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!)

Bring back convalescent homes.

Introduce private sector sickness policies. Six months on full pay is obscene (not just NHS) and open to abuse which leads me on to...

Get rid of agency staffing. Use bank staff instead.

I don't believe in euthanasia at all but I don't believe in keeping someone alive who has no quality of life. Let them go (naturally).

Finally, get rid of the tories.

He said..... but its Unlikely, i 'm good friends with a large ground works owner, he is a multi millionaire, worked his way up from digging trenches, lovely couple.

He pays jack in taxes, all legal.

I also used to live near a former football manager, ex premiership, he once told me at one of his neighbourhood garden parties, that his tax bill is about what i earn in a year, he owned 20 plus properties (all high end) and in one year (after promotion) boosted of earning more in one year than i'd see in a life time,
Nice enough bloke but this idea they pay anything like in proportion to the rest of us is laughable.

They are building a new hospital at the new M11 junction at some point

PAH is on its knees

Bring back convalescent homes.

For whom? For what length of stay? Convalescence implies a trajectory towards rehab and improved health. So it wouldn't seem to cover some very senior people or those with multimorbidities and long-term conditions.

Do you intend them to be for people living alone who can't have adequate social care packages?

I'm asking because I don't know very little about them and didn't grow up with people using them or cottage hospitals.

Introduce private sector sickness policies. Six months on full pay is obscene (not just NHS) and open to abuse which leads me on to...

NHS staff can't come into work like you or me could, us spread a cough or cold around the office all ok but that would kill half the patients on my DD wards, she has been on her rotation for 5 months, had 3 weeks off, 2 lots of Covid and a bout of noro, another got hit in the face, been off for a month or so.

Do you think they should be punished financially for this? .... and how would that aid recruitment?

Aside, most of the private companies i worked for had 6months full pay, it was still subject to HR review if you had more than 3 lots of sickness off in a year.
It was to help employees like my friend whose partner was murdered and another who got cancer.

Yes making the sickness policy worse will help with the huge retention issue the NHS has. Also agency shifts exist because there are no staff willing to do them for regular pay or for bank rates. Sure if they abolished agency shifts a small percentage might pick them up on the bank but trusts have been cutting back for years and it never works out well.

But they have kicked that idea around for years ! Fiddling whilst Rome burns

I agree PAH is on its knees despite some fab people that work there

'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?'

@Helplesstohelp22 people forget that the NHS as an employer has a duty of care towards their staff as well as the patients. If there were risk indicators the pregnant staff member should not have been working with this individual in the first place. Staff shortages?

It's heartbreaking, but I understand staff moving on to work elsewhere.

I’m sorry but I’ll but in here and say you’re wrong. As any economist with a knowledge of European tax systems will tell you, the UK is a bit of an outlier in having such a low basic tax rate (see this for instance: ifs.org.uk/taxlab/taxlab-key-questions/how-do-uk-tax-revenues-compare-internationally). It’s an inconvenient truth but we can’t expect Scandinavian health services on a basic rate of 20% and nic of 12%. If you want better services everyone across the board has to pay, and the best way to do that is to increase the basic rate of tax significantly. Only then do we start generating meaningful amounts. Does any political party have the backbone to do this? I don’t think so. They’d rather protect us from the truth and make promises using magic money trees. And yes and everyone needs to stop dealing with businesses that they suspect are dodging their taxes.

But away from the economics and back to the interesting arguments from the medical profession please.

we can’t expect Scandinavian health services on a basic rate of 20% and nic of 12%.

I'm not knowledgeable about VAT (or its equivalent) in other countries. Does VAT not make a substantial tax contribution in the UK?

Would love not to use agency staff but we can't recruit enough permanent staff nor do we have any staff that want extra bank shifts. We have excess cash in the budget and huge waiting lists so of course we use agency.
I agree about the sick pay being too generous. This causes a lot of problems.

I have family friends in Harlow. Your posts are in line with what they've been saying although I hadn't heard about the new triage service to a GP from A&E. Is the hall on the PAH compound or nearby?

Unless they are trained abroad though, any medics, nurses or AHPs will have used NHS resources in their training. There is no other route to qualification in the UK. As a Practice Educator myself it is beyond demoralising that few of NHS trained staff stay not only within our board but also the country or the NHS.

I can't help but feel that staff shortages in the NHS are partly to do with the changing role of women in society. Previously it was common for men to be the main earner and that meant that woman's wages could be regarded as pin money at worst or secondary at best. Furthermore the greater part of unpaid caring work in our society was done by women, this further cements the implicit idea that it's normal for women to work for little or no money.
Now we have a situation where it's not uncommon for the woman to be the breadwinner, the main earner, women, seeing that good well-paid jobs are within their reach, are much less willing to do difficult stressful work for low pay. If women are increasingly assuming a breadwinner role within the family they are no longer available to do the unpaid care in work furthermore the unpaid caring work is often too onerous or difficult to be done at home anyway because the elderly living much longer and with much more complex health needs.
I feel that going forward it will be much more difficult to recruit anyone to work in healthcare partly because it was previously propped up by women who had no choice but to be exploited but are no longer prepared to put up with that, and they don't have to, they can vote with their feet and get a better job somewhere else!

The complaints are always about money and lack of funding. However one recent NHS experience.

