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!)

have children planning and cooking their own meals once a week throughout their time at school. 4-16 years. Long term this would hopefully Reestablish proper cooking in households

My DD works in NHS, her biggest gripe is lack of staff & too many PT... so everything is inefficient.... important things don't get done and this has knock on effects and so it carries on.

Second, Social Care, it is taking 6 to 8 weeks to get care packages & there is no half way house to place patients, so most stay in hospital.... DD used to work in care, so many EU staff left due to Brexit and then CV very expensive if not impossible to return to UK.

BUT no amount of money conjures up staff, it will take years, need significant pay rises and allow staff from EU to come here to work with no restrictions on visas, health insurance costs and allow family members to join them..... we should nit be taking staff from developing nations, they need them.

Part of the reason the NHS is so much worse than 2019 is because we voted for Brexit & thats a hard pill to swallow for brexit voters.. i know because my in laws, now needing extensive care, can't get it, know why and know they voted for it.

Sadly the conservatives have spent less and less on social care over the last 12 years. Resulting in a serious failure to meet care plans and meet cqc regulations

Sadly social care is the poor neglected relative of the nhs.

This.
I recently had a neurology appointment where there had been six no-shows that morning. The dr asked me if I had received a reminder letter. I hadn't and I'm guessing the no-shows hadn't either!

Start trying to get back all the foreign nurse we scared off with racism and xenophobia. Every time a “incident “ occurs where they are discriminated against I.E discrimination from patients, lack of promotion (in my area the top management are all white and band 5 and below are BAME). Call it out each and every time.

From a personal perspective I would allow nurses to have more autonomy over their own shifts. In my old job I was only allowed to make one request a week, making it impossible to work whilst being a lone parent. The nurse in charge of timetables went off sick and we were able to self roster for a month and it was the happiest team for that month. We helped each other out and covered sickness and parental leave no problem. When she came back we were no longer allowed to do this due hospital policy. 9 experienced nurses left in 3 months.

Not read other comments here’s what I think.
The NHS needs more money every hospital/dept where I work is over spent. This affects every decision from the quality of the food the patients get particularly those in hospital long term through to how drugs are ordered by the pharmacy we are always running out of drugs because they are “on order”, I’ve been in this job just shy of 40 years this never used to happen. Get rid of the Trusts in the UK we couldn’t for example get an ambulance to transfer a very sick patient to a tertiary centre because the computer said they didn’t meet the criteria therefore who would pay for it. We have a growing aging population we are living longer but we are less healthy many elderly patients are on 15-20 tablets a day of which they don’t always take them. It is the elderly who are putting the biggest financial drain on the NHS. They urgently need better support in the community, not just physical support but mental support as well every effort should be being made to keep them as well as possible in their own homes/care homes hospital is not the place for the elderly unless they are acutely unwell. To do this would require more staff at all levels GPS physios OT carers more day centres out of hours support more community nurses people to provide high standards of mental stimulation and support I could go on. We need eyes on the elderly so that interventions can happen early. Those caring for friends and family also need much more support. Where possible clinics e.g diabetic clinics chest clinics should be held in GP surgeries we should be aiming to provide our elderly with top quality care in there own homes/local environment as much a possible. Hospital should be a last resort not a first choice when someone’s mobility has slightly declined.
To do all of this we need to address the chronic shortage of staff, staff are utterly demoralised and exhausted, we are tired to struggling with this mess tired of not being able to do what we believe in and want to do, we need to be paid more we need to look at the training of everyone from health care support workers through to doctors many staff are incredibly knowledgeable but lack formal qualifications and don’t have the time or motivation to train or are prepared to take a possible pay cut to train we need to acknowledge this and look at how we can formalise this knowledge and provide them with a career path and also utilise what they know more effectively.
The issue in the NHS is not too many managers or too many from overseas coming to get free health (in 40 years in a huge variety of locations I’ve only seen this a handful of times) it’s chronic underfunding and cut backs to services especially for the elderly, doing everything is so difficult even ordering IV anti biotics has become a bureaucratic nightmare because it’s all about money do you really need it we dispensed 20 the other day what have you done with it? And now a crippling shortages of staff and exceedingly low moral. Most of us are committed to the ethos of the NHD free health care at the point of delivery regardless of who you are I have had a peer of the realm on a trolley next to a homeless drug addict both treated the same if this ethos is taken away many already totalling demoralised staff I believe will leave creating even more problems.

