To ask what can be done immediately to take the pressure off the NHS?

[Twinklenoseblows]

I've been reading stories about people waiting 4 days in A&E, people being taken into A&E in the back of a van with a broken hip as there are no ambulances ,and doctors and nurses pleading for something to be done right now as lives are at risk. But what can be done that would make a difference within the next week or two?

Promises of more money and more staff will presumably take years to filter through and make a difference.

I guess what is worrying me beyond the immediate crisis is that some bright spark in government is going to say we need a circuit breaker lockdown to reduce flu and covid admissions for the next few months to take some immediate pressure off. The thought fills me with horror so I'm hoping there is something else.

E.g. as a very short term measure could some people be diverted to make use of any spare private GP capacity to try to reduce the number of people going to A&E who could instead be dealt with by a GP if only they could get an appointment. Or is that madness?

Immediate

Immediate significant pay increases across the NHS for front line staff.

Immediate significant increase in minimum wage for care workers.

Special tax reliefs for anyone working in the medical profession.

Tax relief/more benefits for stay-at-home carers but a requirement to take some basic training in care in order to qualify.

Free Visa entry scheme for foreign medical staff – we should be welcoming foreign doctors and nurses and before anyone complains about taking medical staff from other nations, a few years in UK is good for their careers, it doesn’t need to be for life.

Separate A &E from walk-in minor injuries/sickness.
Separate doors – Separate staff etc. This happens in some places but needs to be much clearer.Vulnerable patients with life-threatening conditions such as heart attacks and strokes should not be sat in an A&E waiting room alongside someone’s kid with flu/covid/strep - this has happened to me recently as the ambulance service left me in a chair (no beds available) to wait my turn as they had another call.

Significant tax increases on alcohol, cigarettes, processed junk food etc.
Ban the sale of the worst offenders completely – force a reduction in alcoholic content or the strength of tobacco etc.

During this crisis, the NHS should only provide life-preserving essential services (no electives). Doctors from other departments should be re-deployed to help where possible.

Entitlement to time off (similar to maternity leave) for all staff to enable them look after sick relatives at home. This could alleviate a lot of the issues of getting patients out of hospital.

Paid GP appointments for those that can afford it through more private (but reasonably priced) GPs to relieve the burden on the NHS.
Paid minor injuries/walk-in clinics too. The NHS should remain free but limited to emergencies only. There needs to be more choice for those that can afford to pay – stop the requirement to see your GP for a referral. Allow direct access to specialists for paying patients.

For the future

Full bursaries/free training for all medical staff (probably via write off of student loan after 5 years employment in NHS.

Train more medics through the armed forces.
Increase recruitment of medical staff in the forces through schools etc and provide incentives for them to move to the NHS on completion of training.
If the NHS was run more like the forces, I am sure it would be more efficient.
Maybe the NHS should be a fourth ‘service’.
In future, any threat to our country is likely to come through disease, gun warfare, gas or poisons etc. A better trained and funded medical provision would be an essential provision.

More encouragement for home care, multi-generational living etc. to help with care of the elderly as we cannot as a nation expect to house and care for them all.

Mothers need to be taught how to look after their children when they are sick etc. A compulsory GCSE in child and elderly care or equivalent training would go a long way to helping this happen.

I used to be on the board of our local NHS Trust and saw some stats around how many people who attended A&E over 1 weekend actually should have been there - it was 20%.
The rest were drunks, drug addicts, homeless, people with MH issues, entitled idiots and people who couldn’t get a GP appointment, as well as some who were genuinely worried (usually parents) but didn’t really need emergency care.
A&E is massively overused and abused
The obvious answer is to increase services and access to them in Primary care but how that can be done quickly I don’t know

(Name changed)

My most recent experience of NHS emergency services was on Boxing Day. My 13 year old had sever stomach pain to the point she couldn't stand up straight. So, off we went to the closest Minor Injuries Unit just to be on the safe side. I checked online and it said they were open. Got there at 2pm to discover a printout on the door saying they had closed at 1pm because it's Boxing day and to go to A&E at RD&E. This left the entirety of Mid Devon without any out of hours care from 1pm on boxing day with the reccomendation to go to A&E...

The 2 other minor injury units in Mid Devon closed in the last 5 years and there are no WIC facilities.

So I checked the NHS Quicker App which says its an 9 hour wait in A&E RD&E but a 2 hour wait at a walk in centre 5 mins walk from the A&E. I called ahead and they saw us at the WIC in and out in under 2 hours. However had I not had the app I would have never known this place even existed.

