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!)

Invest in Social Care!

I hope so, but I wouldn’t be completely optimistic. The absolute worst death I saw was that of my relative who suffered with dementia for a number of years before finally dying - hadn’t recognised there were people even in the room and had long forgotten how to talk for such a long time it seemed like. She was essentially a vegetable staring listlessly at the ceiling for a very long time.
She had a “No special measures” in place and two family members, both of the same opinion that all of this was cruel, with Power of Attorney. It counted for very little.

Conversely I’ve fairly recently witnessed the end of another older person who was also going downhill very fast with dementia but still did recognise some family members most of the time and could still talk vaguely coherently. It was very clear which way it was all headed but there seemed to be a constant push for more medicine and treatment.. as if they could get better.. I didn’t understand it, it was already bad and was clearly going to get worst (and he was nearly 100!) but yet family members wanted him to get “better”. You’d have never thought there was a lack of money in the NHS for how much was spent on this person in the final few months but luckily died in his sleep.

Something needs to change. It should be dignity instead of life at any cost.

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

I'm pretty sure it is, life expectancy has increased but healthy life expectancy hasn't it. People are living longer with more conditions.

There doesn’t seem to be any computer involvement. Appts are made by sticking patient labels in a big a4 paper diary!

Some years ago, I read about a bog standard fridge costing around £250 via procurement, when they could have bought the identical* model for less than £80 in Currys.* If true, that's just mad

Should add, it was needed for clinical purposes, not just to keep the milk in.

Yeah but that's not true. A specialist medicines or laboratory fridge cannot be bought in Curry's for £80.

But I'm curious what NHS workers actually feel privatisation will do?

Massively increase the overall costs.

Bring in an insurance-style system so that patients are encouraged to take some responsibility.
Run it like a business, so that sloppiness and waste can be reduced. Make staff more accountable for their errors & take a tougher stance on sick leave.
Definitely don't just hand over more money - it's like pouring water into a bucket with a hole in the bottom!

"The data shows that an 85-year-old man costs the NHS about seven times more on average than a man in his late 30s. Health spending per person steeply increases after the age of 50, with people aged 85 and over costing the NHS an average of £7,000 a year."

"By 2039, people aged 65 or over are expected to represent 23% of the population, or 17.5 million, according to projections from the Office for National Statistics. About one in 12 of the population will be aged 80 or over by then."

We have an entire department dedicated to improvement - there is constant mandatory training, frequent events. The amount of time and resource dedicated to improvement massively outweighs the savings made by any of the 'improvements'. Doesn't help that the improvement philosophy is a mish-mash of every quality improvement system ever tried.

Obviously you do need quality improvement, but like everything it needs to be headed by the right people, implemented in a straightforward way and there need to be regular checks to ensure it's serving its purpose.

slim down the management structure, it’s ridiculous how top heavy it is.

How many managers should there be for an organisation the size of the NHS?

of course there is waste eg procurement & inefficiency but that needs cash injection to solve eg better systems & expertise.

Bingo. It's an ageing population crisis. Talk of firing lax staff or more efficient appointment notifications is just tinkering at the margins.

And I 100% agree with those who said legalise assisted suicide - let's not keep people alive at all costs, when it's cruel to do so.
Social care improvement, obviously, but I'm not sure how!
And I also agree that the NHS should stop providing non-essential treatments - if you want them, you pay for them.

@Cocolatte24 im infertile so it wasn’t a choice.

However I have no problem with paying - that’s not the issue. The issue is if I’m old and frail & most especially if I have dementia, 1. Who will find care for me 2. Who will make sure I’m being cared for properly 3. What happens when things go wrong?

most ppl don’t physically look after their parents but they manage & oversee their care to make sure it’s being fine properly

It was very clear which way it was all headed but there seemed to be a constant push for more medicine and treatment.. as if they could get better.. I didn’t understand it, it was already bad and was clearly going to get worst (and he was nearly 100!)

I didn't listen to the King's speech but all this tragic loss about HMQ - I mean she had a great life and a good death imv. No tragedy at all.
Ditto Pele and Vivienne Westwood - 81/82 isn't really young even nowadays - great lives and great deaths but no one is saying this - it's all tragedy. We need to be more realistic about dying in the UK - it get's us all!!!

Oh crikey, that's worse than I was fearing and is a ridiculous waste of time. Plus if the appointment never actually makes it onto a computer system (which I guess it might, maybe that's what the clnician is doing on the half days?) amongst other things, the Trust won't get paid for it, and will have no way of showing how busy that clinic is and thus no way of eg demonstrating that more staff are needed.

Agree with all this. A close family member was recently very ill with a bowel disorder and in A&E. He was 82, had diabetes, COPD, and a host of other conditions, and had been given 48 hours to live. The doctor sat down and they had a discussion about the possibility of an operation, even though it would leave him permanently disabled, in a bed in a care home, permanently on oxygen and with a stoma, but he might live for another few years. Luckily, he refused and sadly passed away, but it should not even have been a conversation. How many people are being offered and agreeing to surgery that will leave them with such a poor quality of life at an enormous cost?

Stop newly qualified doctors immediately relocating overseas to work.
Stop funding 6 months paid sick leave within every 12 months. It's horribly abused and no one seems to care.

