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?

I'm sure with the right amount of money gp's who are recently retired, work in private clinics, work in specialist NHS hospitals, not burned out, working in quieter areas would be willing to take extra shifts. Well I already know some that do this. Go work for a full weekend in the middle of nowhere that can't get staff and get paid almost full months salary for the weekend or two.

As these appointments haven't been requested and for many are unexpected (they might not even bother to open the envelope assuming junk mail) the onus shouldn't be on women to cancel if not convenient/not wanted
Perhaps the idea is that more women will attend if they don't have to phone and make an appointment, but it's bound to result in loads of missed appointments

I agree - the only time I've ever missed an appointment was one of these. Goodness only knows what happened to the first letter (I never saw it) but I did get the 'you missed your appointment please ring the number to rearrange, missed appointments cost the NHS £XXX each' letter

I don't know if there's a better way

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.

@Itstoocoldoutthere

Just mothers? Are single fathers and other male parents allowed to seek medical help?

I know what you are saying here, but the reality is that the mother is usually the one to make medical decisions wrt children, particularly young children.

You likely get better results by targeting this group.

A lot of recently retired GPs, retired because of the tax consequences of continuing to work, i.e. very high marginal tax rates (up to 62%), the pension tax penalty, and the expansion of IR35 to the NHS which meant retired GPs could no longer work via personal service companies to avoid the 62% tax rate and pension tax penalty.

When people cry out for "the rich" to be taxed more, they need to take responsibility for the consequences of taxing the rich! We'd have a lot more GPs (delaying retirement or working in retirement) if they weren't taxed so highly!

It's not a case of 'dumping' them and it's partly this mindset that has to change. Very many frail elderly people are physically incapable of being cared for by families due to a multitude of reasons. I've been nursing over thirty years and wouldn't do it.
What's selfish is older people refusing to plan for old age, insisting on living in unsuitable living accommodation and falling about all over the place. Refusing to pay for carers and expecting busy working adult DC with jobs and families of their own to pick up the slack. I saw it many many times as a district nurse at great cost to society.
The irony is that many old people stuck in ambulances or on the floor for hours on end are there because of similar circumstances of their contempories blocking hospital beds.

Encouraging us all to be realistic as we age and spend what we've 'scrimped and saved for' on carers, adjustments to the home, downsizing etc would go a long way in keeping old people safer and off the floor. And maybe means test attendance allowance so that doled out to wealthy pensioners can be redirected to those less well off.

I wonder how the demand on the NHS have increased over the last 10-20 years.

During this current crisis, what would the effect be if the NHS were to treat British citizens as priority?

@UnmentionedElephantDildo

No-one's listened to the BMA who has been giving warnings for many years about the demographic bomb of GPs predicted retirement ages.

Is this the same BMA who voted against increasing the number of medical school places and voted against new medical schools?

"to avoid “overproduction of doctors with limited career opportunities.”"

www.bmj.com/content/337/bmj.a748

Sounds like they deliberately wanted to restrict doctor numbers to increase their own member's pay and career opportunities, i.e. by keeping supply low and demand high, basic economics!

It's not immigrants costing us money it's the rapidly aging population which no government has planned for. You do know dementia is now one of the biggest causes of death but it takes years and years to die from ? The state pays billions out.

It's because many specialities have training bottlenecks, chucking more doctors into a ridiculous training system isn't going to help. They should sort out the training pipeline, it's ridiculous in this country. Not only are junior doctors paid offensively low wages as one day if they jump through tonnes of hoops they might earn a decent wage (which is still well below their contemporaries in similar countries); but rotations, the absurd years they need to spend in some specialisms which doesn't actually make them better practitioners is wild. Add into the mix the dawn of PAs who with their 2 year course earn more than a junior doctor and because they're a permanent member of staff get better opportunities it's not working.

TLDR: working on retention rather than recruitment is more important for doctors.

1. There is statistically a sharp drop in the rate of poverty and crime in countries once abortion is legalised so we could debate the ethical and moral implications until the cows come home but your argument just doesn't make practical sense 2)ditto with contraception
2. are only homosexuals not allowed to be reckless then?... because.... you know... it's icky.... Or should we ban all sexual health?

