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?

If you want an immediate effect there are a few things that could be done, but it will cost money.

1. Buy out all private care home places so patients who can’t look after themselves can be discharged from hospitals.
2. Deal with the causes of mental health problems, which are mainly stress at the moment - ban evictions, massively increase debt advice, ban gambling advertising, free school meals for all kids, universal credit up lift.

We closed down the economy to “save the nhs” and now we’re killing the nhs because we’re in debt.it makes no sense.
We need to start spending at least the EU average on health.

Private A&E’s for folk with private health insurance. 🤔

Bring back the sanatorium type places that my Nan always talked of to send people to who are fit to go while they have some rehab or wait for care.

Much more money from government for care to local authorities. Separate out the money that goes on care for people with long term needs like LD who have very costly care packages and manage that centrally.

My view from the coal face- charge. I know this is a hugely unpopular idea. It’s too late for long term strategies/education/ improved SC packages etc; whilst all useful the effects of these aren’t immediate enough.

Charge- a reasonable fee for seeing a GP, attending A/E and ringing an ambulance. Other European countries have managed to find a way to balance the risk of those who literally cannot pay, against those who abuse the services. So why can’t we.

Those who aren’t seeing the daily abuse and misuse of the above services from the inside would be appalled at the things that are going on every day. The expectation, the mounds of unused ‘free’ medication stockpiled in large numbers of homes, ringing for an ambulance for a small cut but implying it’s akin to a partial amputation on the phone…. requiring a plaster to be stuck on it…..

The rows of people in A/E with coughs, colds, tiny injuries they did last week. People ringing 111 for advice for things that literally require baseline common sense, then exaggerating the issue so, woah surprise, A and E is recommended.

Charge- £10,£20 per visit, per appt. Watch all the above miraculously stop attending and ringing. It’s not rocket science. Longer term, fund GP appts, A and E attendance and ambulance use through an insurance system that INCLUDES those on pensions and benefits. In a means tested way of course. Like LITERALLY almost every other European country.

As a definite quick fix so being so entitled and start taking some responsibility for yourselves

Think twice before going to a doctor or a and e as many things can be managed yourself. Definitely don't go to a and e for things that aren't genuinely urgent because you aren't prepared to wait a few days to see your GP

When you get a hospital appointment turn up or if you're not going to cancel with decent notice. DNAs are going up for the 2ww clinics I do basically because the appointments are so easy to get quickly that they don't value them.

Basically stop taking the piss. The NHS is underfunded and breaking but a lot could be appreciated by people taking some responsibility.

People can be the fittest and healthiest ever and still get sick.

I work in health care. My colleagues and I think the cost of living is partly to blame. If people don't have enough to eat or warm themselves, they are more likely to get ill. Immediate solution? Snap GE? Get tories out,?

I’m not sure this would help the country as a whole. Once one striking sector get what they are asking for, the other strikers would increase their strike action and it would also encourage other groups to ask for above inflation rises.

I don’t have any suggestions though but I agree with those people who would like to know what the government are doing right now to deal with all these issues. I’d also like to know what Labour would do, they are also keeping very quiet and not coming up with any positive actions. I’m quite concerned at what Labour will do when/ if they win the next election - apart from throw money at the problems without worrying about our failing economy.

Getting the GP service working again is the big thing I think. If you sort that you alleviate a load of pressure on urgent care.

I agree with this (although don't know how you would get it working again quickly enough). If you have very sick. elderly parents or young children and yet being told not urgent enough to see a GP (so many examples on MN and in my RL), I'd be off down to A&E , even though I'd previously never have dreamt of it.

Stop spending £40million a year on "diversity and inclusion" roles.

