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!)

Top of band 6 is £40,588, and why would they be top of band 6 any more than a nurse? Top of band 5 is £32,934

Because being a HV is a band 6 role, a nurse is generally a band 5 unless you’re a junior sister or a specialist role. But remember a HV won’t get any unsocial pay so if it wasn’t a band higher nobody would apply as you’d take a significant pay cut from being a ward based nurse working shifts. Plus they do a lot of specialist safeguarding work.

My dad spent six months in hospital once. Now he had a decent pension and owned his house outright so while he was in hospital he saved so much money. No food to buy, turned his heating at his house right down, etc. his private pension still got paid every month

i know not everyone is in the same position and some people might lose their wage or still have rent to pay but my dad asked if he could contribute to his food and would happily have done so but they said no.

I meant why would they be top of band 6 any more than a nurse could be top of band 5. They would still have to get X number of years experience at band 6 to get to the top. And you've just explained to fluffyfluffyfluffy why they are a higher band than a nurse.

Thanks for your comment, I really would like people to look inwards to some extent, but this doesn’t take away from being under funded or poorly run I appreciate that. This is not about passing blame to patients.

For instance there is a lot of discourse about HRT in the media. Women are often very disillusioned that HRT does not take away all of their symptoms or feelings and often continually look to health services to address, fix/solve when some of these issues are related to their home and family life, mental well-being, lifestyle and no amount of HRT reviews or med adjustments will make them wake up feeling the way they did 5-10 years before.

Many people are afraid they will waste their time doubling up, ie visiting a pharmacist to then be passed to a GP. Time is precious people don’t want to waste that either, I know of two people in my circle who see sitting in A&E on weekends for a sore throat as a solution to not being able to take time off from their min wage job M-F when their GP is open as their employer is not flexible, and services aren’t always catering to those people. Even I have noticed things like my own impatience at how long queues are nowadays (in shops) and constantly battling with stress about not having the time to wait and be somewhere else.

We noticed a huge influx of sick children in the run up to Christmas with the strep A outbreak but as schools are not open, less children are unwell and now it’s is more the elderly we are seeing who are unwell and people who have lingering viral infections. A lot of people don’t want to be sick at Christmas because the time is precious to them but for instance yesterday, my practice had significantly less calls than it has had on any day across the entire past year. So had everyone suddenly got better or are they busy with their families and self managing? It was a chance for us all to catch up on all of the other work outstanding.

I meant to quote CoffeeBoy here

I will completely admit that I haven't read all of the posts on the thread but I think that if social care services were working properly, then a huge pressure would be taken off of the NHS and it would probably be able to manage. The NHS and the police are where the buck stops if people who need social care support can't get it.
Suitable recovery support for elderly people in their homes/ in some sort of nursing / recovery from illness home, properly funded mental health services and more supported accomodation for people who need help to manage their lives would take a huge burden from the police and the NHS.

We haven't enough staff to staff five days properly, let alone seven. I can work all the Sunday mornings you want, but then won't be there on a Monday afternoon for example. Staff are leaving - another two nurses next month with no replacements, they certainly don't want overtime.

In a similar vein to the DN / housebound thing I don't know if anyone has mentioned patient transport? It costs the NHS nationally around £10 million a year. It's essentially a taxi service and is free. It's supposed to be for the frail and sick who have no other way to get to and from hospital appointments but in my experience is used by people who could easily get a taxi or a lift from family or friend.
I strongly believe that the NHS should not be funding things that aren't healthcare. A fee for such services would mightily reduce demand.

@Menora thanks for your insight. I'm glad this thread hasn't taken the GPO bashing turn that so many do.

Re: mental health services.

GPs are inundated with requests for secondary care assessment of patients who think they have adult ADHD, mild anxiety, mild depression (but have a job, family, hobbies etc. and are functioning even if they are unhappy).

Meanwhile inpatient psychiatry and crisis teams are mainly treating severely psychotic patients who have entirely lost touch with reality, complex chronic personality disorder patients who ligature 5x a day and need 1:1 or even 2:1 care. Acute assessment wards are full of patients that secure services refuse because they're too risky.

