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!)

Your rubbishing the NHS wasn’t confined to a corner of SW London. The discussion is about the NHS overall. It’s not just my opinion, I’ve supplied a link to the data. Inconvenient, isn’t it?

District Nurse here of 20 years, here goes

Better working conditions for social care staff is priority, they are so badly treated, not paid mileage , time for travelling goes on and on. More social care staff means more time to free up district nurses. District nurses need to pass calls onto already depleted social care services as we cant deal with their influx of patients complex patients from hospital. Patients are being sent home to early from hospital without proper input and end up back in like a revolving door.

Get rid of the incompetent health care managers who lack leadership and are not proactive. District nurses are getting tumped as said before with non housebound patients from GP surgeries, We visit patients who then tell you they are going to hairdressers, appointments etc even to the surgeries themselves, The district nurse tells their mangers ,The managers don't sort the problem out and don't back their staff, and you end up with about 200 people on the district nurse caseload who are not housebound, If you free the District nurses up to deal with the complex housebound patients so we are able to take more discharges from the hospital and free the beds up , which leads to less pressure on ambulances stuck outside hospitals, stricter criteria for referral to us

Very importantly many of the British public and the attitudes of people themselves have caused the problem. People expect so much, they wont pay for transport to go to a surgery as they expect visits. As said patients can go out and you tell them they need to go to surgeries, they report you and nurses are not backed up by crap mangers, Charge these people for visits we would soon see who really needs it.

Its not surprising this is happening now to the NHS its had its chips as they say , i really feel there is no coming for it. Staff have been highlighting the failings through datix and incident forms for years and its been ignored

A couple of things that I think would help ( other than sufficient funding and a few more actual beds and better staffing ratios ) are

1. Stop reinventing the wheel, for instance I work in a particular area of the NHS, have done for about 6 years, in that short time they have introduced 3 new services, each one slightly different to the former, to replace the original service. None have done as much as the original service to prevent admissions, they are paying staff more to do less and each time they try a new idea out it costs a lot of money. This can be scaled up each time the NHS goes through yet another rebrand/reorganistion.This is why I get twitchy about the shouts for 'reform' because experience tells me it will cost a lot of money, not deliver what it promises and the end result will be worse for patients.
2. Start listening to the staff and engaing with them and make this a national NHS conversation. We can tell you what has worked in the past, what hasn't, what is working now and what we think would work in the future, there are years upon years of experience within the workforce, utilise that experience and knowledge. Stop top downing and look at bottom upping that might be the wrong phrase for a NHS thread
3. Deal with the social care crisis, one major improvement that would give back some of the slack that has been lost in the NHS system is to reopen or newly open more short term rehab/recuperation beds. Simply dumping people in residential settings where they receive little or no rehab is not going to work at getting people up and fit for home. This isn't a dig at the residential settings, they are simply not set up for this type of intensive rehab, it isn't generally their target market. A slightly cheaper alternative would be to ringfence beds in residential settings and then provide the daily physio/OT input there. Locally I see the ringfenced beds but not the intensive input, a lot of physio's now work in private practice, could they be encouraged to do more of this particular type of work ? what with a recession looming ? Or could people be trained up as therapy HCA's and do a lot of the work under the supervision of a physio or OT ? I know this happens currently on wards in hospitals. Could also be done in a persons home if they increase the number of people capable of doing it ?
4. IT , for the love of God can we all use the same bloody system, why does it have to be so flipping complicated and expensive ? One of the biggest customers in the UK and it has chosen to fragment its IT system to the point of being ludicrous. No other 'company' of comparable size has done this, have they ? I feel for any poor bugger that works in IT in the NHS, our IT helpdesk has about 6 different choices depending on which particular system you are having an issue with ! although I usually ring because I have forgotton my password again !
5. Do proper exit interviews and really take on board the information given. You want to know how to retain staff ? start with those that are leaving, why are they leaving ? Can you offer them anything that would encourage them to stay ? Properly support new starters, when I started it was very much 'in at the deep end' I survived and continued but only because the team I worked with looked out for each other, you had an arrest on your side, someone would do your obs, finish your drugs round, basically a 'I have your back because I know when the shit hits the fan you will have mine' culture. I left my previous role because this didn't happen, arrest on your side ? not my circus, not my monkeys attitude from the top down. I see this playing out in adjacent teams to mine and there is real bafflement as to why they cannot recruit or retain staff amongst the management and yet it is blatantly obvious to everyone else. This isn't management bashing per se, but some are definitely better than others and you really notice a massive difference if you are blessed with a good one or lumbered with a bad one !

The same group of patients request a list of 20 different medications every month, because they get them free - even if they're no longer using some of them and have cupboards full of drugs whilst working age adults pay for every script.

Def this

Why aren’t they getting regular drug reviews? My bloke gets one every year. Sounds like they’ve got lazy GPs.