During our wait at the walk in centre 6 parents with small (under 4) children turned up after being sent over from A&E (not including those already waiting) because they were told they were not an emergency (higher temps but kids running around still). One woman was even ranting to everyone who would listen that they refused to prescribe antibiotics for her son and she wasn't leaving until she got them because he had had a temp or over 38 for 5 days now. Another parent, upon hearing this, got up and left after realising they weren't just handing out penicillin willy nilly. It is madness.

From our time of arriving at the WIC at 2:45 to our leaving 2 hours later the wait time for being seen went from 2hrs to 4 hrs (The WIC is open 8-8). The A&E wait on the app was now 26 hours.

The Gov needs to fund more non emergent care. The NHS needs to make people aware of MIUs and WICs.

It’s worse because the welsh government are not managing the workforce crisis. I’m a labour supporter but the welsh government are dire.
In a population of 3 million 3/4 of a million are awaiting NHS treatment.
A quarter of the population!
44% of welsh gp’s are due to retire in the next 10 years.

Reinstate the NI hike that Truss cancelled?

It doesn't help that so many people are coming to live here... More houses built, but where are the hospitals being built?

Where I live the town has increased by 4 times in last decade. Yet the local hospital the same.

I used to work in A&E about 15 years ago, it was hell then, I seem to think what it's like now.

*dread

But immigrants pay taxes which makes more money available.

If people across the uk stopped seeking gp care when it was not needed and would never have been entertained 20 years ago, I think it would relieve up to half the pressure.
Doctors tell us this, many appointment are unnecessary, patients should have stayed home or got paracetamol from the pharmacy.
Then because all the gp appointments are taken up, people with more serious problems that could and should have been dealt with by the gp, are instead accessing a&e.
So now there aren’t enough appointments available at a&e for the actual accidents and emergencies.

GP’s to stop screening appointments when you call up! Having to justify wanting a GP appointment is incredibly annoying. I had tonsillitis not long ago, all I needed was antibiotics and I was in agony. GP surgery refused to see me so I sat for 5 hours in a walk in centre / non urgent care centre to be given the antibiotics I needed all along. Granted this wasn’t a&e but it would have been a 10 minute GP appointment whereas instead I had to block up a space in non urgent care in order to get something so simple.

Recently took baby DC to children’s a&e due to high fever and listless (they’re only 3 months so was worried). Pretty much all the kids in the waiting room were age 2-5 with flu/strep symptoms. I saw the nurse making up multiple bottles of antibiotics. We were all waiting there minimum 4 hours. A GP appointment could have sorted out 75% of the kids in there if parents could have gotten an appointment.

Entitlement to time off (similar to maternity leave) for all staff to enable them look after sick relatives at home. This could alleviate a lot of the issues of getting patients out of hospital.

This is rubbish, you're assuming there's an army of relatives all poised to drop everything & look after relatives.

@Ravenclawess what's the name of the WIC in Exeter? I've never even heard of it. Why don't they have any information up at RD&E saying something to the effect of "do you have X, Y, Z symptoms? It would be more appropriate to attend the clinic on X Street"?

In fact, I'm sure there used to be colour coded handouts available in the reception that gave examples of "red" conditions (A&E) "Amber" (minor injuries) down to "green" (take some paracetamol and stay home) etc, but I've not seen one of those for a few years now?

Immediate things to do is reduce capacity going to a&e. Have more accessible gp/pharmacy appointments for minor stuff and turn away/redirect people that arrive at a&e to them. So this also means 111's scripts need to not end up with having to go to a&e which more likely happens.

Gvmt could also consider a one off pay bonus thing to increase staff at hospital and to stop strikes but then after crisis is over in spring sit down and really have a good chat about a long term strategy re pay and conditions. They need to consider whether the money they send to foreign countries is important and can it be redirected.

Recruitment and retention is a biggie as well and the impact Brexit had on foreign workers.

Blaming the people who need the care is exactly how they all want us to think to shift the blame on us when it’s actually their fault. Look at the bigger picture!

@Squabbledee You may not want to look after your own parents, but there are a lot of relatives who would, if they could take time off work to do so. It doesn't have to be nursing care, that can be brought in. Sometimes, just providing meals and someone to talk to is all it needs.

I personally think our society has become incredibly selfish because of this attitude that we can just dump all our old people in care and someone else will pay for them to be looked after.

