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!)

The only texts I get are when my GP surgery goes to emergency only and they text to say “ do not call - emergency only “
So if the GP is emergency only then where do people turn ? And they wonder why A & E are overwhelmed

Such a huge issue but I'd do the following

1. We need to pay more tax to fund social care. End of. No bitching and moaning. We want an nhs it has to be done
2. Use said tax to fund care homes or convalescent homes with properly paid staff
3. End all uni fees on nurses
4. Go back to Training nurses on the job with day release Have dedicated staff to do this. This should

Be free

1. Then end the need for bank staff At extortionate salaries
2. Same applies to doctors midwife's radiologist etc etc
3. Wards need to be managed by experienced staff not clerics
4. Waste. Letters. Stationary one use supplies the list is endless
5. Get rid of long term underperforming contracts

10. Pay rises 11. Charge people for wasted time 12. Nurses at triage should be able to turn people away at A&e for ridiculous complaints such as paracetamol broken toenails And yes this does happen.

I'm
Sure there are hundreds more but I can't think of them now.

I've not worked directly for the NHS, but I'm trained in within a specialised mental health field and my MSc was geared up to be pipelined in to the NHS, so have done a lot of volunteering within NHS services.

Middle management is such a huge issue. Jobs that just don't need to exist filled by people who honestly just make work for themselves. It must cost the NHS billions.

The lack of money in mental health care is shocking, and when their are roles available they are 6 months contracts which take months to fill because all the paperwork that needs to be filled out is across different systems and departments.

And just generally too many people to cater too who aren't paying NI toward the services. The NHS is a great idea in theory, but the UK is very different now compared to when the NHS was started after WWII.

Like a PP said I think it's a lot worse than the general public realise, I honestly don't see their being an NHS for that much longer.

Get rid of the agency staffing system - 'middle men' agencies earning ££££ an hour. Pay NHS staff the rates that agency staff receive.

Funded tuition for medical personnel on the understanding they work 10 years in the NHS after qualifying.

Look at sick pay (this should apply to all local govt, civil service etc) full paid sick leave for 6 months in every 12 months is unsustainable.

Agree with PP about community hospitals, convalescence spaces, 24 hour clinics.

Prevention is better than cure - ensuring everyone has access to good food, return of surestart centres, exercise brought back into primary schools.

I'm an outsider who sometimes works with (and occasionally within) the NHS and LA social care and have done on-and-off for 20 years. You cannot separate the problems of the NHS from the problems of social care.

Connect the NHS to social care. For a couple of decades they've been playing budgets off against each other because of the disconnect. It's an artificial competition that the Treasury plays.

If DTOCs could be largely eliminated and the whole TOC process made to work reliably, efficiently and to time, then there's a chance of getting enough fluidity in the acute care system to keep things moving. You could firehose cash at this in the short term, but this would be expensive and temporary.

Separate acute/emergency from chronic/elective.
Invest in respite and rehabilitation centres.
Re-invest in preventative measures based in the community.
Start a debate with the public about what the GDP health spend should be, what this means for overall government funding, and the public thinks should be funded and what should not - with some honest discussion about quality of life. Don't give the public the decision though, they're bad at those, but let them have opportunity to understand the issues.

Replace the convalescent hospitals and cottage hospitals that have nearly all been closed during the 12 years of this car-crash of a Tory government.

That would largely resolve the bed-blocking problem and enable ambulances to function again.

It was not long ago that all these facilities were closed down, and it was a decade ago that the Conservative government decided the NHS had to run above safe capacity for “efficiency” despite being told it would have the opposite effect. How come the entire nation seems to have developed the memory of a goldfish and forgotten all this happening? It was in the news an awful lot at the time…..

Also, bring social and residential care back into state provision rather than being farmed out to profit-making private equity firms, who load care homes up with debt, charge vast fees, take huge profits, but pay the staff the minimum wage.

Then, start investing in a healthy population: day centres for the elderly and adults with learning disabilities; good municipal leisure centres/ facilities to encourage healthy lifestyles; access to good quality outdoor play space. We did have all this in the recent past - before it was all cut in the name of “austerity” and the ideology of a small state.

A healthier population is what’s needed for the NHS to survive long-term. But for that, you need government to give a stuff about the well-being of ordinary voters, and we haven’t had that for over 12 years. No wonder it’s all such a mess.