If you want quick results, you need

a) fewer people in hospital, and reducing the burden of infectious diseases would help enormously

• Evusheld for the immune compromised
• masks in all clinical settings (to clamp down on spread within hospitals - also good if you want things like cancer care to be safe)
• consider mask mandate for public transport, and encouragement to wear them in all crowded enclosed indoors spaces - to be in force during winter virus season (when there's more floating round than just covid)

Longer term - invest in good ventilation/air filtering for schools and other indoors places

b) faster safe discharge of patients who no longer need acute care

• probably no quick fixes avaiable

Longer term - needs overhaul of rehabilitation, convalescent and social care. More investment inn social care. Possible reintroduction of 'step down' convalescent provision, dependent on solving recruitment difficulties for exist levels of provision in care sector

Even longer term, recognise that what we have is a "National Sickness and Treatment Service", and decide where "Health" (public health and prevention strategies) actually fit in to this

• Government could at least show willing to talk to the unions.
• Bring back walk in centres

These are longer term:

• Better health and nutrition education and address the causes of poverty and illness
• Amalgamate backroom functions like HR and education and look at hospital mergers where feasible, the duplication of functions and roles is so shocking
• Sort out NHS IT and procurement for starters
• same uniforms and equipment across the UK or at least England ( with allowances made for specialist hospitals)
• Bring back bursaries for nurses
• Make the NHS an all party concern and not a political football
• And much as I hate to even mention this, there is going to have to be more personal health insurance and better personal healthcare and responsibility going forward. Unless we want to take the Logan's Run approach to society....

Extend GP hours, really? Where are we going to magic up these extra GPs from? I personally know 3 that have quit recently because they were completely and utterly burned out.
One of my DC is just about to qualify as a nurse, 2/3 of their cohort have quit before they even qualified.
Staff won't stay where all they get is criticism and abuse, especially when they know that financially they can earn much more elsewhere.

I'm interested in your quote about using prayer with bariatric patients, do you have a reference for this please?

I take issue with this to a point.

When you look at the cost of poor services in maternity it doesn't make economic sense NOT to invest in it because of the impact on long term physical complications, negligence claims & subsequent increases to insurance premiums and cost to society from women who end up with mental health issues from things not going to plan.

The cost of having better staffed services is LESS than running the service properly.

My suspicion is it's very much the case in other areas of the NHS. Early intervention is much more cost effective long term before something becomes chronic.

We've known for considerable time that prevent has been a better option than 'cure'.

This includes a massive rise in obesity. That's not just come from no where and we know that levels of obesity are not the same throughout socio economic groups.

The issue is long term neglect of health issues and investing money in the wrong place, often in the name of 'cost saving' to one department only to pass it on and increase costs to another further down the line.

It's badly run because budgets are ring fenced and not linked and politicians don't understand the concept of putting money in the front end to stop problems 5 years down the line when they are no longer in power.

PFI was a massive example of that - and that predates the conservatives coming to power. it condemned us to a generation of paying contractual rents etc which were extortionate rather than lower amounts if we'd just put it through as national debt at the time. That meant money wasn't available for actual care and set the ball rolling on massive issues which have only got worse.

It's therefore not merely a Tory thing. It's a chronic failure for the past 30 years by all parties.

OP - what planet are you on thinking there could be a lockdown? The economy and the NHS have been wrecked in part due to lockdowns, there is literally zero chance the govt would bring one in.

There are some very hard truths we just aren't prepared to face. Even an NHS that was properly funded and politically supported would be struggling. The simple truth is we all need to pay a lot more. And get a lot more strict on what is treated and what is not. But I don't think people want to hear that. They want low taxes and a bottomless pit of treatment.

This. Particularly on MN, there seems to be an expectation that the government should intervene in every aspect of your life and solve your every last problem. Nothing is ever an individual’s responsibility, it’s always a ‘lack of support’ or ‘mental health issues’ etc. The hard fact is that even if we didn’t have the tories in charge, there simply isn’t the money and workforce to provide all the services that are expected on here.