1. Failure to diagnose a fractured T12 despite it showing on Xray. F2 confirming to me that it was not broken.
2. 6 month delay arose re referral back to rheumatologist whom I was under already due to severe osteoporosis and having zolendronate.
3. GP refused initially to help re another broken bone - refused further referral, refused physio, refused to accept that T12 was newly broken.
4. T12 confirmed privately
5. Referred back to rheumatology.
6. Saw rheumatologist 10 months after the break. 1.45 minute delay in clinic. No apology, no reason.
7. Rheumatologist recommended teriparitide. Not covered by NHS so I am paying £2400 for the two year course.
8. Rheumatologist office and I cancelled the next zolendronate appointment.
9. Infusion dept phone to tell me to go for bloods before infusion - explain treatment has been changed and I have cancelled the appointment.

10. Infusion dept phone me again and very very slowly explain that I can't have zolendronate and teriparatide. 11. Clearly nobody reads the notes. 12 . Attend appoint yesterday at 11.45. There was a 1.45 hour delay again. No apology, no explanation no attempt to call me in advance. 13. Appointment rescheduled for 28.2 at 9.15. 14. I wasted 2 hours yesterday. I work full time. There is never a calculation for the cost to employers and patients for the time wasting and mismanagement. I am sure these costs double the GDP contribution. 15. Delays in clinics are normalised and have been for my entire 62 years regardless of which government is in power.

I do not understand how giving more resources would prevent the sort of shambles above. The issues arise through mismanagement and because there is zero respect for the time of the patient and nobody, not one individual in the NHS has ever accepted that patient or taxpayer time is as important as that of those in the NHS.

If I were a Tory politician, I would aim to train more young people to gain maths (and science) A levels, so that I'd ensure a steady stream of medical students prepared to be exploited!

I went out for lunch today, and listening around the restaurant, all sorts of people are outraged at the way the nhs has been failed.

Isn't it unthinkably and remarkably grim that even with all of this genuine concern, we all seem stymied at a way to make an effective protest and demand some progress?

I think, judging from Sunaks speech, he think that he has it:

Sunak said he was confident things would improve within months and asked the country to hold him to account

In other words, bring in more private sector providers.

Another way to make great strides would be to tax more for the NHS and also to raise pay for social care. And to bring at least a modicum of private care provision into the public sector, eliminating the profit motive. Not that this could happen, because it doesn't fit the prevailing philosophy-from either side.

For me I don’t think the nhs needs any more money it just has to stop wasting it
on trying to save money.

After a back injury I thought I would get an
mri which would have cost £300 to find out what was wrong.

However in order to save the £300 they spent over £250,000 over 7 years on me. Not forgetting the sickness benefit I got because I couldn’t walk never mind work and was in so much pain. 7 years of being in agony, 7 years of being shouted at as I wasn’t improving. 7 years where it was decided that I needed a new hip and I couldn’t get one till I was 60. 7 years where I couldn’t work, couldn’t sleep.

I was in so much pain that It very nearly cost me my life.

So the NHS’s
attempt at saving money ended up costing them £249,700
As a minimum.

I know I am not the only one this type of thing has happened to.
Multiply that figure by 1000s and then you see where the money is going.

Currently with our current IT technology emailing patients is a far more long winded time consuming process. We book an appointment which generates a letter automatically to the patients address, it gets printed, put in envelope then sent. To email a patient the letter gets printed we have to find said letter from massive pile of other letters, scan on, pdf, then email then hope that the email doesn’t bounce back as people rarely get their addresses wrong but emails are often incorrect or changed. Then you as lowly admin staff are constantly bombared with emails about everything to do with the nhs as the patient now has your email address. I have had emails back asking what bus would get them to their appointment on time.

If you employ empathetic touchy feely people to be doctors - where do you get the geeky nerds who stare at xray screens all day. There's a constant shortage.

The problem is that the NHS cannot give you that scan because they have a constant stream of people in more urgent need than you.
The UK has some of the lowest number of scans per capita of any European country and of course, we don't have so many radiographers either.

The NHS is run by people who don't know what they doing, from Govt to Trust leaders, the lack of staff is symptomatic of this, they have the money but do not spend it wisely, esp on training/equipment and most importantly, retention - see below:

Someone i know, a skilled HCP, has had 2 bouts of Covid and flu, yesterday she had her meeting with HR to discuss her sick record and is on a disciplinary measure for the next 6 months, no other absences - and they wonder why staff leave, which is what i ve advised her to do -

A decent private sector company would have the flexibility to work around a sickness policy that is designed to pick up a pattern of absence not punish people who get work related illness.

I think like in all organisations the solutions would come from listening to employees at the "bottom" those who are actually doing the jobs that are in contact with the patients, those who know how stuff works (or doesn't), sadly, changes in big organisations are always driven by the top instead of the bottom and a lot of the budget goes in paying those at the top too, as well as on "vanity projects" that sound/look good on paper but don't necessarily improve how the organisation works.

@BorisisaLune

The problem is that the NHS cannot give you that scan because they have a constant stream of people in more urgent need than you.

AND poor admin meaning scarce scan slots are wasted. My OH has needed several MRI scans for his bone marrow cancer over the years. Very rarely have they done it on first appointment. That has been a variety of reasons. Once he turned up and the referral/scan request was apparently "unclear" and the radiographer couldn't contact his consultant so didn't do the scan. Another time, he turned up and they had him down as for a "tracer" injection which he told them he couldn't have (his consultant knew he couldn't have it as it was discussed at the consultation!), so instead of the radiographer doing it without the tracer, they refused to do it - that was an admin balls up by either the oncology admin doing the referral or the scanner admin ticking the wrong box on their day sheet! Another time he turned up at the hospital per his appointment letter, only to be told he should have been at the other hospital 25 miles away!

Until they sort out the shambolic admin, there's really no way to "fix it".