for the mail ? What a load of cliched claptrap from someone who I doubt has ever cared for anyone in a professional capacity.

@RosesAndHellebores In 2010, the economy had been absolutely wrecked.

That isn’t actually true.

Government debt was very low, state institutions (eg NHS, schools) and the UK economy as a whole was in good shape until the Global Financial Crisis, which was caused by irresponsible lending in the financial markets, mainly by US firms. It was not caused by the Labour government of the time.

The damage to the UK economy was done under George Osborne, the Conservative chancellor. Austerity was totally the wrong response to a stalling economy when interest rates were low.

And combined with Lansley’s reorganisation of the NHS, it was a disaster for the nation’s health and well-being.

Had we not had austerity we would be in a far worse mess now.

@Anotherusernameanotheday thank you for your contribution to truly critical thinking.

The NHS started to fail in 1948 when Bevan had to stuff the GP's mouths with gold to talk them round. It's always money where doctors and nurses are concerned - theirs - with not a thought for levels of wastage or efficiency and zero cognizance of the needs of the patients.

I don’t think this is the case, countries who didn’t employ austerity did much better financially. There’s lots of evidence that squeezing the middle and bottom is counterproductive

Can someone explain why

1. the NHS still uses letters and the postal system, when they could email and pdf, which would be cheaper and more reliable.
2. When I go to A&E they have no way of accessing my records, and therefore have to start from scratch as if I was new to the NHS therefore making the process less reliable and more time consuming (and expensive)

Probably because a letter can be read and reached by everyone, an email? mmmmm more reliable? not everyone has an email address & in the case of older people, a letter can be pinned up to remind all inc relatives that patient x has to go to appointment y.
My district hospital uses text messages the day before as a reminder too.

Thats odd because i went to AE a year or so ago, they bought up all my records just like that.

Immigrants are staffing the nhs. Keep them coming.

It’s British over 65s who are the main users of the nhs and from whom the massive demand is coming.

Computer systems in the NHS:

GPs use 1 of 3 systems and they don't speak to the other systems. So if you move practice you might move onto a new IT system and your notes won't be visible.

A&Es use different IT systems that don't speak to each other.

AMU/ambulatory units in different hospitals use different systems and don't talk to each other.

Mental health trusts use entirely different systems all over the country that don't connect to "physical health" IT systems or even to each other.

I work in a city. In the large hospital they use a prescribing programme. In the mental health hospital 10mins drive away they use another one. They don't speak to each other. So a patient seen in A&E with a medication overdose and then sent to the psych inpatient ward will not have their medication history automatically available to us and we are reliant on accessing GP notes or the discharge letter (if even available).

These systems are all disconnected because the NHS signs absurd 10 year+ IT contracts it then can't break when a better system comes along.

Had we not had austerity we would be in a far worse mess now

Thats not what leading Tories say, Osbourne said it went too far and Hunt has said similar, esp in regard to NHS spending, he say different now but on the back benches he didn't.

It was needed for 5 years, after that, we should have been investing, its the main reason our productivity is so low, the NHS is screwed, our roads are in a shocking state & we pay the earth in Council tax.

The economy in 1997 was still in shock from the ERM fiasco, hence Blair had to agree to Tory budget from 1995 for the first Parliament & what you rather deceitfully miss out is the Global Financial Crash in 2008, note Global.

Would also add that patients have a right to make their summary care records invisible (this is the only way we can access incredibly brief info from your GP record i.e. current meds, allergies, major conditions). Which is fine if you're compos mentis but becomes dangerous if you're admitted unconscious or confused.

Scotland is moving towards a National Care Service to try and resolve the care issues. It'll be interesting to see how that works. We've had Joint Health & Social Care Partnerships for a few years to bridge the gap between NHS and council care services and how well these have worked varies up and and down the country.