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!)

@HeBeaverandSheBeaver
Student nurses do train on the job. They are supernumerary too.
The managers aren’t clerical staff. They are senior nurses called ward managers. We still have matrons too.
Bank staff are different from agency staff. No where near as expensive.
I’m not sure whether we are overmanaged. Yes there are different tiers of management who have increasing layers of responsibility and see the bigger picture. This will need replicating with all the myriad of departments and services. People quoting the ‘director of lived experience’ vacancy didn’t read the full thread and it turned out to be a fairly important post to ensure quality of care was maintained.
Agree that wealthy pensioners should be contributing towards their care and not squirrelling money away for their children. My mum paid almost £300k towards her care as she was self funded. Some form of means tested contribution should be implemented so funds build up over the years so canny folk can avoid paying tax.

We have a rapidly aging population with high care needs and multiple co-morbidities
I agree this is a big part of the problem, we've our heads in the sand & haven't accepted this yet😶

So many staff off sick time and time again, weed out the chancers.
Stop employing just anyone to get numbers up. Employing someone not interested or just downright lazy does not help us one bit, and they can't get rid of them because they have a permanent contract. Would it not be sensible to offer 3 or 6 month conracts to see if they are suitable for the job.
The amount that must be getting spent on agency and guild staff must be ridiculous......one I was working with the other day....£60 an hour bank holiday rate.

It's cheaper for the NHS if people quickly die of heart attacks. One of the biggest problems is people actually living longer with dementias for example which cost a fortune. Dementia is going to become the number 1 cause of death in future. Dysphagia treatments, antibiotics, falls , infections , diabetes , the costs mount up and it takes years to die from.

waste reduction, fair contracts for equipment, medicines, etc., and better pay to retain and attract staff. invest in prevention -how much money is spent on self-afflicted illnesses. Health as part of the school curriculum.
practical stuff such as early intervention - people not diagnosed for a long time then a long wait for treatment costs far more and potentially more serious outcome. I'm thinking a form of healthbombing where triage and investigations can be concluded over a matter of hours or a couple of days.

As to wasting money, the NHS trust where I live hold random clinic days to carry out health checks on staff. That surely is a waste of money. This is on healthy staff, without symptoms who would surely visit their GP if necessary.
Also the NHS doesn't always investigate where certain departments have high staff turnover and simply waste time and money on recruitment and training.

Communication from seniors to staff is also lacking and staff often have to turn to their peers to find anything out, especially when new, this doesn't help with retaining staff as they feel undervalued.

I worked in the NHS for 30 years and never quite got my head around how much sick time was taken off by colleagues . People absolutely milked it because they could - six months on full pay, then they'd come back and take off all their leave that they'd built up during their sick time off. I went to work abroad in their NHS equivalent and you got no paid sick days until you'd worked there for six months.

Sort out social care. If the 120ish people waiting to be discharged with social care support could go home over night in the hospital I work in, we’d be able to place patients needing admission quickly in to the right bed from the Emergency Department, so no ambulance queues, and we’d be able to run our theatres efficiently. Though it wouldn’t sort out staffing alone, it would mean that people can do the job they’ve chosen to do - rather than, for example, nurses working in surgical wards looking after medical patients, and without some of the compromises being made now.

Whilst I don’t disagree that euthanasia should be legal it is actually possible to do something, I’ve drawn up a legal document (power of attorney) stipulating when no resuscitation or medical treatment of any kind is to be given. I’m my case when I cannot recognise named family members. Hopefully this will be respected so that if I am afflicted by dementia, or am brain damaged, I will die of a simple infection (Covid, flu, UTI anything) without medical science prolonging a life I have determined at a healthy period of my life (I’m 40) to be of no quality to me. Reason for sharing this is that this is possible for everyone, if they want to take charge for themselves.

Well in those specific cases, mobility problems stop people working, acne less so. Gastric bands are not very successful, hip replacements are. Of course it's not straightforward. I'm not a specialist in everything, but these are discussions we need to be able to have openly. But in general we need to be concentrating on cheap treatments that are successful and that a lot of people need. And the people who get the treatment need to be young enough to have a good potential quality of life.

