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 don't work in the NHS but elsewhere in the public sector but I can see some of the same issues in the health service as elsewhere.

The whole public sector is a massive political football which means that ill thought out and highly disruptive change just gets layered on top of previous changes, none of which are properly implemented. This leads to a plethora of poorly implemented systems with poor knowledge transfer and lack of efficiency.

So my change would be to focus on doing less organisational change but doing that change better and fully, and to do that you need less political interference, stronger, more capable management and the resources to do it. Which is why it will never happen.

I said weed out the chancers..... of which there are many.

They go off sick, come back just before they go to half pay, work until the full pay kicks in again then off sick they go again.

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

nothing else needs to be said.

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.

See I think there is far more nuance to the above. We know that people die younger in poorer areas & richer areas enjoy better health. It's a socioeconomic issue too.

1. Sort out IT - but this is probably an impossible task.

1. Free training for nurses, subsidised training for doctors - work for X amount of years, or pay it back.

1. No more bank staff. Speed up the recruitment process for permanent staff. More flexible contracts for those that need them. Stop hiring people on short term contracts - they're going to leave for a permanent role as soon as they can and then you've wasted money on recruitment and time and effort on training.

1. Reduced remit. NHS should provide a basic service and do it well. We're trying to run before we can walk with a lot of therapies/diagnostic services.

1. Increase walk in/small injuries clinics/community health centres. Educate the public about how to self-triage and self-treat (tbh I feel the NHS website is really excellent - do the public not use it?).

1. Who has oversight of resource allocation?? I have seen some crazy spending decisions. I kind of agree with previous posters - there is a lot of money sloshing around and I'm not sure 'more money' is the answer.

There have been some great suggestions on this thread. The NHS is so enormous that trying to effect any organisation-wide change in culture/practice is basically impossible. The only practical solutions are around recruitment and remit, I think.

I’m a GP. I dont think it’s fixable now. We are on the road to a 2 tier health system of private health care for the rich and woeful health care for the poor thanks to the Tory Government.

I get your point, but not everyone uses email. My elderly parents don't for example.

That's true, but everyone who does use email could supply their email address to be used and anyone without one could still get a letter.

My dad has been having ongoing treatment for the last year and has regular hospital appointments. Not only do they send him emails, they send texts as well, plus letters! Often he gets duplicated letters as well. Huge waste of money.

People like you are so the problem.

@TheRedLip how would you attract the best staff?

We need a conversation about what the NHS covers, it can't cover everything. Does it need to be free at the point of access for all? Affordable, but putting a price on something often gives it value, say £1.50 per prescription ( up to a max of say 4 prescriptions) for all adults. We don't expect food for free ( I know we have food banks) so why do we have free medicine? Managers should be managers not ex clinical staff who have been promoted, they may have been good nurses / ahps etc. This does not mean they would make good managers

@Shiraztonight medicine isn't free for many though?

Also why don't older workers who work pay NI particularly as younger people will get seeing pension age pushed out?

The current prescription charge is £9.35 per item. Yes there are exemptions for some chronic conditions but not sure that removing those would achieve what you are aiming for.

I'm in Scotland so they are free, nearly 90 % are free in UK

Agree with all the people saying that while there are inefficiencies, the crucial bit is tied up in social care and end of life care.

Investment in social care and preventative and public health would improve the population's quality of life, as well as reducing health spending.

Some of that money for social care also needs to come from individuals- unless we plan to really encourage euthanasia (horrible thought) an ageing population will mean more money needed, and it's vastly unfair for young people to face a future of paying even more in tax and getting less from the system, in order to allow a wealthy older person to pass on the full value of their house as an inheritance.

We also need to look at elderly and end of life care. There's a lot of talk about treatment being assessed on Quality Adjusted Years of Life, but we don't talk about the long term life (and cost) impact from young children waiting years for autism assessments and speech therapy, or the knock on impact of poor dental care due to lack of funds, while we perform heart operations on 85 year olds, on circumstances where the doctors themselves would absolutely decline treatment for themselves or their loved ones, because the pain will be severe and net benefit minimal if any.

