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!)

More staff and keep training to a high level and make sure people at the top actually understand what is needed at a ground service level. Also can’t work unless other services are equally well resourced - social care/housing especially. All the early years support. Education. I get overwhelmed just thinking about it as I don’t know how to manage things. Having people at the top of the pyramid that understand things and care about society as a whole would help (thinking government here).

@Anothermother3 ..and where will you get these potential degree level students from?
Or the 250k extra social care staff?

@BorisisaLune well exactly the point and why you can’t fix one area at a time. Currently a lot of foreign staff are already a big part of things - never mind the countries they come from - they used to come and do the targeted recruitment but that’s now frowned upon. It’s cyclical and if work conditions don’t improve then it’s a downward spiral. More investment in education and the grants that used to make it more possible to study health care roles and end up with a career in health care - so many in health care don’t want to promote it to their own families at the moment which is really sad. I don’t know 😢 I’m one of many who weren’t educated in the UK.

@Anothermother3 As far as i can tell, it wouldn't matter if you paid HCP 100k per year, there is a finite number of people suitable and able to be HCPs, all you'd do is take workers from other sectors, leaving these areas short of staff.

We simply do not have enough people in the UK to do the work we currently need doing, if we improved productivity, that might free up workers?

NHS still recruit from developing countries.

I'm not an NHS worker but I do work in social care. One of the problems with social care is due to cost cutting they got rid of community hubs and made mega adult social care departments across 2 or 3 local authorities. You lose the personal touch. I think with health local GP/community clinics with adult social care based in these would make a lot more sense.

Big fat yes to an earlier post in getting rid of the internal market, which can be done for free.

I know of patients who spend weeks and months extra in a £2k per week specialist bed, because a different commissioner doesn't want them in a bed a third of the cost because it comes out of that second commissioner's budget. Madness. Wouldn't need any more commissioning staff, just better inter agency working.

It's poor management. My local hospital with an inadequate A&E that there are campaigns to save, announced on Friday that is has lost £2 million because it failed to take people off payroll when they left. Almost a million is unaccounted for due to no forwarding contact details. The other million is on repayment plans with a team now hired to administer the fiasco.

It could only happen in the NHS. It is about my money being pissed up the wall.

As long as NHS is used as a political pawn, I expect little will change.

They do still recruit from developing countries but less brazenly (think agencies attending uni classes a few decades ago to get new graduates to come over). The thing is that while I get that there is not an infinite supply of people what has been done is mass down grading of posts so they’ve scrapped staff at the lower levels or just upped the level of responsibility for lower banded staff. There aren’t infinite people appropriate for health care but if you could make the assistant posts worthwhile to support the more senior posts and give a level of responsibility appropriate to the pay band it would go some way to making things more sustainable and make people want to be HCPs and work in health. I know it’s not simple but that’s got to help. Same as education a teacher with enough support staff in a class where extra Ta support is needed is going to be more likely to remain in post. Surely some of that is possible?

Yes we can tinker around the edges and address retention levels but fundamentally, we have so few HCPs per head of population, i think its about 1/2 that of Germany and France.
Make the rolls more attractive? get more people in, just leaves other sectors short of people, students who can get 2 or 3 A levels are not normally short of career options.

On waste @RosesAndHellebores even if there were non, it doesn't get us more people & yes some management is dire in the NHS, lets face it, if Matt Hancock is the solution, just how bad is the problem?

A close friend of mine was in the ambulance service (not a paramedic). She said that in order to get fired from the NHS, you'd probably have to kill someone! There's too much dead wood. 6 month sickness leaves are fairly common.

Point taken @BorisisaLune but the local trust is defending local allegations that asking for the money back puts stress on staff who have received non contractual.payments and pocketed it. The Trust shoukd be focusing on internal incompetence and negligence and external dishonesty. I run a large HR Department and along with other staff I would be dismissed for this level of negligence.

@JMSA

People are going on disciplinaries at our trust for getting covid twice and then a bout of flu !!! it was 20 days in total inside 6 months, the person i know who this has happened too is now leaving the NHS, she was happy before this, how stupid.

Say if an specialist ICU nurse broke her hip and had 6 months signed off, do you think she should be fired?

Considering the exposure to disease & being attacked, i'm not against the NHS sickness policy, making it tougher would just piss off staff and make retention harder.

Bigger fish to fry with the NHS.

Indefensible isn't it.

@BorisisaLune

Say if an specialist ICU nurse broke her hip and had 6 months signed off, do you think she should be fired?

The trouble is that she'll be on full pay for those 6 months in the NHS. In the private sector, she could be on as little as basic SSP. So, it costs the NHS more to have "sick" staff because they're ham-strung by the contracts which force them to give their staff full pay for months, then half pay for months, etc So, from a financial point of view, it can be cheaper to get rid rather than pay wages for months or even years for them not working. Of course, that argument falls flat on it's face when there's a shortage of staff and no one to take the job of the person potentially being fired (but if they're not working anyway, what's the difference?).

Plenty of private sector have very generous sick policies, especially in the more skilled sectors.
I ve always had very generous sick pay & BT, OpenReach and Babcocks all pay over 3 months full pay and 3 half and thats just the 3 companies i have had dealings with, longer term employees get better - its good to work for an employer that cares about your health and wellbeing.