I’m in the private sector now but did work in a&e for 5 years and nhs theatres for 2 years.

• legalise assisted dying. It’s brutal what we put people through when they just simply don’t want to live anymore
• Community hospitals, rehabilitation centres where people who are fit enough to leave hospital but not well enough to go home can stay. Following surgeries, strokes, waiting for care packages to be put in place in their home environment, waiting for residential care places.
• pay staff more, make the job more attractive. The private sector isn’t much better but I’m paid well. More than the nhs. Plus I get private healthcare too which has served me very well in the two times I’ve needed it.
• encourage people to become nurses by offering more ‘apprentice’ roles. Pay a wage whilst they train. I earnt £2.30 an hour as a student and then a third of that went on my parking costs at my hospital as ‘students’ weren’t considered for staff rates. There was nowhere nearby to park as all residential permit.
• less paperwork. So so much time is spent on computer/paperwork. We often finish a whole surgery before even completing that patients paperwork. Give patients choice if they would prefer to go paperless.

I would like to see more training provided to the current staff to upband, any training given to staff should result in higher paid people too. At the moment we have staff who won't learn how to take bloods, do cannulas, ecg's etc because they aren't paid any more to be pulled from all directions to do these jobs. Value nhs training and make the most of it.

Nursing associates should be given the FULL training to be a band 5 staff nurse. Similar courses should exist for every single nhs career too. Why is it we say every year how many nhs professionals we are short of but at the same time the uni's have over subscribed medical courses? I know many good healthcares that got rejected on nursing and midwifery courses.

Tighten up the sickness policy too, it is shocking how easy that is to abuse.

I'm probably way off on all of this but I would just like to see more investment in the people and a bit of encouragement. If you're under band 5 you're basically stuck in shit pay unless you put yourself through uni, pay for it and work placements. If the nhs really wants more qualified staff they're going to have to provide the opportunity (in my opinion).

Worked in the NHS for 30 years another 16 to go. It's never been this bad. Colleagues leaving to work in private clinics or abroad. Pay and conditions better in both. Last 3 students I've had have all been aiming to emigrate on graduation.
How do we sort it?
Investment and the country realising if they want a better system like Germany or France it must be paid for.
Reopen local cottage hospitals to allow patients to be rehabed . Most gyms and rehabilitation areas in hospitals went.during COVID and haven't come back . Patients can't cope on d/c fall and come back in.
Better social.care with Investment and training. Most NH are private, they need to make a profit it's not working is it? So why would privatising more of.the NHS work more.
We also need to charge for missed hospital appointments or cancellations within 2 days this really adds to waiting times in my clinics where the wait is.up to 12months for an appointment. Appts go out 4 to 6 weeks in advance by text / email.
People. Need to grow up and take responsibility their own health too.

NHS ITU nurse here. Worked through covid and the current madness.

1. degree apprenticeships for nurses and on a large scale - thousands, instant bolster to workforce and retention. (Not the old training, a degree apprenticeship). Graduate degree apprenticeships also 1-5-2 years to train a nurse or midwife. Student nurses are keeping the nhs on by a thread. They need a paid wage and also to feel a sense of belonging.
2. community / rehab / long stay elderly beds (these have all been cut historically and is why we are seeing current problems, for staffing I think we need to look hard and try way harder to encourage people into nursing and care work but also need to recruit abroad if we want our patients to have any care.
3. Hospital at home teams across the country. Flying squads. Whatever it takes to manage the elderly at home for as long as possible. 93% of beds in my hospital are occupied by over 65s. 75% are delayed discharges. H@H teams do exist and do work it’s just a postcode lottery.
4. being clear with relatives that just because they want their 95 yo relative to have full escalation and painful interventions it doesn’t mean it’s fair or right and no matter how much threatening they do should not influence care (it shouldn’t but it does)
5. (I’m not right wing btw 😂) a national service style scheme but for healthcare support roles, (obviously those working in healthcare exempt) people have lost track and sight of what happens in the nhs and also lots of potential nurses physios etc are lost.
6. a full and frank look at what can and cannot be provided by the nhs, although the potential inequalities in care do scare me.
7. Closed door EDs (in place some places) and far better walk in GPs for OOH. It works in some places. Better minor injuries / urgent care centres. These are available in places but it’s not uniform or standardised. Good practice needs to be shared.
8. standardisation of nurse associate / associate practitioner / senior HCA band 4 roles and implementation across the country, but fairly, not instead of staff nurses.
9. nationalisation of home care, more community day centres etc.
10. end outsourcing and also , there are many incessant non clinical roles - an irony being quality improvement - quality is low because an RN has 3x the safe and legal amount of patients, it can be improved by more RNs. We need to walk before we can run.
11. Some decentralisation, too much pressure on large super hospitals. More smaller hospitals and let people be cared for closer to home in a smaller setting.
12. no more single room general wards, and ideally back to nightingale wards or large bays, this is a slow burn though.
13. bring back nhs / nursing staff accommodation.
14. a 0.5-1% on higher rate earners for nhs / health and social care. MPs pay rises to matched and capped % as equal to nhs pay rises.
15. strict fines and criminal charges where applicable for V&A against nhs staff (capacity dependent). This is a large driver of people leaving.

