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?

They can decide. Wales has chosen not to.

Valk, in response to your post:

To use contraception and abortion as an example and leaving out empathy, kindness and any ethical concerns from a purely financial point of view they are more cost effective than forcing women into and continuing unwanted pregnancy.

Imagine a 'Sliding Doors' scenario:

Stream 1 - A healthy woman aged 20 has a copper coil inserted for contraception. It lasts 10 years. All goes well, the NHS see very little of her for the next 10 years.

Stream 2 - Same woman can't afford the upfront costs to have same coil fitted, has to go with a less effective but less immediately expensive method. Gets pregnant, again can't afford the upfront fees for a termination so has the baby.
By the time the same 10 years as above has passed funds need to found for at a minimum all pregnancy and birth care, vaccines and other early medical checks for the child and a school place for the child. The mother will also be less economically active for a greater or lesser period of time.

This only needs to happen a couple of times per thousand women and you've fully wiped out any financial benefit.

I note with interest that viagra wasn't on your neocon laundry list of what to cut.

Short term solution is to throw money at the problem. Gp offices open longer so gp problems don't have to go to A&E. NHS buys more services from private sector. Give nurses the right to do some procedures or checks. Make insurances more affordable. More phone appointments available for patients that don't actually need to be seen. Insurances cheaper so those that can afford it will take them. Reduce the need for sick notes so people who just need something to say "james has fever" to employer won't be taking appointments.

Real terms health spending is up. So what do Labour supporters want to see in terms of spending? Can they say how much more is needed and who pays.

I was for the extra social care budget as that is where the main problem lies - fix that

Then try to get our rather unhealthy population to take more responsibility for health.

I prefer those two things to endless funds being thrown at NHS.

Inflationary rises of 19% not recommended.

But people need to be told again not to go to a&e for minor things. However people need access to medical help within a reasonable time. Perhaps triage everyone off to pharmacy nurses GP and then through the magic a&e doors.

Measuring how many people are there because they can't speak to anyone else for help and deciding actions for that is the only way to genuinely relieve pressure on the NHS.

Immediately increasing the amounts the councils will pay for step down or any other social care would take a while to trickle down. The money comes from central
Government and nearly
All social care is privately contracted. I manage mental health services-even if we suddenly started getting paid double for our contract overnight I still wouldn't be able to magic up and train staff in time to help this particular crisis

Sorry what, you think women should pay for childbirth?

That couldn’t possibly lead to women avoiding maternal care and a vastly increased rate of mother and baby deaths, could it?

It's on Sidwell Street by Iceland. It used to be the sexual health centre.

Gp offices open longer so gp problems don't have to go to A&E.

Who is going to staff it? Practices round here are short of GPs. GP in the family, has been qualified for 4 months. They want to quit medicine, citing burn out.

Should NHS remain devolved?

It seems to be performing worse in Wales (by a considerable margin) and also in Scotland. Also Whitehall is v wedded to regional autonomy (the "postcode lottery") which doesn't seem to bring any particular benefit. But social care and public health are matters for Local Authorities.

We need an overhaul of the organisation of public health, social care and patient care (as its only the latter we tend to refer to as the NHS).

Long term solution is to look at the organisational culture.

I would say that it has no real leadership, just a series of ever-more-senior managers. And that's not leadership.

These aren't the things that will free up capacity in the short term to get us through this winter. But they're the issues that will determine the best way to deliver a national service.

Short term quick fixes:
GPs to open 7 days a week.
Simplify paper work to discharge patients more quickly.

Long Term fixes:
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

One went home (the one with the sore nose), but the others refused to go. So they had to wait to see the nurse for assessment, and were then all sent to the OOH GP. So they weren't taking up beds, but they were certainly taking up time which could have been spent on people who actually needed it. They didn't need to see the GP either.

The thing is, people who live lives of the exemplary healthiness suggested will still get old. They are probably more likely to get old than most, although genetics/sheer luck etc play a part. It isn't a question of them living fit and active until 90 odd and having a quick CVA/MI and dying. Their bodies will still wear out, they will fall and break things, they will develop illnesses, they will need hospital and other care.

My husband is in hospital. His health and mobility have declined rapidly over the last few years and I gave up work to be (sole) carer. A lot of investigations which may have helped didn't happen, because Covid and we battled to keep him at a decent baseline, which went because he finally got Covid and while in hospital, in bed, lost the mobility he fought to retain. For most of his life he had a standard of physical fitness that few people attain. It isn't helping him now.

Long-term people need to take more responsibility for their DC and themselves. People here seem to think the state is responsible for everything and anything. I noticed this when I moved back here. Not the NHS, but schools. They seem to be the de facto parents now as children's own parents are not trusted to feed or keep them safe.

It is the same with the NHS. Both sets of elderly parents use the NHS at least twice a month, each and have no other ailments besides being elderly.