Going back to our ICU nurse, so she is dismissed (goes and works for the DWP on 37k as an assessment worker) and the trust is a specialist nurse down, they then employ agency staff for 3 years until a replacement nurse is trained up.

Meanwhile, other staff see how she was treated and that they are all now on 2 weeks full & then SSP and start to leave, meaning more agency required.

Companies need to keep hold of their staff who are qualified and highly trained- because they’re difficult to replace so it pays to give a generous sick pay. It also has to be earned with years of service in the nhs. It’s not as if people can just take whatever they like. I think it’s very fair that people working directly with sick people get more sick pay, it doesn’t take a genius to realise that they’re likely to
to be sick more often! Not to mention contact with toxic substances such as radioactivity, cleaning solutions, entonox, blood
and bodily fluids

Recognise that quality of life is better than quantity of life. Accept that people die. The number of patients that I end up going to who are he'd bound, have severe dementia and yet we are keeping their blood pressure down which stops them having a stroke (but prolongs a their hideously undignified existence), is phenomenal.

Stop semi privatising the health service. At the moment we have to commission out services to the cheapest bidder every few years, which 1) inevitably means that its a shit service and 2) you have to pay a commissioner around £50k a year to do it, plus a procurement team. It's a complete waste of money. The NHS never used to be semi privatised and it worked a lot better.

Enforce Health and Safety Legislation that says that care homes must be equipped and insured to pick patients up off the floor safely, so they don't just call an ambulance saying "we aren't ensured to pick people up", we'll actually, legally you have to be.

Reopen community hospitals and increase funding for social care from the money you've saved above.

That's what I'd do in my first 100 days as the CEO of NHS England

Let all the staff work from home because it’s the new way and productivity is better when working from home, plus I will always be there in the school holidays to look after my kids.

very much agree. Can’t sort out NHS with social care is in such a mess. Co location of nhs & social care in the community as well as hospitals definitely helps. So much time is wasted going back & forth on emails & doing phone & paperwork catch ups with people you barely know. Relationships make such a difference

I can’t believe that the community hospitals will work - they are quite small and surely within a short time they will just become care homes full of elderly patients who can’t manage on their own.
Why would we be able to move on patients from community hosps that we can’t move on from regular hosps.
Are they all fittish, non dementia suffering individuals able to manage at home ? If we can afford physios/ OTs/ social workers for those in community hosps we can afford the same for those in general hosps.

There are a lot of people in the admin side of the NHS who refuse to cross train or do anything that is beyond their job description, or god forbid, above or below their band. You don't get that "luxury" so much in the commercial world. As a result of this there are people employed to do very specific jobs where they have nothing beyond the basic requirements of their role expected of them, and it creates a mindset and attitude of "nothing to do with me"; this can be a real issue and causes more hold ups in helping patients than there are already.

Obviously this is not the case for everyone, and I know people who are doing the job of more than one other person atm, as well as their own. But I often think that there could be more teamwork and shared responsibility. The band system can be restrictive for a number of reasons, and this is just one of them.

Sorry...but it is totally brazen. There are either recruitment teams from agencies, or the Trusts own staff doing stints abroad to support recruitment. Teams of people doing airport meet and greets. It is so totally wrong but it is currently the only way to staff nursing roles to anywhere near funded levels. However, it is just raiding the low levels of resources in developing countries.

If the govt scrapped tuition fees and kept the NHS bursary they may find recruitment eases, but also look at the high ,Eve,s of attrition from nursing courses..part of which is students being put on placements in hospitals and being used and abused to fill huge gaps in Healthcare Support Workers instead of learning.

The whole system is collapsing and frankly as someone with a private sector background I do not intend to stay as rank incompetence riddles the whole organisation

Absolutely this!

No queues.

When I asked would I be having an mri the consultant reply was that the NHS wasn’t made of money and they would get to the diagnosis through guesswork. He liked discovering what was wrong with a patient.

Given he said all this without looking in my direction and never once looked at me I did think at that point someone would get to a diagnosis when I was passed on to physio.

What you say doesn’t make sense

How can there be so many people having scans that there is a waiting list of longer than 7 years yet also have very few people being scanned.

I think the lack of testing is the fundamental reason the NHS is failing.

Like my back issues where a £300 test could have diagnosed the problem and got it fixed within 6 months my Dh had cancer. He returned to the GPs surgery at increasingly frequent appointments over 6 months.
He was displaying all signs of bowel cancer but even though he asked to be referred for tests he was told to stop worrying and using Dr Google. (He wasn’t. His df had died of bowel cancer)

The GPs never referred him on for tests. Instead I had to carry him into A&E where he was diagnosed.

Testing after the first appointment would have meant a pretty simple op. An over night stay in hospital.

Instead he spent 4 months in hospital only to be told that there was an operataion he would be suitable for. But then told he couldn’t get it (I think we lived in the wrong postcode) We ended up paying for it.
The NHS wanted to put him on a care pathway to death.

We talked over the time he was in hospital to other patients and the one theme that came out of this was that everyone knew what they had wrong but heir GPs wouldn’t test until they got to such a bad stage that it involved extended hospital
stays and sometimes operations that might never have been necessary if they had tested after the first appointment.

The money the NHS waste by not testing is where the problem lies.

No good spending money on adverts to show what to look out for if when you go to the Dr’s they ignore you