my most controversial suggestion, we need to legalise euthanasia / assisted suicide in some form, there’s a lot of people living with pain and limited dignity and it’s cruel.

I agree regarding charging for missed appointments. I personally think we should have means tested charges for A&E, as exists in other countries. However I’m conflicted on this.

The high cost area supplement needs reassessed and applied to other high cost areas e.g. Edinburgh, the wider south. It should be a sliding scale of enhancement and probably more than 20% in London

• get rid of PFI
• get rid of private contracts for maintenance or cleaners
• actually sack people for poor performance
• be innovative when it comes to recruitment/ retention. One of our nurses is term time only, if it gets you a good nurse for the majority of the year why not try it? One of my colleagues is an HCA who doesn't want to work nights anymore and was told she can't? When nights are the easiest shift to fill due to increased rate and less stressful shifts? So now we've just lost a good HCA.
• sort out recruitment! Why does it take so long?!!
• ditto employ band 3 admins to deal with setting up new starters etc. In my trust this all has to be done by the line manager so you have band 7s spending hours getting people access to email, records systems, phone systems. That's a fully trained, experienced nurse right there, sitting doing meaningless tasks for each new starter on their ward.
• take bullying seriously
• take racism seriously
• sort out the parking
• managers need to value staff more. Our head of ops said we weren't going to get staff milk anymore and we had to bring out our own in (we already bring in our own tea and coffee obviously). Ridiculous. We wonder why we shed staff. I was speaking to a consultant who turned down a job offer and was told he wanted a parking space and his own allocated desk space (not even his own office, just his own desk!) The private sector could offer that, we couldn't. And we really cannot recruit consultants!

The managers see these things as non important but they are important to people doing the job day in and day out. Milk, parking, not hot desking, getting access to systems on day one not months after. These are the things that matter to staff!

Procurement. It’s sanctioned robbery.

Sort out the managerial bullying. It’s a nasty culture and it’s getting worse.

People who don't have e mail ? I agree about letters. I got an appointment letter the other day , a day after my appointment. Got put down as not attending.

She couldn't consent if she has dementia, we can't just go round euthanising people.

I'd target wastage and education

@America12 but if she had consented before she developed dementia would that not suffice. Wouldn't suit everyone but lots of us would be happy with that.

Or text. My GP practice sends a text reminder.

I missed an outpatient appointment a few weeks ago, because the letter was delivered around midday on the day of the appointment, which was at 9.30.

The cost of Nurse training could be managed better
with various options ranging from as it is now and self funded
or offer free training with tie in on sliding scale
say it cost you 30k
you leave in 3 years pay back 15k
you leave in 5 years pay back 8k
you leave in 7 years pay back nothing

Totally agree about social care assessments. Some patients here are waiting 3 months for discharge assessments, and the wait for adapted or supported social housing is approx another 6 months. There's no incentive for councils to devote more resources to this, but if social care was integrated with the NHS, they would have a vested interest in speeding up the process.

They should bring back bursaries for student nurses and maybe doctors too, then wipe out their student debt after a certain period of NHS service, eg 10 or 15 years, to encourage retention.