@Pianofar "Reopen community hospitals, minor injury units (and staff them 24/7), and go back to holding clinics in the community. "
I don't know where you are but as a community nurse this already happens. We even run clinics on Christmas Day!
One of the many problem is hospitals refer non housebound patients to district nurses without questioning if they could go to the practice nurse or clinic.
When patients are informed of this they complain because the hospital or GP said we would visit.
Practice nurses are not given the time to do training for things like compression so the only option is clinics or home visits. We get complex wounds patients referred to us that make demand's because they do not like waiting in for us but as a service we cannot give times as we expect them
to be in.
We cannot give times because someone dying or a blocked catheter takes priority.
We try to encourage independence but families see it as a "nurses job" such as pain patch changes or insulin.
We get asked to do blood pressures by the GP when they are not our patients rather than loan a BP machine to them.
To cut a long story short we are taken advantage of, because we have a duty of care.

I completely agree with this.

I've watched 3 family members die in the last 18 months.

All of them have been terminal and have died slowly and in pain. One of them was extremely annoyed that they were being kept alive against their will, when all it was doing was prolonging their suffering.

They were terminal, in their late 80s, and very clear minded. Refused a DNR but had to keep removing their own tubes.

The Health Foundation, Nuffield Trust, and King's Fund have many excellent analyses and reports.

E.g.,

www.health.org.uk/publications?

www.nuffieldtrust.org.uk/news-item/myth-3-we-should-copy-other-countries-and-adopt-a-social-insurance-model

www.kingsfund.org.uk/publications

So as someone who knows a lot of people who work for the NHS at various levels, the thing that's struck me is the amount of "middle management" or "behind the scenes" people who are paid staggering amounts of money, when that money imho would be much better going to doctors and nurses and the people "on the frontline", I guess you'd say.
To give a recent well publicised example, the "director of lived experience" role for NHS midlands who earns £115,000 a year, but I know quite a few people who work for the NHS in a "consultancy" style role (not medical consultancy but HR for eg) who earn THOUSANDS, and as it's not a private business it goes unquestioned. They're just ones I know - it infuriates my doctor and nurse friends who know of many more examples.

I think that if the NHS is relying on well meaning people to allow themselves to be exploited because "long reign the NHS", then it's a failing business model.

That's before you get into the nitty gritty of how it's actually run day to day on the ground....

I think the NHS needs to do much much less and do it well.
Some conditions are so expensive to manage that we should probably stop. I absolutely love my patients but some require two to one or even three to one care at all times. Its not sustainable.
We should look at quality of life towards the end of life much more actively. People should be allowed to die more easily. No pegs, no dysphagia assessments in end of life, generally speaking.
Yes to voluntary assisted euthanasia. No one should be alive five years after they stopped recognising family members.
No fertility treatment. No cosmetic surgery. No breast reconstruction, no gender realignment surgery. No gastric bands, no acne treatments.
I know people benefit from all those things, but when we have people who haven't been able to see a gp since before covid, are waiting in agony for two years for a hip replacement, who are dying aged 40 from colon cancer that was diagnosed too late and people refuse to pay more tax, then we have tough decisions to make.
I don't actually see a lot of waste in the NHS, but I do see a lot of staff working way over hours for free.

We need to separate out care costs from the other local authority budget.
We need to accept that quality care costs and be prepared to pay for it. Care homes are not making big profits despite what some previous posters say. They need 95% occupancy to break even these days.
We need more short term accommodation for those who need short term support and are not able to go home but are well enough to not be in hospital.
We need a falls team who are able to get those who have fallen and are unable to get up but are not injured off the floor freeing up paramedics.
GPs need to be open longer hours every day and move back towards a preventative rather than a reactive health service.
More local drop in services for the elderly to increase general well-being.

Absolutely correct. The modern NHS does too much it should be a basic heath service but do it well. I see waste though from middle management jobs doing stuff that isn't core like that "director of lived experience " and too many managers and poor procurement.

Apparently only 2% oh NHS monies goes on management, which is much less than the private sector. Getting rid of a manager who costs 100k a year would pay for two months care, if that, for one of my patients. It's an absolute drop in the ocean

I’d take it out of direct government control and make it independent. Decisions made for the good of the users not political ambition or ideological beliefs. You only have to listen to government ministers for a few minutes to realise that they have little clue how anything works, or what services are provided or what different staff actually do. It’s embarrassing. And we keep wasting money every 4/5 years on major restructuring for very little gain.

I would ban prescriptions for low value items that can be bought in the shops. Paracetamol for example.

This 👆🏻

but in addition we need more GP surgeries, more hospitals and a ton more staff.