We need to educate people about how social care is funded v how the nhs is funded & make people care as much about social care as they do about the nhs.

the “jaws of doom” graph has been known about for years. Councils fund social care & councils are running out or in some cases have already run out of money

people need to understand this & get real about funding

No more money. The NHS needs a massive reform. Cottage industries within Health Authorities for job protection.

We also need to look at ourselves. What responsibility are we taking for our own health be that getting bladdered and falling over or eating rubbish food knowing that the good old NHS will put us back together again.

AND EXPLORING A CO PAYMENT SYSTEM WITHOUT BEING SHOUTED DOWN BY THE WOKE LUVIES SCREAMING OUT THAT WE DONT WANT TO TURN INTO THE US. THERE IS SOMETHING INBETWEEN!

Stop reconfiguring it. I worked in the nhs and in my 16 years it had a major overhaul 4 times all led by government tinkering. Its a waste of money and time and people. Many good people just leave. If it was a business it would have evolved organically according to need.
Use innovation in the right way - innovation in terms of things like robots has increased cost by about 47% with no corresponding increase in quality. Bring innovation into admin (and get rid of paper pushing)and get really good customer roles that pay well to manage patient journeys.
Have skilled people writing contracts and pay them properly. It will stop the nhs getting ripped off and then having other businesses making a profit sorting it out.
Have smaller teams - these huge teams bread unhappiness, take away loyalty and togetherness and make it difficult to manage.
Stop driving efficiency without realising what it means - it has made the nhs inefficient as there is literally no slack in the system.
Move money from hospitals to the community - but no one wants to do that as it is a political hot potato.

There is loads that could be done and could have been done if it had been allowed to evolve rather than being tinkered with by politicians, who use it to get elected.

No more money. The NHS needs a massive reform.

Good luck in recruiting & retaining staff then

Having worked in social care since 2005, the jaws of doom diagram linked, the spiralling underfunding of social care has been a frightening and heartbreaking reality.

AND EXPLORING A CO PAYMENT SYSTEM WITHOUT BEING SHOUTED DOWN BY THE WOKE LUVIES SCREAMING OUT THAT WE DONT WANT TO TURN INTO THE US. THERE IS SOMETHING INBETWEEN!

I keep seeing this being said on here, I am not totally opposed to it, some of the European systems seem to work well. However no-one ever actually comes out with anything like a costed plan or even a suggestion as to what the cost to the consumer might be.

@Exasperatednow How much will it cost the average family in the UK ? Are you talking £100 a month, £250, £400 or more ? The problem with introducing yet another financial burden on families at the moment is that a lot are struggling with increases in just about everything they need, so housing, heating, fuel, food.

We need to confront the fact that people are living longer but in poorer health. This is only going to get worse as the baby boom generation (those born 1945 - 1965) move through old age.

I have a lot of sympathy f9rnthose wh9 say we keep people alove for too long. For 85 years of his life my beloved grandfather was fit and healthy - he was mentally sharp, walked miles with his dog every day and the only health interventions he had were two hip replacements (farmers wear them out!).

At 86 he had a massive stroke and was saved but with severe mental and mobilty imparments. He lived the last 6 years of his life in a nursing home, barely able to recognise his wife and children, crying every day as he did not understand where he was. it was heart wrenching.

Many times my dad, who found him after his stroke and called an ambulance, says if he knew then what he knew now he would not have called an ambulance.

I'm not against a co payment system, I like the French model but pensioners are going to have to adopt it too otherwise it will be far too big a burden.

The problem with introducing yet another financial burden on families at the moment is that a lot are struggling with increases in just about everything they need, so housing, heating, fuel, food.

This is a huge problem at the moment, I'm not sure what the solution is tbh.

Assisted dying for those of us who don't wish to decline into senility and a vegetative state.

Stop forcing everyone to live until they're 120 whilst existing in vegetative states.

The reality is that the cost of setting up a decent social care system is huge, which is why even the latest scheme has been kicked into the long grass. Maybe we will go back to families looking after their elderly parents in their own home, as many already do.

Get the computer systems communicating with each other would be a start. I work in a community trust - largely MH based. We cannot access any GP records or "physical" medical information because we use a different patient records database. It's the biggest pain in the arse when I'm having to waste time emailing GPs to request they look on their databases for information I need to do the referral work I've been asked to do because I can't get at it any other way - this includes basic things like access to paediatric reports (which is a bit of a requirement when I'm allocated young adults just moving into adult services - no wonder carers get pissed off being asked the same questions again).