@methodbehindmymadness absolutely!! People getting angry because can't give an EXACT time for DN visit because 'going out for lunch with daughter' having refused to attend a clinic same day!

Nc as i give too much info about myself
I've worked in the NHS for 18years as a physiotherapist. Here's what I would do:

Depoliticalise it. It's kicked around like a football, with short term, knee jerk reactions. Poor long term planning. It needs a cross party group ( not sure if these exist)

Fund it properly - in line with population change and need. It's been defunded since the Tories were in power every year. Honest stats about how many GPs, nurses, AHPs, beds etc there are presented each year.

Reinstate the training bursary for nursing AHPS. staff are leaving in droves and we cannot recruit.

Social care needs a huge sort out. There is no flow through the system. The NHS is becoming more like social care - privatised, fragmented. Properly fund an army of responsive/ well trained and fairly paid carers.

Proper rehab facilities - in the home as well. It's so forgotten about And makes a huge difference to people's lives/ health.

Social incentives to go people more active - post covid so many older people are struggling. Make public health a priority from birth - walking/ cycling/ nutrition/ swimming.

IT systems that work and communicate with each other - so frustrating.

Unfortunately this government just don't seem to care and will run it into the ground.

I love working in the NHS and I seem the wonders and miracles that occur in it. However it's so run down and you are left unable to do the job you know you could be doing with the right staff/ resources

This is spot on.

The NHS is seriously underfunded and the staff are dangerously overworked and underpaid.

The NHS isn’t failing, it’s being failed.

What is really interesting on this thread is the amount of blaming of the very people who need to access the system and those working in it and yet actually very little blame being opportioned to those in charge of it all. If anyone does dare to opportion blame to those who are ultimately responsible ( the government ) a certain prolific poster will bear down on them from a great height to chastise them for being woke, lefty, liberal in a lefty sense not to be mixed up with libertarian, and probably a surly nurse, the only type they have met, ever !
The government is ultimately responsible for what happens in the NHS, if its a bit or a lot shit, most of that can be laid at their door, they do have the power to make a real difference but appear to be choosing not to, why is anyone's guess ?

Managers always get a bad rap, but they are often the ones on the line accountable for juggling absolutely everything happening in that unit/department/practice. Yes I am one of them. I know there are managers who are sitting at nice desks WFH drinking coffee doing Teams meetings but most of them front line are trying to keep everyone sane and not getting paid much for it, get no lunch, no over time, multiple staff crying on you every day, angry patients, sorting out a crisis a few times an hour etc.

At a commissioning level (ICB) there appears to be mostly pen pushing wastage. For instance I know our ICB are mostly WFH but still renting a massive amount of real estate no one uses. Whilst a lot of other services are operating out of run down shit holes. You can’t get hold of a lot of people on a Friday as they all work condensed hours and have Fridays off.

There is not much wastage of stock or supplies at primary care level as funny enough, GP’s run their own business and every penny is accounted for but hospitals and trusts are so vast and disconnected from each department it’s almost impossible to keep their spending in line. When I worked for a trust they had about £10k of half out of date stock shoved in a store cupboard at any given time, no one was paying any attention (until I got involved). If someone orders the wrong thing they don’t send it back.

As for drug reviews, this is what should be happening but often isn’t because they just have no time to do that piece of work. I am so tired, its hard to explain how it feels. It feels like a battle to just stay afloat. I often don’t feel we are safe, we have so many staff off sick or leaving. I’ve had staff crying this week, afraid of making mistakes, working extremely long hours to cover their colleagues just to keep things going. Everyone is working on the edge of burnout.

The answer is.. I don’t know anymore. They have a scheme to recruit ARR staff to reduce pressure on GP’s but these staff have never worked in primary care and it takes so much resource to supervise them and train them. A lot of the GP Registrars are failing their exams and having to extend their training for months on end, so it’s slower to get them into practice (don’t start me on how much it costs each practice to train them in lost appt time/supervision/tutorials).

I dislike saying it as I will get flamed but a vast majority of patients just don’t listen. They don’t ever go to their pharmacy for any help. They even ring the GP to check their script has been sent before toddling off to their pharmacy so they don’t have to make a wasted trip. They don’t even go to the MIU optician or dentist they all come to their GP for sore eyes, ulcers, fungal nails, swollen fingers. Patients who have a cough for 2 weeks (but no temp or other symptoms) come back repeatedly as baffled and fed up as to why they still have a cough. People with borderline cholesterol or HBA1C demanding to speak to a GP instead of accept a lifestyle advice chat with a HCA. We all want to help people but we are drowning in modern day health anxiety and expectations of quick fixes. We see trends as well from social media, this year we have been drowned in adults asking for ADHD assessments (do you know how many forms are involved in this and chasing them is very time consuming). Perhaps the issues are also dentists being too expensive, mistrust in pharmacists - I don’t know. It’s just a massive combination of shit from all sides. Brexit destroyed social care and care agencies and now people are blocking beds as they have no care to go home to.