How many of us don't eat healthily, don't exercise and don't actively do things to protect our MH and instead deal with it retrospectively? You can't stop some illnesses, but being in a good place gives you a better chance to deal with them, and get over them quickly.

I'm not sure of a short-term solution. TBH, I have been optimistic about the UK since I moved back here 7 years ago, but now I think it is broken beyond repair.

Heathy people can get older but looking at European countries we don’t score well on health.

I don’t think we benefit from this but someone would have to compare the numbers.

GPs used to have a fairly "mixed diet" of patients in v short slots. So they'd see easy patients v rapidly, and have time for a bit longer with more complex ones.

Now it's longer appointments (generally a good thing) but of course without increase to number of GPs, that means fewer appointments, so patients get a better service, but a longer wait to access it.

More of the routine things went to other practitioners, to try to manage the demand on doctors' time. Doctors start to see only complex patients. It's no longer a mixed diet, and despite longer appointments, they don't get to know their patients. And they start to burn out. Because it's a harder workload medically (obviously within their capability and training, but instead of seeing the ups and downs, it's seeing only the difficult or distressing)

It becomes less attractive. No-one's listened to the BMA who has been giving warnings for many years about the demographic bomb of GPs predicted retirement ages. Shortages all round, which even the spread of the telephone appointment, isn't going to counter

One good initiative was the opening of NHS drop in GPs alongside A&E departments, as are the private drop in centres eg at major London railway stations (a home-address-based GP service doesn't really work well for commuters, and at least this deals with some of the routine/minor/occur during the working day issues even if it is a direct cash cost to the patient)

I agree there are a lot of time-wasters. However, relative currently working in A&E says most of their patients are elderly people who’ve had falls. Not sure what can be done to reduce those.

Decent and widely recommended patient information booklet about falls prevention and self-management.

csp.org.uk/system/files/get_up_and_go_0.pdf

It would be helpful if people could be taken through the part of the booklet on how to get themselves up again.

We need walk in centres for people who would see GP. Manned by Lots of Nurse Practitioners or just knowledgable people to take details maybe do BP, and maybe one doctor.
Doc prescribes or forwards the patient to A/E or sends home or arranges a gp appt for their own gp at a future date.

ime any problem at a care home means patient is ambulanced to hosp when in the past the GP would have visited them at care home - doesn’t seem to happen now.

I am going to go with settling the pay disputes for nurses and doctors and ambulance people. Then a serious recruitment driv of already qualified personnel and a hefty increase in training places. But the government would have to want to and they just don't.

In the next week or two

• reduce alcohol consumption
• encourage people with flu to stop mixing for a few days until recovery (although you’d have thought people would get it after covid - but they don’t)
• give NHS staff the authority to turn people away without fear of litigation or complaints /losing their job
• some kind of campaign to get families to look after their own relatives- even short term until placement sorted (they would need time off work and will give all the reasons under the sun why they can’t do this - but still say someone else has to)
• a freeze on private work (to force health workers to take NHS shifts)
• cancel the very little elective work being done

Quite a few European countries charge for health care at the point of contact. Including childbirth and their infest mortality is lower than in the UK. I personally think that helsth care should be affordable but not necessarily free at the point of contact and then appropriate ways to handle it for people who can't afford it. I belive it's quite rare for health care to be totally free like like in the uk

I don’t think the NHS can afford targeted therapy for 1 person for such an array of complex MH conditions though. I can’t begin to add up the cost in my head, not the mention the practicalities of it. Mental health is also relatively new in the scheme of medicine so not as well understood as other areas. Do you feel there would be a realistic chance of ‘cure’ with the right therapy or do you feel you would need it on a relapse/indefinite basis?

Most areas run falls clinics - a short course to which GPs (and I suspect others) can refer people, and which a carer can attend alongside. Usually run by a physio or an OT, they typically include exercises, safe movement, tips for a safer home and an OT home check

I suspect there's a bit of a backlog, as they're group activities and so would have been suspended for a while, but they'll have resumed by about spring 202, so should be pretty much back on course now

We have no falls clinic running any longer in this area sadly.
These would take months to prevent falls though but are an excellent thing if run well.

Why would we consider euthanasia for the over 65s? How silly. We definitely need to consider not treating people who have a diagnosis of dementia, it sounds harsh but actually it’s the opposite - dementia is a drawn out, cruel and terrifying death whereas something like pneumonia or a UTI would be swifter (if not instant) and spare them that suffering.

Obesity, alcoholism etc - yes there should be some kind of charge for this. Not the full market rate for their drugs. But something like £100 for every A&E visit caused by alcohol intoxication, or £20 for every obesity related appointment.

No IVF on the NHS, it simply cannot be justified at the moment.

Maternity care - why would I charge people for that? It’s a two way street, we need babies to be born as much as people want to have them. I don’t want there to be nobody in 30 years to cut my hair or take my bins away. Children are an investment in the future and always worth the money.