The public have absolutely no idea (lucky for them) what serous mental illness looks like.

Also re: mental health services. 2 members of staff on a local ward were violently attacked by the same patient who suffers from what consultants have described as an incurable personality disorder, one stuff member being pregnant. This individual is barely an adult. Services will have to care for them until they die because there is nothing fixable. How many others will get hurt?

Morale is rock bottom because staff are being left to cope with these patients without safe nursing numbers to do so and people are getting hurt.

Severe PD are more common because people are living in dysfunctional families, often in poverty and born to parents with their own untreated mental health issues, and social support is just not available before things get severe.

Could you care for as many as five young women on a ward covered in self harm scars from ankle to face who will ligature if a single member of staff turns their back for a moment? It is like a horror film.

That is the reality of mental health services now.

Look at the French and German models accept that the NHS can no longer run as it now is and we have have to let go I wish a political party would be brave enough to announce this

we need to pay more towards our physical and mental healthcare

I work in mh there are too many upper management making decisions for us on wards/units that have no real idea of the day to day running of such places they just want statistics. Often half my day is taken up with supporting patients with everyday tasks or they just need to come and chat this is an essential part of the work but this isn’t calculated in the endless reports. The increase in time spent in meetings since covid is ridiculous

more support in the community 24hr hubs where people can go sometimes they just need company and to talk sadly cut backs in community support has led to the police being relied on which isn’t fair on all involved

no working from home unless it’s work that can be down from home completely

We do need to spend more on healthcare, Germany and France spend over 12% of GDP on theirs compared to our 7.8% pre pandemic in 2019, obviously there has been a jump during the pandemic years in the UK, but a lot of that will have been spent on pandemic associated healthcare.

The German system does seem very thorough and looks after people well.

www.howtogermany.com/pages/working.html

Excellent Twitter thread and article by Shaun Lintern. Lintern lists "Ten fast ways to improve the NHS" in the shorter-term.

twitter.com/ShaunLintern/status/1609253977664659458

Article www.thetimes.co.uk/article/ten-fast-ways-to-improve-the-nhs-mhh7szz8w
Archive version: archive.ph/7VstN

I left a hospital because they kept moving me to female PD service I have PTSD from all the ligatures , headbanging one even disemboweled themselves on leave with a knife. They are disfigured and so young. it was honestly horrendous much easier looking after hardened criminal men in secure services. I'm now in organics , brain injury and loving life.

I don't work in the NHS and in fact I'm treated abroad. I pay about £850 a month for health insurance. I get a pretty decent service for that. But:
It doesn't cover all the treatment I need. And
It still took 6 years for a full diagnosis and treatment of endometriosis;
I have an injury that hasn't healed but apparently is untreatable, so I am in pain management, including IVF infusions which are expensive;
I had a surgery where the surgeon screwed up. Ranks were closed, another surgeon corrected it, my insurance paid;
Important drugs are currently out of stock and there is no pressure from the government on the drug companies to get their acts together. I have been fobbed off with a generic painkiller that only costs 10% less but doesn't work properly (the slow release mechanism isn't the same). Luckily my doctors understand the problem and have adjusted my dose.
So even expensive private systems still fail the patients. However I think a European model like France or Germany would work better than the NHS but the restructuring would be very expensive. Also in France there are still areas where it's very difficult to get a GP, or indeed any treatment, because it's a big country and some areas (even densely populated ones, lack doctors and medical facilities.
I would actually happily accept euthanasia now, because my life is so limited, but it's not given for chronic pain.

@Helplesstohelp22

GPs are inundated with requests for secondary care assessment of patients who think they have adult ADHD, mild anxiety, mild depression (but have a job, family, hobbies etc. and are functioning even if they are unhappy).

This is an issue related to defining the NHS remit. Mental illness is real, but not everything is mental illness. Being unhappy or unsatisfied with your life is not mental illness. Being anxious - but functional - during a period of massive economic and ecological turmoil is not an illness. Its normal. I read a quotation from a GP in an Independent (I think) article recently talking about the large number of people who make a doctors appointment not because they're ill but because they're unhappy. "These people used to go to their priest - now they come to me".