Recruitment is another huge one - we just cannot fill roles. We have stuff out for advert and get zero applications - partly it's that our geographical areas we cover are so bloody huge that people look at the map and think nope - but people have left for more lucrative private posts. I spend huge swathes of my day in the car between visits because I'm covering too large a patch to cover staffing holes we can't fill. That's not productive either.

Also those pockets within the NHS where staff have given up with any compassion or seeing patients as people - our local hospital has huge areas where that level of rot has set in (unless there's a TV camera crew around) - I went to A+E recently and was horrified at how staff were so burnt out and fucked off that they were just yelling at patients. Patients who clearly hadn't understood how the cases had been organised into different work streams were just getting yelled at and the Basil Fawlty communication technique of yell it a bit louder and a bit slower deployed as a result. That department needs to invest in some form of communication work - even if it's giving people a slip with the type of stream they're in circled on an easy read information sheet as they're allocated would help a bit. I think once the compassion fatigue rot sets in in a department though it's hard to redress because senior staff train students and newer staff who pick up the same "oh god she's off with the buzzer again" eyerolling type attitude and run with it. I know one cancer nurse who will sit and mouth off about her patients being "annoying little shits" - if she's in charge of a student nurse - they're likely to pick up at least some of her values unfortunately and then you end up with a department full of them.

Cut away swathes of pointless corporate admin management roles and spend the saved money increasing the amount of front line clinical staff.

We need to confront the fact that people are living longer but in poorer health. This is only going to get worse as the baby boom generation (those born 1945 - 1965) move through old age.

But time & time again you hear I paid my stamp, it's all the fault of immigrants, I want to leave my house to the dc.

I have an in-law who is early 70s & now on lots of medication. They are doing great but & have received excellent care but I have been shocked at what is "available to them" if that makes sense. So much medication (often not used), free transport to hospital, attendants allowance, a carer in the home for a few hours a week, therapists etc. If this is replicated across millions no wonder there is no money left.

Withdrawing treatment can work but it is hard. Mr Monkey's dad (who was rather frail) had a stroke and a heart attack. The hospital said there was not much more to be done at his age and health. They withdrew treatment and food/water (except pain relief). It took 4 days for him to die.

It was difficult but peaceful and dignified in the end. Family got the chance to visit and say goodbye.

No, we need to manage population ageing. A massively different, and much worse, problem.

Maybe we will go back to families looking after their elderly parents in their own home, as many already do.

more woman work though now & people in general have to work far longer

Isn’t it also something to do with the shift in wider attitudes?

In days past children provided more care and support for their parents.. and also people older parents) just cracked on with life a bit more than they do now. Now the first thought is ‘what am I owed, what can someone do for me’ rather than ‘what can I do for myself’.

The combination of the two is increasing demand for social care.

I worked in Australian healthcare and when they needed a bed they just kicked a long-term resident who was clinging on.. out. If you’ve got someone hogging a bed who can function outside and someone who needs life saving care that’s what you do... but we don’t. Those who were discharged managed. People will. This sounds hard but you have to realise some people aren’t clinging on to a bed because they need it. It’s because they’re getting meals prepped and company/ social stimulation and they don’t want to leave that behind. Society has shifted from a more community and family care model.

You see the same with childcare. Parents and neighbours would chip in. The adage ‘it takes a village to raise a child’ comes to mind. That support model has eroded.

Parents have been forced to fork out for the replacement model... nursery and childminder care. Old /disabled people dependent on social care are going to need to do the same.

I used to live in Australia and it's completely different there,
I would start by linking all services, all the nhs, government, driving, policing, job centre ect in one streamlined service.

In Australia you can book anything anywhere thanks to the fact that everything is linked, visiting family across the country? You can still book a gp appointment at any of the local drs.

They always reserve appointments for emergencies on the day however you can book your appointments months in advance on an app. People wouldn't be using gp surgeries unnecessarily if they knew they were accessible (think panic buying TP during the pandemic)

Therefore saving emergency rooms from clogging up or people falling unnecessary ill due to the fact they can't be seen when they need to be.

I would also bring in paying a small fee for prescriptions unless you're low income, for example each prescription collection is £4

Just those small fees would help fund the nhs millions, we can pay staff properly with that money and it would actually encourage people to be employed by the nhs rather than agency.

If backwards Australia figured it out 10 years ago, with the money the U.K. has they can definitely achieve it. The problem is all political where the government has a higher control over the population by restricting services.

I'd be interested to know specifically which corporate admin management roles you'd cut? As in what job titles do these people have and what actual work are they doing that isn't needed?