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'd love to give more money to the NHS but have fuck all left over each month as it is. I had a ruptured aneurysm 3 months ago at the age of 31! Very unlucky as it was down to the structures of my blood vessels, which both my grandmother and great grandmother also have (my mother is getting scanned/tested tomorrow). I'm lucky to be here. It was discovered in ambulatory care, after being sent home from a busy A&E and told to return the next day.
I am so grateful to the doctor who needed to just make sure it was a migraine and ordered another test.
All the people saying pay for this and pay for that already forget its already costing people fortunes getting to and from hospitals. It's not like people WANT to be there. I had to borrow money when I had surgery for my week in hospital. My DH couldn't visit daily. My kids weren't allowed on a neuroward. People aren't chosing to become ill.
The way some posters are talking, it's like all the illness and accidents are deliberate so you should pay. What happens when we can't? We just die? Get insurance like America?

Increase payment for care costs so carers are paid more. People stuck in hospital is causing major issues.

I refused a discharge of my mum until the next day because it was not safe. The hospitals are quick to chuck people out. My mum would have been alone and could not manage safely getting to the toilet or preparing food alone, but I could be with her the next day. The nurse was not happy but I am fucked if I am going to agree to a safe discharge.

To tackle this in the short term, they need to sort out beds in adult social care or care in the home and sort out the staffing crisis by giving a decent pay deal quickly. Even if they offered a one off lump sum now and kept negotiating the rest of the payrise, that will help.

Have a temporary adjustment of shift patterns for carers and a massive increase in wages to encourage experienced staff back. Speak to local authorities who will know where local beds are and which homes have capacity. And pay accordingly. For people who could go back to their homes, that’s where you need care in the community.

this won’t be solved by central government dictating- they don’t have the knowledge. It’ll be done by using local authorities to help the adult social care side. It’s always money that’s the answer for most of this. Because there hasn’t been enough money for years, it has made it worse. Reforms avoid the actual problems.

Rates of illness need to come down quickly. Encourage masks usage (I don’t think we need a mandate as enough people would do it voluntarily anyway), remind the importance of ventilation. All the hand washing stuff is bollocks against covid/flu. And have another push for vaccinations.

They’re spending money by being fucking racist and ignorant when it comes to immigration. Holding up the process and not putting through claims quickly as they waste time assuming every person is on the scrounge when most are not!

If claims were processed quickly, then we could welcome people in to do the jobs that need doing and send back the ones that don’t have a claim.

Suspicion and incompetence towards asylum seekers costs money.

And give money to councils to sort out adaptations and work with elderly people to stop them going into hospital. Councils used to do this more. I know when a friend needed a hospital bed at home and a commode it was delivered very quickly. Now there are delays. And there are longer waiting lists for peoples homes to be assessed to stop issues developing such as falls. Some simply grab rails in the right places can stop people falling and ending up in hospital.

The government is totally penny pinching and ends up spending more money in the end by cutting these services.

One thing that would take pressure off the NHS immediately is elderly patients being discharged into the care of family.

I don't see any racism. I see zero houses , a full and broken Nhs and education on it's hands and knees begging for help.
The money is available but its being spent wrong.

Look after our elderly and neighbours.
Our culture is shameful for this.

@TooBigForMyBoots How will that happen?
Do you mean family are told to take them into their house without any adaptations or carers and manage however they can?

It is. But we also have a culture where women are having children later and often by the time elderly relatives are getting ill, they still have dependent children at home and are working a job. There is often no one at home. And no financial leeway to quit work.

We need more doctor surgeries or walk-in centres as well as more nurses and doctors. (They also need an increase in wages to stop them going to agencies)

Maybe have NHS open days at schools where they show school children what the NHS do and the different jobs. Also free courses for NHS staff with financial support. I really wanted to go back to university (I have a useless degree in criminology) but can't afford the fees. I really want to become a midwife but can't afford to leave my waitressing job to do it as I have a child.

I agree with MrsNoodles55; a nominal charge, as is levied in many European countries, including the one I'm from. I love the NHS being free at the point of access -hell, I love the NHS, full stop. But people take advantage, or assume entitlement. Anyone eligible to pay for prescriptions could also pay £12 for a GP appointment, or a trip to A&E. In the country which I'm from, transportation to A&E in an ambulance costs a flat rate of £15, and eligible hospital inpatients also pay a fee of £10 / night on a ward. I honestly don't think it's unreasonable.

Breathalyse visitors to A&E; if intoxicated, they could pay for treatment of injuries reasonably thought to be related to consumption of alcohol (or drugs).