Today I waited in an ambulance queue to get into the hospital for 8hrs. Some of the patients had been in the corridor for over 12-14hrs !

our population is ever increasing for various reasons but the infrastructure is not

We need to manage the population growth.

Population of England:

1981 46.82m
1991 47.88m
2001 49.45m
2011 53.01m
2021 56.49m

How much over sixty million by 2031? What will be the age structure and health needs of the additional people? Where will they be living? How are you going to plan for it? Or will any attempt to discuss the issue be shut down by accusing people of being racist and anti-immigration?

We sadly have a very unrealistic attitude towards quality of life vs quantity of life in this country. Even Prince William said of his 96 year old grandmother that they had hoped she would get a bit longer when the Queen passed. I don't support blanket decisions but a discussion between families when someone is well not at a critical point about what they would actually want if they were to deteriorate.

For example, if you had advanced dementia and were non verbal and bed bound and incontinent and you aspirated on some food (because my swallow reflex is deterioring) would you want to be held down to get a cannula in to give you antibiotics and fluids and for an oxygen mask to be held to your face because you don't have a clue what's going on and are petrified. This kind of event happened about 4 times in my grandfathers last year of life. Or would you want to have a form in place that says in the event of x I want to stay at my nursing home where I know the staff and my family can visit at any time with my own surroundings and be given medicine to ensure I do not suffer and come to my natural end?

ex nhs. Stop further PFI (philosophy of buy now pay a LOT tomorrow). Good rota software. Retain experienced staff - eg higher pay, flexible working with fewer out of hours shifts for >55s. No big re-orgs (waste lots of money) - first try funding nhs appropriately (so similar ratio of staff per capita to other developed nations).

I haven't had an nhs appointment letter for ages. They usually text with a link and PIN. Once accessed you can download the appointment letter

And what about people who take 8 paracetamol every day? Are they expected to
go to the shop every 4 days? I think you’ll find the nhs really don’t provide people with small amounts of paracetamol anymore

@antipodeancanary you’ll have to explain to me why people can get a hip replacement costing thousands which isn’t life threatening but they can’t get acne treatment which would prevent them from permanent scarring for their lifetime on an area which they can’t cover up? Some acne treatments are quite toxic And need to be prescribed and monitored by hospital consultants. And gastric bands can save a considerable amount of morbidity and thus quite effectively save money long term (including reducing the load on hips and thus the need for hip replacements) You see it’s not quite so
straightforward and that’s the problem. We should really be concentrating on prevention a lot more

It's not just the NHS , it's social care which links things all together. Care packages aren't in place which leads to delayed discharge, and conditions are becoming more complex to manage in care homes. We have a rapidly aging population with high care needs and multiple co-morbidities , the choices are make healthcare a more attractive profession, pay more taxes or private insurance. Try to attract immigration or maybe accept that keeping people alive in very very very poor health for 10+ years isn't beneficial. I strongly suspect they will legalise assisted dying but it won't be for caring reasons but to reduce the bills.

Everything mentioned before. And...
Years of shortsightedness.
Years of mismanagement by the wrong people.
Years of politics informing policy when it has absolutely no buisness doing so.
Cronisim and corruption (government)
Years of corner cutting .
Lack of collaboration (pitting trust against trust instead of working together) inclusion (getting the right people involved) participation (making the changes that need to be made- a national IT system for starters).
Setting more targets instead of solving root causes!
Blame rather than support ( look at GPs - setting newer tougher targets rather than saving the problems or paying dentists enough to cover lab fees so they can continue to take NHS patients)

The first year/6 months of pandemic was so dynamic in terms of the changes being made and flexibility and collaboration. Honestly it was incredible what was done without laborious processes (still following all clinical Governance and safety) this should be how it is all the time! Especially as we know it can be done.

Neglect of the most valuable NHS assests- the people delivering care! I have worked in private healthcare systems abroad and it is not a great working environment generally. Accounting for every pair of gloves you use, inferior but cheaper equipment, decisions directly governed by finance not quality of life.

The government want to devalue the NHS so much that it's unfit for purpose, and the public are crying out to sell it off as they can't see an alternative. We are absolutely at the pivotal point right now. The NHS can be saved without an overhaul and correct finance but I am certain that it won't be due to greed. The demise will be painful, and protracted with the money making parts siphoned off and the public picking up the tab for what's left.

Tax cigarettes, alcohol and sugary foods more highly and put this towards NHS care. If people want to partake in habits that ruin their health then they should pay more towards their care. We also need to overhaul social care. Where I live as I suspect in many areas there are long waits for care assessments and care packages to be set up.