None of this is easy, but we can't go on as is.

@startingitallagain I thought GPs were actually run as companies and only contracted by the NHS. That would explain why so much variation over performance, what they spend on their phone systems and how many receptionists. Having moved recently I had to change surgery and the new one, while anecdotally having a better reputation, is just nowhere near as good. The attitude seems to come from the practise manager - the last one was amazing and the new one, they just don’t get it right. I was 70 something in the queue the other day. Had to ring old surgery to ask something and was only on hold a very short time. Old surgery could always get seen if needed on the same day. New one, I’ve given up. And so on. I would love to compare their processes and accounts and make sure standards are followed etc.

In what way?

I've been an NHS nurse for nearly 2 decades, I've been fortunate that aside from maternity leave I've only been poorly a handful of days. I just don't think that medical and healthcare professionals should be beholden to the NHS, nor do they owe the NHS anything when they've funded their own training and worked many many placement hours unpaid. I was fortunate and had mine paid for, I wouldn't be able to afford it now. If the NHS looked after their staff better people would also be off less. What part of that makes me the problem? The fact I don't believe we live to serve you.

I have got examples of things that can be bought on Amazon etc for much, much cheaper than the price our department is forced to buy it at. Even simple things like office goods. It’s an absolute racket!

Pointing out the reason for a problem does not make someone the problem.

Immigration is needed to solve the issue of low birth rates. We have a dependency ratio crisis looming. People are living longer and retired on average for more than 20 years when in the past the average was 11 years. Due to low birth rates we won't have enough workers paying taxes to pay for their retirement and care. The answer is more children or more immigrants. The latter more effective as it works in the short term and immigrant workers are more likely to have a higher fertility rate. Brexit has added massively to the issue.

I don't work in NHS now but did for 8 years.

It needs managers who are skilled at managing. It also needs clinical people in the management chain. There was no trining for managers and anyone could apply internally. I had 6 line managers in two years and never even met 4 of them.

Technology. DS works in tech in the NHS. It's pitifully backward. Even though large sums have been spent it's not interconnected and they can't recruit skilled IT people because the pay is so much better elsewhere.

On recruitment and retension of staff.
Student loan forgiveness if new doctors work in the NHS for 5 or more years.
Student bursaries brought back for nurses.
Massively expand medical schools in less glamorous areas. Recruitment in Northern towns is impossible but could be incentivised by offering cheaper training / tuition fees if they stay on to work.

Radical changes such as semi privatisation and charging some people for some things.

@Eleganz The current prescription charge is £9.35 per item. Yes there are exemptions for some chronic conditions but not sure that removing those would achieve what you are aiming for

As @Shiraztonight says, in theory people pay, but over 90% prescriptions - and probably even more when you look at it on a £ basis - go to people who don't pay, either because of age, socioeconomics or illness type.

This is the kind of misconception that tends to lurk in the heads of healthy(ish) people, who don't realise that a HUGE majority of NHS and social care spend goes to support people who are not in work, not in good health and in many cases will never recover.

That is still a good thing - everyone deserves care, and any of us might find ourselves in that situation one day.

But it also isn't sustainable to have a shrinking pool of people in work, paying a growing amping per head for a growing pool of people who have had far more paid out on them by the government than they ever paid in. This group includes most pensioners, many people on benefits, and also people with lifelong health conditions (I am in this.last group, so am not making a dig, but am wanting to be pragmatic).

Meanwhile people who are in work are struggling to get a basic GP appointment, can't get support without huge waiting lists or going private if their kids are having major mental health troubles or need braces, and know that the money will be gone in a few decades when they need it.

As a social contract, this doesn't work.

*amping? Amount, rather...

To those that say get rid of bank staff, do you actually know the purpose of bank staff.

Bank staff can also hold a substantive post, of which I do.

I don't get paid any more than my substantive post for working a bank shift.

A bank shift is our overtime as the NHS very rarely offers overtime at a higher rate.

Buy yeah take that away from us.

I suspect many are getting bank and agency staff confused. In any case agency and people doing bank shifts keep things going!