Perhaps triage could also filter according to an 'eligibility bar'; "Fine, we'll treat your tiny injury from last week (to paraphrase a PP), but as it doesn't meet threshold for A&E admission, you will need to pay for it. That'll be £60 for my time and this plaster, please." I think people do know when they're taking the piss, and knowing their splinter or boil will be vetted by a hardass triage nurse with a card reader and a list of eligible ailments, would definitely deter chancers.

From ValK's shocking list, I must admit that I agree that Prep should not be paid for on the NHS, although I suspect that were it not available, many of the risky behaviours would still persist, and the cost of funding life-long antiretroviral therapy would be even higher. Which is probably why it's available on the NHS.

A nominal charge would make things worse. People paying will not be happy with a quick 3 minute GP appointment and will demand their monies worth. Money will have to be spent collecting this money. And if people do not pay do you just refuse them healthcare?
Others will not pay and by the time they turn up in A and E will have worse issues that could have been treated more quickly earlier. That is what happened after the pandemic. The patients immediately after were largely sicker and cost more to treat.

Yes. This is the only thing that would have an immediate impact.

A lot of the so called piss taking at A and E is by people with mental health problems or dementia not getting the care they need. Sort that part out.

Sadly the only thing which can be done to reduce pressure on the nhs is to stop elective surgeries, which we really don’t want to happen.

Getting rid of the Tories would give a morale boost.

Its elderly British people with a massive lack of adequate social care driving these issues. The ICU I work on currently has zero beds to admit into as we can’t get our ward fit patients to the ward as the wards are all above capacity and full of patients waiting on care homes / POCs. If a patient has a cardiac arrest on a ward we have to swap one of ours into the bed they vacate, thus delaying that patients ICU care. Us having no beds it’s causing issues in A&E Resus and all contributing to the ambulances piling up. We have 70% icu patients and 30% delayed ward fit, and even with the hospital management being told we are closed they can’t find our ward fit patients beds. I know this is the case all over the country too. Because of how overloaded A&E is bed managers are pushing softer and softer icu admissions too, so it’s very hostile as ICU consultants have (when we still had one bed) had to be very clear that we can’t take any patient below Level 3. Opening up winter wards, day units overnight etc just means wards that at best run with 2 nurses to 30-40 patients will run with 0-1. The safety and life of patients on these wards cannot be guaranteed.

To be clear I think plenty of more active ward patients are discharging themselves and pushing to get out sooner as things are dire / they are trying to help. It is a crisis of social care .

In my trust we need 2500 social care beds, and enough nursing staff and care staff etc for these . That’s the only thing that would clear the back log.

And if families refused? Do you just drop people back to their homes knowing they can't get their own food and hope families will not leave them to starve?

@Agsiajva Glad you commented. From the other side this is the major issue I see as well. Even getting a hospital bed and a commode delivered for my mum took well over a week.

Immediately a "national emergency" needs to be declared.

GP practices need to become 24/7. Even if it costs eye watering money to pay agency. People need to be able to see and speak to GP's in a timely manner.

Triage nurses need to be able to send people away from a and e without worry about their jobs. If you've rocked up to a and e with a boil or a cough you've had for 2 weeks. Leave and contact the 24/7 GP service.

All Pharmacists need the ability to be able to dispense more options, from broad spectrum antibiotics for UTI's infected cuts, bacterial tonsillitis, strep A and so on.

Social Care and LA's must immediately reveive increased funding. So they can top up on care fees and speed up discharge of well patients. Unfortunately also selection of care provider needs to go. I'm very sorry if the only available bed in a suitable care home is 20miles away, but it's a bed with appropriate care. A transfer can be arranged by social care once discharged.

It’s an incredibly sad situation all round. Peoples relatives have been having to bring patients to a&e who’ve had strokes, heart attacks etc by car. It’s an absolute humanitarian crisis. Me and my colleagues are absolutely sickened and saddened by it on the daily.

From another West Yorkshire girl 🙂 (although many years since I lived there).

Could you say that again in English, please?

@MoscowMules A suitable care bed is not about one not being near, people are discharged all the time to temporary arrangements. But often about one being available that will take someone will that level of need. So if someone has dementia, then only a nursing home will take them, not a residential home. There is a severe shortage of places with some homes refusing to take on any new residents even though they have rooms, because they can not get the staff.

I wasn't suggesting that people be discharged to be alone. They would be discharged into the care of their adult children/ NoK.

What sort of person would leave their grandparent, parent, spouse or sibling to starve?