There's some good points there about charging ,@mrsnoodle55 . I can see that charming would bring a bit more money into the system (though we could increase taxation to the same effect, overall). And I can see how it might deter some people from unnecessary usage - But would it really stop the feeling of entitlement you describe? Wouldn't people feel more entitled to the medicine or healthcare they think they need if they were paying? And getting healthcare is never fun - we do already pay via our time in the very long queues - so if an 8 hour wait isn't deterring people from turning up at A&E, is a £20 charge really going to?
Personally I'd be happy to pay if it meant I could get healthcare when I need it. I'd also be happy to pay more tax for it.

They could open up more mental health crisis centres where people can drop in, get seen quickly by MH trained staff- assuming they can find staff to staff it. This would take some of the pressure off A & E's.

A&E would cope if they were not having to babysit patients waiting to go to wards. The most pressing need is to get people out of hospital the other end so what can we do.
If any of you have elderly relatives in hospital awaiting any sort of care provision, try and be creative.
I went in today as extra shift as our hospital was pretty dire. One son told me he had set up live in carer for his mother's discharge but they could not start until next week so he planned to move in with her until they could start and had found a couple of friends who were happy to come and assist with personal care for a few days. It is so rare to find families prepared to flex like this and find solutions. Most say they have heard there is 6 weeks of free care on discharge so they want to wait for that.
Another patient told me she had carers lined up for as soon as the doctors said she could go. We need families who are able to and have resources to,to help themselves and not expect everything free that you can get. Yes, it is our right if we have paid our taxes, but being on a ward in hospital is not a safe place for anyone. You catch other people's illnesses, you decondition, you become institutionalised, you lack sleep etc etc
If your relative is admitted, go to their house if able. Check it is clean and tidy. Don't tell us a week later when we want to send someone home that it needs a clean out the boiler is broken, or even better, that as they were in hospital you have decided to have a wet room installed which won't be finished for 3 weeks, or you have taken the opportunity to grab a 2 week holiday and if we discharge mum whilst you are away you will sue us for negligence.
We need to focus 100% on community care and resources if we are to solve this issue. If we can get that right, the NHS will cope.

Little things would make a massive difference.

The effects of elderly patients falling over costs millions. Yet every bloody day I get relatives laughing and telling me that "oh no, my Mum won't let you pick that loose rug up".
And you just know that a month later she'll be admitted with a fractured hip.

Replace Bake off with Joe Wickes, 😁get everyone moving instead of encouraging the scoffing of neat cholesterol, mixed with sugar.

Start charging a fee for missed appointments.

Start charging a fee for those injured during completely avoidable idiotic behaviour, ie drunk driving or superglueing oneself to something in protest.

Buy out all private care home places so patients who can’t look after themselves can be discharged from hospitals

Where are you going to put the residents who would be displaced by this?

If you propose to requisition available rooms only, but then pay only LA rates, what are you going to do when the home goes bust? (The higher charges for self-funded residents is what keeps some places afloat)

Give a shit about staff and value them. Golden management rule, always ignored in health. Find money. Pay less for bombs if you have to.

One of our local hospitals triages people outside the A&E doors (often in cars) - only people who truly need to be there get to go inside. The wait has reduced from 12 hours to 2.

Totally agree and lots of things could be put in place before accidents happen. very simple things like grab rails, extra stair rail, stair lift. Many elderly people leave it way too late to make changes like a walk in shower or move to suitable accommodation. They try and go up ladders to change lightbulbs or do a bit of DIY as they are too proud to ask their family to help or pay a few pound for a handyman to do things. I see it a lot in my work role. I had to insist a few weeks ago that a 78 year old with an already dodgy knee did not go up a step ladder. She insisted she would be fine if I held the ladder for her ! No way was I letting her do that I just did it for her, but this is how accidents happen, elderly people think they can still do what they did when they were 20 years younger.

Stop lying about the value of the spend. People aren't stupid.

Don't say things like, when a journalist complains about lack of beds, "well, there are chairs!"