I’m a nurse in a receiving area so effectively I’m front door. I have no idea where we would even start with the NHS tbh. However, I think a general change of culture within the public is one of the main things that needs changed. People need to start looking after their own health & taking some responsibility. You don’t have to seek medical assistance for every cold, flu, bump, cut, fever. I also believe that the money needs to be put into the community to help the acute services. We need more care at home available, we need more GPs actually seeing their patients. Do you know how many people are stuck in hospital literally waiting for packages of care or nursing homes? Also, nurses in nursing homes can & should be doing more medical care. We have many people admitted from nursing homes that only need some iv antibiotics or fluids, why can’t a GP go to a nursing home to assess & prescribe this & the nurse can carry it out? Don’t even get me started on management & how much we don’t need them with their crazy salaries 🤦🏼‍♀️

But I'm curious what NHS workers actually feel privatisation will do?

I honestly don't think that anyone will be interested in buying the NHS, because we are so used to free at point of use it's not as lucrative as elsewhere. Even if people are forced to pay, ie this treatment will cost x it still won't be like places such as the US where elective stuff forms a large part of the income. We've seen it in dentistry here, people pay for the bare minimum (if even that) and go without additional stuff.

The more likely scenario is that more and more gets contracted out to the lowest bidder who squeezes wages, terms and conditions, the level of service suffers whilst they turn a profit.

If it was fully privatised though staff would be paid more as there wouldn't be a monopolistic employment market. Probably help with recruitment as healthcare cover would be included in the employment package.

One thing that could help is greater emphasis on housing fit for older age and incentives to use it. How many people are rattling around in the the family house needing domicilary care as they can no longer cope?

My friend's parents - both in their mid seventies undergoing cancer treatment - live in a modern apartment complex for older people. It is a well designed one bed flat with a 24 hour warden and communal socialising spaces. They don't need personal care but my friend is pleased there is a warden keeping an eye on them and they live somewhere easy to live in and care for as they age.

It is run by a housing association and they qualified as local residents. I think they put down a substantial deposit and pay a monthly rent as well. They sold their house to move in. There probably won't be much of an inheritance once they go but my friend does not care, it is worty it to know her parents live somewhere suitable.

Doesn't help that the improvement philosophy is a mish-mash of every quality improvement system ever tried.

Obviously you do need quality improvement, but like everything it needs to be headed by the right people, implemented in a straightforward way and there need to be regular checks to ensure it's serving its purpose.

Couldn't agree more with this!

Why? They pay university fees and spend many hours on placement without reimbursement. There's a lot written about how much it costs the NHS to train a doctor, but the universities also pay the NHS to have them host students so- not convinced to be honest. Now if fees were paid and perhaps a bursary then sure I'd agree with a return of service arrangement as they have in Wales for some healthcare degrees. The issue is more the the low pay and ridiculous hoops junior doctors need to go through to progress that causes people to leave or move abroad.

Most people I work with have very few sick days, I don't think because some may abuse it it's reasonable to wish it away. Much better would be to improve working conditions (this is proven to reduce sick days).

The collapse of the NHS is just one of a plethora of interlinked societal problems. To fix the NHS requires sweeping societal
and political change involving redistribution of wealth and being realistic about how we will manage an increasingly needy, geriatric population.

There is a growing generational wealth gap - compare the affordability of housing and living for current working generation vs their parents and grandparents. The over 65s now own >50% of the wealth in the UK, and median wealth for those in their 60s is 9 times higher for those in their 30s. Source www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/bulletins/distributionofindividualtotalwealthbycharacteristicingreatbritain/april2018tomarch2020#the-generation-gap

Despite this gross equality there is a perception that the elderly have already "paid their way" and now deserve to retain all of their assets whilst their care should be paid for through general taxation. The voting population (majority of whom are cannot abide the idea that an elderly couple might need to downsize their large family home to pay for their (prolonged) old age. They cannot abide an increase to retirement age. But the taxpayer cannot sustain a retirement that lasts for up to 30 years and is complicated by vastly expensive health and social problems. Something has to give. At the moment, what's giving is the health and social care system.

Older people are the largest group that vote and they vote conservative, I believe primarily to preserve their retirement assets and to preserve the generational wealth gap. Even alternative (eg current Labour) government's still fundamentally serve this same agenda because suggesting that the older generation pay for their own health and social care by reducing their assets is political suicide. The result will be the total collapse of health and social care and a period of great suffering for everyone, that one hopes will eventually be reset by a more equitable system. It can't be fixed by any recommendation from anyone without or within the NHS system IMO.

That said, my recommendations would be:

• Integrate health and social care
• Greatly increase health and social care budgets in line with similar developed nations
• Fix the pension tax trap for NHS consultants
• Scrap nursing tuition fees and bring back the bursary / a salary for student nurses
• Pay rise for all staff shortage groups in health and social care
• Massive initial investment needed to expand and buy back private services and escape PFI contracts, with the effect of greatly reducing ongoing spend
• For that matter, reverse the health and social care bill 2012 and everything that's followed
• Get realistic about death (this is it's own topic). Interview anyone and they wouldn't want their future to be end stage dementia with an endless purgatory of delirium whilst all measures (needles, operations, antibiotics, feeding tubes etc) are used to keep them alive as long as possible. But this is the standard approach. Public awareness / cultural mores have a lot to answer for (see reaction to Liverpool Care Pathway)
• I disagree that the NHS has too many managers. It's a vast and complex organisation it needs good management and good management costs, like everything else. My experience is that administrative and management support is being stripped for clinical staff and that makes the work harder. Clinical staff who are expected to be managers often don't enjoy the work, don't do it well, and aren't well rewarded for it. It causes senior clinicians to leave.

@Ginmonkeyagain I was reading there isn't enough of this type of accommodation available.

www.pbctoday.co.uk/news/planning-construction-news/senior-living-housing-shortage-exposes-scale-uk-housing-crisis/116689/