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?

Not did I say it did - there was no need to post such a rude response just because I disagreed with your position.

True

@TheCountessofFitzdotterel en.wikipedia.org/wiki/Birth_tourism

maternityaction.org.uk/advice/nhs-maternity-care-for-women-from-abroad-in-england/

The private sector does everything better than the public sector.

Yes, like our magnificent privatised railway system [heavy sarcasm]. I’m old enough to remember when trains were cheap, generally reliable and run as a public service. Not old enough to remember how harsh life was before the NHS, but my parents’ generation remembered and thank god for the NHS.

Make all GP’s work in the medical practice, not from home.
be able to book a Gp appointment, instead of having to wait until the condition is at crisis point.

last week, I was unable to get through reception triage, until my condition was so bad I was granted a nurse appointment. Nurse had to check my treatment out with a Gp, due to not understanding my complicated health condition. However, all Gp’s were working from home that day. So my prescription was sorted by a nurse. Told to go to hospital straight away if I got worse. Of course I got worse, as not right prescription!!

Slippery slope. In practice this would mean cutting IVF, letting more premature babies die as ‘stillbirths’ and letting more children die of Cancer when treatments are too expensive. Like the NHS used to do.

Open separate children’s emergency care centres

Does anyone here have any experience of the mental health intervention, "The Friendship Bench" aka "Grandmothers on a Bench"?

The Friendship Bench (FB) project is an evidence-based intervention developed in Zimbabwe to bridge the mental health treatment gap. The FB aims to enhance mental well-being and improve quality of life through the use of problem-solving therapy delivered by trained lay health workers, focussing on people who are suffering from common mental disorders, such as anxiety and depression.
…
Uniquely, the FB uses ‘grandmothers’ to deliver the therapy. These grandmothers are community volunteers, without any prior medical or mental health experience, who are trained to counsel patients usually for six structured 45-minute sessions, on wooden benches within the grounds of clinics in a discrete area.

www.centreforglobalmentalhealth.org/the-friendship-bench

I keep seeing reports and publications about how well they work. This is an interesting talk about them from Dixon Chibanda. Do they only work in cultures that have respect for grandmothers/senior citizens?

I'm fascinated by what could be done at a community level.

Maybe the 10million wasted unattended GP appointments would be a good start, followed by a similar amount of hospital out-patient appointments missed.
The service is strained but this level of abuse of a free service is not helping patients access services.
On an individual level it's easy to fix, either turn up to your appointment or cancel it in good time to allow another patient to access the valuable time of a healtcare professional.

Not a quick fix but... Is there some way pharmacists can prescribe certain things like antibiotics? My friend's son has scarlet fever and she had to jump through so many hoops, including being told no appointments until 3 Jan (this was 30 Dec) and having her case closed 3 times as "routine" by 111 that she had to go to A&E to get him the antibiotics he needs (he also turned out to have tonsillitis) She didn't want to go to A&E but had exhausted other options.

I know this happens a lot in other countries but I don't know if their pharmacists have different training that would take a lot to implement here?

So much of this thread is blaming individuals (particularly women), for structural problems which they haven’t contributed to.

33% of beds are currently occupied by people who are medically fit for discharge. The crisis in social care needs fixing - increase pay, increase local authority funding, increase immigration. Tories and their paid influencers would rather you blamed each other for being too old or too fat or too concerned about your children though.

Baffled by these sorts of comments

where you think staff will come from? These aren't jobs many people want to do.

Not a quick fix but... Is there some way pharmacists can prescribe certain things like antibiotics?

Some can and already provide this service. Issue is the government also cut pharmacy funding so I don't know where the money for training and service provision would come from.

Community pharmacies are struggling to stay afloat as is it is

I agree with discharging as a fix but still think we are unhealthier than other countries sadly and it’s never discussed as an issue. It’s frustrating to never have it addressed as part of the problem.

(The paid influencer part is silly though, unless you are being paid by Labour..)

How could that possibly be justified when working residents who are not British citizens pay the taxes that run the NHS just like anyone else?

I'm not a British citizen. Have lived here and paid tax for 20 years. You're saying I'm less entitled to medical treatment than you because of the colour of my passport?

A lot of the problem with the trains is that they're controlled by the state via the franchising and funding system, so it's not true privatisation at all.