Yes the point on lower funding seems to go over the heads of those who keep saying the "NHS is broken, can't be fixed"

Apart from the Blair years, we have consistently paid less than EU countries for healthcare for decades.

No other EU country forces nurses and AHPs to go into around 45k of debt either.

This is so absolutely true.

However there are some working solutions being put in place for this with primary care mental health workers under the ARR scheme, along with social prescribers. Reception staff should be trained as care navigators to be able to confidently direct people along to other services but it’s often hard to unpick these issues. As part of my role I have tried to tackle frequent attenders by navigating them to more appropriate services, one lady was coming weekly to complain about her finances, what is a GP going to do to help with that? Some people want ‘things on record’ later down the line for legal claims so will spend time building a medical case for themselves with their GP.

This goes back to my HRT quote, many women are unhappy at going through the menopause, and it is very hard to separate what the medical profession is able to achieve.

This goes back to my HRT quote, many women are unhappy at going through the menopause, and it is very hard to separate what the medical profession is able to achieve.

I might have agreed with this once but since having been prescribed medication to block estrogen (post cancer treatment) the side effects were dire. Severe anxiety, depression and no ability to concentrate and a downward spiral as each side effect exacerbated the other, HRT needs more attention by GPs imv.

I sadly lost a close family member a few weeks ago so spent a lot of time at the hospital and the majority of the time in A and E. because there were no beds. They didn’t think he would last the night (but he did!).

The staff weren’t great and I ignored the surly almost rude attitude of the nurses and a particular junior doctor but as an observer the people waiting in A and E were a real mixed bag. Whole families cluttering up the waiting area. A middle aged chap demanding a tea because he was ‘parched’. There was a family in the corner playing cards and a guy shouting that he had waited 3 hours and others were being seen before him. Someone else kicking off that they shouldn’t have to pay for parking. It was truly awful. The only people who were ok were the old people who had clearly fallen and were just accepting of the wait time.

I also heard someone saying that you should always call an ambulance because then you were seen quicker and bypassed the queue.

Its not just the staff - it’s us too…

We need to look at a German/French system urgently. As a supplier to the NHS for many many years they job protect massively. Jobs on top of jobs and each Trust doing things differently.

I’m not saying I don't agree, but it’s the same cyclic argument. To increase spending, where the money is going to come from- a look around this site alone will show just how many are struggling to keep their heads just above water as it is. Even with the political will to do so, there’s no more significant. taxes to be squeezed, in the short-to-medium term at least. What are your thoughts/ideas for this additional funding?

With regard to funding. People generally mean that others should pay. I have seen Amazon, Bill Gates, Musk etc being the people who fund it! If they really don’t believe that Amazon pay enough tax then don’t buy from them. If tax is increased for them then you do know it’s US who will be funding it. As for Bill Gates et al. He is American….

I was going to make a formal complaint about the staff’s attitude and I am sure some on this thread will say they are burnt out but what if we all behaved liked this, waiters, shop staff etc. Both of which I have been over the years.

The junior doctor was particularly obnoxious especially as it was an End Of Life situation along with the young ward doctor when he was finally moved. Both looked very young (compared to me!) and their attitude was appalling. The consultant I eventually spoke to was much much better.

In the end I decided to just put it down as an awful experience

Tax is already quite high for low to middle earners... can't come from them.

imho UK is going to have to look at a wealth tax on assets and on higher taxes on the wealthy, 177 billionaires and 2.4m millionaires, tax investment income as "income"..... increase CGT to match income tax rates?

We also need to hold to account people like Sunak who said we'd be better off outside of the EU... i.e a 12billion annual saving and better trading opportunities... points based immigration system (to make up for loss of EU workers).... where has all this gone?

Combine above with looking again at how NHS spends money.

Quite frankly, there is no alternative.... well, there is.... people die needlessly waiting for treatment and thats us.. ordinary folk.., not the wealthy or the political elite.. they wont want for anything.