@ValK lols

Not sure the private sector does trains, energy and water better than the state, does it? There are some things you want a choice about, some things where you just want a decent level of service and not to think about it.

As to not spending on abortions and contraception - do you know what a birth costs?! Or the cost to the state of raising any child, not to mention ones who weren't wanted for some reason and might not get a good start in life?

Do you know the cost of prep compared to the cost of treating HIV? The cost of trans treatment compared to the cost of mental health treatment and failed suicide attempts?

What is performance pay for NHS staff - you get a bonus if someone survives cancer? How does that work?

Agreed. I was in A&E recently (for a legitimate reason) and the number of people who turned up non-A&E problems while I was waiting was astounding. When you get there, you have to shout your problem through a screen, so I had a good insight into "sore nose", "I've got a cold", "my foot hurts", "I was sick in the night" and so on. These are people who shouldn't even be bothering a GP, never mind A&E.

Immediately:

• triage tents outside A&E. Anyone who doesn't need to be in A&E doesn't get through the door. They get sent home with advice/ to their local pharmacy/ to the tent next door staffed by GPs and nurses.
• massive advertising campaign on TV, radio, billboards etc. educating people on how to treat mild ailments and to go to their local pharmacy or ring 111 if they're not sure whether they need to see a GP or go to A&E.
• one-off heating, vitamin and healthy start food voucher allocations to people on benefits.

Then:

• open up a subsidised immigration scheme for English-speaking HCPs

Plus all the long-term fixes: social care, university places for studying medicine, bursaries, HCP pay, more minor injury units etc.

This. Sorting out appropriate discharge and step-down care for the elderly and making sure that they are actually looked after rather than sending them back to an inappropriate situation which will get them blue lighted back is a huge part.
But ditto privately funded care homes, the pay there is shit too. And to do that, people need to accept they have to pay for it….and every time a government, Tory or otherwise tries to suggest that people might have to take it out of their home, there’s an outcry and the policy gets dropped. Boris had an 80 seat majority to push through the reforms to social care and the anti-obesity strategy and he bottled it both times.

If nurses get a pay rise, it then applies across the whole NHS because of the Byzantine pay structure. A 1% pay rise would cost £900 million. 19% is not feasible, they need to accept that and have a sensible conversation with the pay review body.

Presumably these people were packed off home pretty quickly. And maybe they weren't the brightest sparks in the first place. That's why you have triage.

It cannot survive any longer as a free service (yes free for kids, but not working adults)...

£10 per GP appointment
Operation/child birth etc .... You pay slightly more tax in your wages. A bit like a student loan.

We pay for opticians, dentist and other services, why not this?

You need easier and better ways to permanently opt out of screening without being harassed within an inch of your life.

Its impossible. Despite attempts to do so. I find it deeply upsetting and it sets off my anxiety to unmanageable levels. The gp is aware of this and still persists.

I've never met a single person who has gone to A&E to get a bandaid put on their cut finger or paracetemol for a headache, let alone been willing to wait 12 hours for an ambulance and 2 days in A&E to do so. Nor have I seen a single piece of evidence indicating that abuse of the service has increased since the time when it used to work properly, and is therefore the reason why it no longer does.

Is the idea that between 2000 and 2010, when most NHS metrics such as A&E waiting times, surgery waiting times etc were vastly improved, it was because everyone in the country used the service responsibly . . . and then after 2010, some fiendish anarchist scheme spread through the entire population telling people to turn up at A&E every weekend for no reason whatsoever to bring down the system? And that that just happened to correspond to when the Tories took over and real terms funding started being cut, but that obviously had nothing to do with it?

Obviously I don't expect the Tory bots to admit any of this, so what about some simple evidence instead? We're always being told that the NHS is overburdened with managers. Given the horrendous state of A&E and the costs involved, some of those managers must surely have been occupied measuring and tracking how much time and resources are wasted there on unnecessary treatments. Can anyone point to anything from the NHS itself - and I don't mean randoms on some internet forum claiming that they are "on the frontline" - indicating that increasingly wasteful abuse of the system is the reason for its problems and the key to solving them?

GPs to open 7 days a week.
More funding to Train more GP midwives and consultants.
Reopen the urgent care/walk in centres we had.
Re open convalescence home to alleviate the issue of bed blocking in hospitals
Simplify paper work to discharge patients more quickly.

But of course none of this will happen 🤣

Discharge people to private hospitals for rehab/step down care-government would have to pay them but it would free up some beds?