I recently had to deal with a complaint about a lady who didn’t want to wait indoors for a DN visit as she wanted to get her hair done. We had re-referred 3 times and each time she had not been home when they visited so they refused to take her onto their caseload. We offered a nurse appt in practice but as she had been coded as housebound at some point, she refused point blank to come in. The patient and her relatives were very angry I wasn’t able to get a DN out to her home at their convenience

I dislike saying it as I will get flamed but a vast majority of patients just don’t listen. They don’t ever go to their pharmacy for any help. They even ring the GP to check their script has been sent before toddling off to their pharmacy so they don’t have to make a wasted trip. They don’t even go to the MIU optician or dentist they all come to their GP for sore eyes, ulcers, fungal nails, swollen fingers. Patients who have a cough for 2 weeks (but no temp or other symptoms) come back repeatedly as baffled and fed up as to why they still have a cough. People with borderline cholesterol or HBA1C demanding to speak to a GP instead of accept a lifestyle advice chat with a HCA. I can imagine this. It must be very frustrating. I used to work in care and so many people just don’t listen to advice about healthy lifestyles. They just don’t want to know. It’s like we have a culture of expecting other people to take responsibility for everything.

Yes. I appreciate you not flaming me!

I am not talking about people who are unwell and need medical attention all being annoying. HCP do not think that, but there is a proportion of society that is not taking responsibility for themselves. Following a healthy lifestyle can be hard, even I know this personally but it’s sometimes some way to fix to the issue.

We cannot keep glossing over the issue of health anxiety, improved ease of access to health information (online consults, the internet) and the impact of rising costs and long waits of other services such as dental, opticians etc.

Many people who get free or prepaid prescriptions do have an expectation that they are entitled to their free medications so won’t visit their pharmacist to pay for something OTC. There is a cost of living crisis, So it’s inevitable that people can’t afford it but this puts another strain on services. Many people don’t want to eat or drink less really. Plenty of gout and GERD pops on the daily lists at this time of year. Some things are somewhat avoidable in hindsight

so many people just don’t listen to advice about healthy lifestyles
I agree, I think we have enabled people to sabotage their own health & expect to be patched up for free....then again, no wonder people are stressed & turn to food, alcohol, etc to try and cope, it's a minefield & idk what the solution is?

You will see this during recession and times of uncertainty, people will turn to these coping mechanisms. It’s not like mental health services have the resources available to assist. People often do not seek help addressing these consequences of poor lifestyle choices until something is going wrong, and then they don’t want to change. Then there is a section of society who are healthy and very health conscious but anxiously so and need a lot of reassurances which is their way of trying to cope with stress

They are closing NHS funded LD respite beds which is going to cost the government more money. Parents will say they can't cope and SS need to find full time placements or private respite. Keeping carers onside keeps the bill down.

1. Stop expecting the staff to go above and beyond for years on end, just to keep the service running and compensate for underfunding and understaffing. It is a job, not a vocation or a lifelong sacrifice competition.

1. Do exit interviews - my service lost a lot of experienced staff but not one was asked why they were leaving. It's also quite upsetting to hear managers talk about their dedication to their job and 'our NHS' while completely lacking empathy for those below them, their work choices and refusing to hear their views.

1. Better work flexibility, addressing bullying behaviour, less reinventing the wheel over and over again (this one is particularily annoying), more part time posts, integrated and user friendly IT systems.

And who staffs this? NHS trained staff that's who

Not really. We seem to be recruiting more and more staff trained outside of the 'traditional NHS' route

Im a qualified nurse and over 15 years I have worked in a huge variety of places.

I would massively reduce the health visiting budget. I worked as a health visitor for around 5 years. About 5% of my job required a qualified professional. Most of my job could have been done, and was done better by childrens centre workers.

That health visitor who pops round to explain about all the important safety things with your baby, is getting paid top band 6, around £44k per year. That gynae, nicu or a&e nurse is on around £28

£28k per year

*District nurses are getting tumped as said before with non housebound patients from GP surgeries, We visit patients who then tell you they are going to hairdressers, appointments etc even to the surgeries themselves,

I raised this earlier. Expecting the hospital to ferry you to the hospital - I lived in the states everyone drove/ knew a driver / paid for a lift. Ambulances attended car collisions but weren't seen much at all.

There was recently a person on the radio whose father had died waiting for an ambulance - (person far away couldn't help) but surely, surely there was a neighbour, taxi, uber. I know that the best option is an ambulance so you can receive treatment en route/ not have the fractured leg moved unneccessarily but if the option is die waiting you'd surely just get there somehow.

We British seem very nannied.

@Menora We cannot keep glossing over the issue of health anxiety, improved ease of access to health information (online consults, the internet) and the impact of rising costs and long waits of other services such as dental, opticians etc

I hadn’t considered this before. An interesting point that I’ll need to think about more. I wonder if people have lost confidence in themselves or maybe think that medicine is better than it is. That it can fix more problems than it can.