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?

Pharmacist at Boots also told me that they now dont order meds until they know what they need beforehand.

DD worked at an independent pharmacy. She said staff from Boots often came round, asking to borrow common drugs like SSRIs, because they didn’t have them in stock. I don’t consider it an admirable business policy, to expect smaller independents to carry the cost of ordering drugs, storing them and paying for them, so Boots can borrow them?

When covid happened, I remember the number of panicked posts on here from very overweight posters, worried that if they caught the virus they could become very seriously ill. I mean, really? They’d been told about strokes and heart attacks etc for years and suddenly surprised covid would follow a similar pattern?

^Laughs in American healthcare
^
They pay through their nose for theirs yet they have one of the highest obesity rates in the world 🫠

It's almost as if your argument doesn't make sense

Er because it’s an additive risk? Surely that’s obvious. They’re allowed to be worried about it and try and take responsibility to reduce their risk (I know overweight people who then took up exercise after hearing of the risk).

Highlighting this comment by @BradfordGirl because it needs to be seen: The US is a clear example of how paying for healthcare has no impact on peoples personal responsibility. That is because the reasons for peoples lifestyle behaviour is complex and not as easily changed as the mantra of personal responsibility suggests. All that happens is that people die younger. The US has a much lower life expectancy than Britain.

Pay NHS staff more. We have to make the NHS more attractive to retain staff and reduce agency bills, especially in General Practice. There are no more GP's. It will take years to train more and the ones left cannot / will not work longer hours in the current situation. Pay well, and they are more likely to stay thus reducing agency costs.

Charge patients for non-attendance - reinvest into NHS.

Charge patients a with alcohol induced, drug induced injuries / medical issues a set fee.

Charge for meals in hospital.

Reduce the allowance criteria for free prescriptions.

Charge patients a with alcohol induced, drug induced injuries / medical issues a set fee.

How do we differentiate between those going too far on a night out and those battling addiction, which is an illness? Or do you not differentiate?

Charge patients a with alcohol induced, drug induced injuries / medical issues a set fee

This is a terrible idea, even when considered purely on practicalities.

These are people who are disproportionately likely to be chaotic and not pay, so the NHS would be left with the cost of billing, administering and chasing people for money they're not going to get back. They'd have to recruit people to do the work, which would pose all the usual problems that NHS admin recruitment is going through at the moment. There'd also have to be some method of scrutiny, judicial review if nothing else, so the NHS would also end up paying for involvement in that too when the more capable of the cohort who had been charged challenged it.

Its difficult isn't it? Perhaps a set fee for those that get wasted on a night out and end up passing out / taking up a room in A/E. Maybe a sharp, short shock of self responsibility in the form of a fine may even deter repeat offenders. It would be good if money from this could go into addiction services.

Or more likely just lead to deaths. People will not take their alcoholic relative to hospital who has passed out again.

@Lordofmyflies Charge people for food in hospital? Would just lead to some patients not eating the meals and surviving on cheap snacks like crisps. Which for some will delay their discharge.

Or, even worse from a purely costs angle, people who are under the influence or drugs or alcohol when they get injured don't die, but they wait until they become more critical and therefore expensive to treat. The larger the bill, the less likely a person is to be able to pay it obviously. The NHS therefore ends up on the hook for both the more expensive treatment caused by this policy and for trying to enforce a debt that the person may be simply unable to pay.

Charging pissed up people is one of those ideas that gets floated sometimes but quite obviously doesn't survive any degree of scrutiny.

MN The NHS is not a hotel
Also MN Charge people for food in hospital

What's clear from all this is that there isn't a quick fix or it would be fixed.
Unfortunately there is a misplaced sentimentality about the NHS with people treating it as something sacred. It is (or should be) a public service like Street lighting and tax collection. Tax funds public services so why don't we clap for tax collectors?
The NHS is a badly run anachronism and need totally overhauling and treating like the German system. Simply chucking money at it as all governents have done and continue to do -despite the predictable kneejerk sqwarks about 'the tories' is making it even worse.

In some hospitals the food is not much better than crisps, if you are lucky enough to actually get any.
(York Hospital I am looking at you.) The option to pay for nutritious food would be an improvement.

That is sad. The food in my local hospital is usually very good.

@JangolinaPitt Read the thread. There are a lot of knowledgeable people who recognise a major issue is social care. If you don't fix that, nothing will change.

This would only be a good idea if running admin for this kind of system was free. It's not!

Every patient that enters the NHS system is given a patient number. Can it be that difficult to allocate a 'fee' to a patient number payable on discharge or within 28 days? Private hospitals already use this system. Something has to change. People vastly underestimate the cost of healthcare and over estimate how far their NI contributions go.
Our A&E department now has 3 side rooms padded with gym mats for inebriated patients to recover in. The amount of time clerking, monitoring, cleaning up vomit and bodily fluids every night people who have had 'one too many' is ridiculous. Its like herding cats most nights rather than dealing with medical emergencies.

Private hospitals aren't usually using this system for people who are on drugs, for starters.

You don't get anywhere near a private hospital unless you have a policy and a paper trail. It's a condition of entry, whereas it isn't for an NHS facility. Private healthcare companies already have established, well resourced financial and administrative systems, as well as legal processes. So they already have both a clientele who can and do pay, insurance companies to chase and the systems in place to facilitate these things. That's why they're profitable. You don't graft that same system onto the NHS by doling out invoices to drunk homeless people who have about as much chance of paying them as they do of getting angels to fly out of their arseholes.

It's a completely unworkable idea.

There is already something similar in place which could be extended, being the internal "business" market. Different trusts already "charge" other trusts and the national funding body for the services they provide. It wouldn't be re-inventing the wheel to "add on" to that system direct patient charges. There's already a small army of pen pushers paying money to each other in the highly fragmented NHS system.

Provision to charge patients in the NHS already exists. It's just that it requires staff, doesn't come for free and in order to be profitable, needs to actually recoup all those costs and more. Given that some people who present at A and E for treatment while under the influence are homeless or otherwise transient, and therefore not going to pay, that's a considerable hurdle. This is even before we start considering how to administer the inevitable exemptions for people who've been the victims of a crime, which obviously is fairly common on nights out.

There was a young woman on the news recently who had been spiked on a night out and she felt as if they treated her like she was just drunk

What’s the moral of this story?

Save the NHS by not spiking drinks?

I think it's more their inconsiderate refusal to provide strobe lights and a DJ.