The govt (via quangos) control what trains are bought, what services are operated, timetables, fares, what stations to stop at, etc. A train firm simply can't decide to run a train from A to B via C at a specific time for a specific fare - they have to jump through hoops and get quango approval every step of the way. There are countless instances of private firms trying to run a particular service, but they are told what route to run, what time to run, etc which often makes it unviable.

The railways are about as far away from the "free market" as is possible!

On an individual level it's easy to fix, either turn up to your appointment or cancel it in good time to allow another patient to access the valuable time of a healtcare professional.

Is there an official breakdown of who is a non-attender? I keep seeing threads where people receive letters about being a non-attender when they didn't receive the appt. letter until after the date of the appt.

I don't know how easy it is for people to cancel appts. Again, there are threads here were people try and phone to cancel one but the phone rings out and there are no other communication channels available to them.

I don't know if these represent a small proportion of those who don't attend or not which is why it would be useful to know if there is an analysis of the millions of no-show appts.

Not providing IVF is absolutely nothing like letting babies die. It's not creating something, rather than letting something die. Completely different.

@saleorbouy

Maybe the 10million wasted unattended GP appointments would be a good start, followed by a similar amount of hospital out-patient appointments missed.

What are the reasons?

Personally, I've only ever "missed" one GP appointment, which in fact I'd cancelled and re-arranged but the GP gave me an ear bashing about missing the earlier one. It was a strange situation. I'd an appointment for my son at something like 4pm and I had an appointment at say 4.30. We phoned up to change son's appointment (he had another conflicting appointment) to later in the week. I turned up at 4.30 and got an ear bashing for son's "missed" 4pm appointment. It was only when I insisted he check the system to see the new appointment later in the week did he reluctantly accept that it was their fault the first appointment hadn't been cancelled off the system!

My MIL has missed loads of appointments, but her dementia is getting worse, and we had no idea she was missing them (she never told us about them), now we now, we make them for her and take her! Hardly her fault she has dementia and can't remember things! I wonder how many missed appointments for for the elderly/confused and for the chronically unwell who simply aren't well enough on some days to attend?

As for hospitals, we've been put down as DNA's many times as often the appointment letters don't arrive soon enough or don't arrive at all. We've lost count of the number of letters that arrive a day or two after the appointment or we get home from work on the day of the appointment to find the letter in the letterbox, delivered that same day! How hard is it for them to send out letters early enough, or to phone/text for late notice appointments? It's as if they don't want you to attend (maybe they don't and are just fiddling the statistics?).

They also need to make cancelling/re-arranging easier. Far too often you ring the telephone number on the appointment letter and it is a disconnected number, or just rings out, or goes to answerphone and you leave a message which they ignore!

The NHS needs to get it's own house in order re appointments, and only then, when it's a functional and efficient system do they have the moral high ground to blame patients.

Sorry but you are seriously suggesting that abortions should not be available free on the nhs?!!!!

Have you even thought about the implications of that on women?
No I thought not! 🙄

MintJulia · Today 08:04

And, yes, I would charge for missed appointments.

I recently went for a mammogram. I got there early, expecting to wait and was see immediately. The previous SEVEN patients hadn't shown up. None had bothered to cancel their slots. I was told this is not unusual.

Stupid, selfish, wasteful and hideously expensive

Or maybe they didn't know about their appointments because the NHS like to send everything by letter and there's been postal strikes?

Paid influencers is a big thing, though they won’t be directly employed by the parties as that’s illegal. But the Tufton Street gang absolutely have used paid astroturfers on sites like Mumsnet to influence debate on issues like Brexit. The NHS is their next big battleground, so absolutely people need to watch out for being influenced by ultra rich libertarians who want to break down support for state funded healthcare.

As a country, we’re not the most healthy but also not the worst (by most measures that’s the US). Early intervention has been fucked over by the Tory government too (eg the Sure Start centres used to do loads of stuff around healthy eating and family physical activity). Shaming individuals for existing in a society that simply isn’t set up to help them make healthy choices doesn’t work.

Indeed, removal of contraception and abortion is a alarming opinion.

I get the NHS needs to cut back, but not send us back to the year of its inception regarding women's body autonomy!!!

Charge people for turning up at A&E with drink and drug related injuries. If it costs you a grand to have your kid's stomach pumped, you'll know where they are and what they are doing next time.

Not everyone has the ability to care. Do you have any idea of what caring for an elderly relative could actually involve? The impact that could have on people?
And as more and more people end up living in tiny matchbox sized homes there simply isn't the space or facilities for them.