Could pick holes with most/all of what you're suggesting but that'll be enough to be going on with

1. Fines for missed appointments (including GP and hospital appointments).
2. Don't get so drunk you need to be taken to A&E.

That would take quite a bit of the pressure off immediately.

@georgarina
The point I am trying to make is that A&E departments have a large number of people who present who do not need to be there such as people with minor viruses, homeless people seeking accommodation. You clearly needed to be seen with sepsis and I certainly would not include you in the group of people who should not attend. I actually do hold a senior nursing position and have lost count of the hours I have spent over the years answering complaints such as my toast had too much butter on it or why wouldn't you give me extra benzodiazepines when I asked, the NHS treats these sort of complaints in the same way as a complaint about clinical errors (such as your sepsis).

Preventative care over crisis management. In my experience and from what I’ve seen from everyone I know, the NHS does not act in a preventative way and only tend to act when things get serious. But if people were treated properly before things escalated this would definitely help.

Properly training ALL STAFF in mental health issues rather than telling suicidal people to have a cup of tea/a bath/a walk. Lots of people ending up in A&E on a regular basis after repeated suicide attempts and yet they’re told to pop in the bath and discharged with little support. and thus the cycle continues.

Sorting out middle management.

I guess these aren’t immediate fixes, but are definitely fixes that could be implemented in the short/medium term future.

I agree with pps who have said we should discontinue IVF on the NHS. Inability to conceive isn't an illness and we are not underpopulated.

But the right to family life is a human right.

Should we also cancel any other non-life saving treatment? Surgery to correct cleft lips? Hip replacements?

And get a lot more strict on what is treated and what is not. @Glittertrauma interesting... what would you suggest?

@cptartapp

What's selfish is older people refusing to plan for old age, insisting on living in unsuitable living accommodation and falling about all over the place.

Yep, MIL is like that. She thinks she's invincible and just expects everyone around her to pick up the pieces, whether it's family or the NHS. 15 years ago her husband died (NHS negligence) and we were telling her then she needed to move as the house was too big (Husband did the huge garden etc), it was nowhere near shops (husband drove her everywhere as she never bothered learning to drive), not even on a bus route, no downstairs bathroom (even though there was space and she has the money), etc.

Now she can barely get up the stairs (won't pay for a stairlift), garden is an overgrown mess (won't pay for a gardener), she stills walks to the shops (half a mile away) in the ice and snow, etc.

She just bats us off whenever we've suggested she move or get people into help, she just does the "emotional blackmail" on family to pick up the pieces - the typical "woe is me, I'm a widow" etc.

She refused to pay privately for cataract surgery and instead preferred to wait a year to have it done on the NHS (of course, family had to take her shopping etc in the meantime as she couldn't see to walk).

"Right to a family" means the state shouldn't stop you having a family. It doesn't mean you've got to be given a family at all costs. You've misunderstood the fundamentals behind the Human Right's Act.

Anyone eligible to pay for prescriptions could also pay £12 for a GP appointment, or a trip to A&E.

Very much disagree with this post. The fact of the matter is that anyone eligible to pay for prescriptions is likely to be the same person who ends up in A and E regularly. It's not right that over 60s get free prescriptions and everything else from the NHS as a blanket rule. It is the same group that is using most of the beds / appointments (through no fault of their own) It should be looked at and maybe only those receiving pension credit get everything free (or with particular illnesses as is the case with younger people) plenty of 60 year olds are working so why do they automatically get everything free? Also elderly don't pay NI.

Properly training ALL STAFF in mental health issues rather than telling suicidal people to have a cup of tea/a bath/a walk. Lots of people ending up in A&E on a regular basis after repeated suicide attempts and yet they’re told to pop in the bath and discharged with little support. and thus the cycle continues.

What treatment do people expect in these cases? Suggesting sensory-based grounding or distraction techniques is a well-evidenced crisis technique for suicidality. Those sorts of things are meant to fob people off.

In that case we need to redefine what "right to family life" means.

Well said.

Agree there are too many ppl trying to access the service.

On my last visit to A and E ( vaccine induced tachycardia) the receptionists were redirecting people to walk in or GP emergency. Only those with substantial concerns were allowed through.