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!)

I would centralise a lot of stuff. So for instance every hospital will have x amount of people writing guidelines from scratch, which are all based on national and international evidence such as NICE guidelines. Literally whole departments in every hospital full of people writing guidelines. It maybe needs one per hospital for any local tweaks. And I say that as someone who used to write guidelines for my local hospital.

sort out purchasing. My old ward needed some large plastic storage tubs, the type you buy in b&m for £5. You can only use the approved nhs purchasing site and the boxes were significantly more, about £45 iirc. How much is that being repeated up and down the country for every item which is bought?

definitely look at middle management tripe roles, what’s necessary and what isn’t. It’s been 5 years since I left the nhs and in that time those sort of roles have ballooned. I work very closely with my old nhs dept, so regular meetings, etc with them and some of the new job roles I’m amazed by.

When I left there was a head of dept, two matrons, 4 ward managers, 2x band 7 specialist. There is now head of dept, dept head of dept, 3x matrons, 4x ward managers, at least 8x band 7 specialists and a number of band 6 specialists who are no longer doing patient facing direct clinical work. 🤷‍♀️

This is a patient direct dept. I imagine in areas such as admin, etc the unnecessary roles are even more.

Gosh there is so much going on that needs addressing! The biggest issue is staffing. Gp’s are extremely low in numbers, the BMA suggested around 36/37,000 in England, that’s a shocking amount considering the elderly population we have who do need more frequent medical care. I’m not surprised people can’t get appointments, I am surprised people don’t seem aware of it. NHS nurses are short by 50,000 and again this has a massive impact. Retention is poor because they are burnt out and are treated appallingly by some trusts and sadly by the people they are there to help…so much so they are in the process of installing body cams. We need more care in the community to allow care outside of hospital to allow discharges. We need more places in care homes but these have reduced as well. The public also need to start looking after themselves, there is abuse of the system but more people declare that lifestyle doesn’t matter matter because it’s their life….until they develop health issues as a result and need care. Many don’t know how to self care, even stupid things like how to remove a splinter. I’m shocked at the numbers of people who book in with things and state just in case. They end up joining a room filling with other ‘just in cases’ all outraged at a 7 hour wait. I’ve seen it get worse over the years. There’s no one element.

Isn't there already a fee for prescriptions?

In my team we send appointments by post, email and text.
Even so people sometimes still say they never knew about the appointment and ask for another one. Email can easily go to junk mail so we do have to use post as well.

It’s currently £9.35 a prescription

www.nhsbsa.nhs.uk/help-nhs-prescription-costs/nhs-prescription-prepayment-certificates-ppcs

It’s currently £9.35 a prescription

But why do over 60s not pay? completely unsustainable

You're not factoring in immigration.

And also look at systems for each dept. So Dd is a frequent flyer to a specific dept due to a chronic health condition. We were there end of Nov and they gave us an appt for mid Feb which I put in my phone but for some reason it didn’t save. We then unexpectedly were back as an emergency the following week and while I was there I asked the band 6 junior sister if she could look in the diary to confirm the time of the mid Feb appt. She happily checked for us but said she hadn’t got round to sending the appt letter out yet.

Apparently she sits down for half a day a few times every month to do appt letters. Every single person with an appt will have been given that appt face to face while they’re there. So why the need to send out letters. Not only is it a cost to the nhs but also a waste of her time. And why is a band 6 nurse doing it?

Even with immigration we still have a massively ageing population. Immigration is just stopping it reaching disastrous Japan levels.

@TashaBasha the ageing population is a bigger issue than immigrants. So many immigrants work in the NHS!

we need more immigrants because people have stoped having dc.

There are now more over 65s than u15s, it's an absolute mess due to lack of planning & no investment.

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

Tricky when they have raised the pension age, it is unlikely my parents will still be alive when I eventually retire in 17 years time. I certainly couldn't look after them if they had substantial care needs without massively reducing my hours at work and as I am the only wage earner that would be impossible.

children looking after elderly parents - bear in mind 1.5 million ppl over 65 have no children & that number will only increase as 4 million ppl over 50 don’t have children

it's not a solution

They should. This is what I noted in my post.

Older people need to pay the increased charges of the increasing demand they’re putting on the network. Their demand for services has outstripped what they invested in with NI contributions, and what their parents demanded at similar ages.

If that means having to sell homes or downsize to fund care then it’s win-win as it’ll free up the family homes they’re occupying and assist with the housing shortage whilst also funding their demand on health services.

I work in primary care.

We need lots more money to enable us to pay for more doctors snd more staff on more than minimum wage, so we can open longer hours and take the pressure of hospitals.

We can't find staff to work for minimum wage and we can't afford to pay them more. Also we can't afford to pay for more doctors and we don't have space in the building to run more surgeries 8-5.

Indirectly and long-term: solve the housing crisis. When people can afford homes, they have children. Those children grow up to be a robust tax base.

@Cocolatte24 they won't vote for it though.

Agree that there is "dead wood" that needs to be pruned and some new starters are chancers. However, making all new contracts temporary won't attract good people who are currently in permanent roles. Employment law already provides the option to terminate a contract in its early stages, and to dismiss on grounds of capability or conduct, so those options should be used instead.

Also, recruitment should be more focused and challenging. Ideally the option of not appointing anyone if no candidates are up to scratch should be taken, but in reality recruiting managers are often desperate to fill rotas so...

Of course all of this would require investment in good HR support.

We also need investment in quality improvement and staff development but according to the Daily Mail and other clueless commentators these are non-jobs.

Apparently she sits down for half a day a few times every month to do appt letters. Every single person with an appt will have been given that appt face to face while they’re there. So why the need to send out letters. Not only is it a cost to the nhs but also a waste of her time. And why is a band 6 nurse doing it?

I'd ask why on earth anyone is spending half a day a few times a month sending appt letters. Any basic patient admin computer system should be capable of automatically generating a letter as part of the appt booking process - you get to the end of the booking process, the system presents you with a list of template letters, you choose the one you want to print, possibly have a choice of printer too, then out it prints. Are your DD's appts perhaps not booked onto the IT system at the time you're told about them for some reason? (not necessarily by the clinician - it's something that the clinic admin/reception staff would generally do)

I'm currently under physio. You book your appointment on the way out. No letter just a time and date on a card. The only letter I got from them was the initial appointment.

Well then those people - without children - benefitted from not paying childcare costs, not paying clothing costs, food costs, education, hobbies etc. They also benefitted from having more time to focus and commit to work rather than raising a future population to fund the care they would need.

They should have therefore earned more/ have more saved. They made a choice that would have financially benefited them back in the day and now they should use those funds that they saved.

People who can afford it should be encouraged to get private health insurance and use private gp. It's possibility but less encouraged than elsewhere in Europe (in my opinion). Also jobs could offer occupational health care so that the basics could be treated outside the NHS.

Indirectly and long-term: solve the housing crisis.

It's not just housing though, it's the fact that real wage growth has stagnated for years. record low interest rates masked this as borrowing was cheap & many were pacified because although their salary hadn't grown, their house value increased. Obviously many younger people haven't got on the ladder yet so are screwed from both sides.

@Ginmonkeyagain 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 think you are slightly confusing 2 issues here.
there is definitely a rise in poorer health, but it’s not the people who are living longer with the poorhealth! Yes they might need huge amount of care in their last few years, but the obesity epidemic causes a lot more poor health across all age ranges. They generally die younger.