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?

My son just had an asthma attack. He's been blue lighted to a&e twice and admitted previously. I work at our Trust, and know how horrific a&e is right now.

After the second admission, I bought a sats machine so I could monitor his oxygen levels as i was so blindsided by how low they had become without me noticing, and I asked for emergency steroids to keep at home.

My son just now has had 10 puffs of his inhaler, and is still struggling a little. However because I have the sats monitor I can see his sats have come up to 96 from 90. He'll keep taking puffs until they're at 98 at least.
I feel comforted we have the steroids if needed.
Previously in the same circumstances he may have gone to a&e because his asthma plan would have signposted us there after 10 puffs, and I would not have the sats info to inform me of their improvement.

From my experience at work, the pp who said investment, status and effort needs to go into social care and care plans is absolutely spot on.
In addition, tax breaks for all adults in a household where there are older relatives (whether in need of 'care' or not), additional funding if care is involved (even if employed), Ad campaigns to promote benefits of multi generational living on loneliness/ mh / benefits on children having older relatives around when they get in from school.
Better than living wage for carers, proper respected qualifications and status to be a carer, better training.

This is all long term though. Short term we need to get working visas sorted ASAP for all the vacant posts in nhs.

In the dept I work in a third of our posts are unfilled.

I would like to see proper MH help given to people who are taking some initiative to change their lifestyles if they are a risk factor to their health, but are having issues because of their poor MH

Having spent 10 hours in A&E over the festive period, being treated and then referred on, I sat and watched such time wasting use of the resources it's quite depressing

Add to that the bed blocking for various social care reasons and hospitals are locked in.

Part of the problem is that we don't really have any control over our population growth. Aside from ever longer lifespans, immigration has soared in the past few years and we can't really seem to stop it.

Like what though? MH issues seem almost endemic now to the point where even if we had unlimited cash I’m not sure there are enough qualified psychologists or MH practitioners to provide the level of service required. It’s also a bit chicken and egg - many people will be depressed because they’re in shit health and filling their bodies with rubbish, but think it’s the other way round.

There's no short term remedy because there's not enough doctors and nurses. The government claim there's thousands more FTE GPs than in 2019 but a Guardian article from earlier this year says the numbers have dropped every year since 2015. (Government also brags about moe medical school places, but neglects to mention that Tories earlier cut them!) You can't have 24/7 GP services without GPs. British GPs have patient loads far higher than anywhere else because the British solution has been to force GP surgeries to accept patients rather than leave patients without a GP as happens elsewhere. So you have a GP on paper but can never see them. The only possibility is importing doctors from abroad.

All the lifestyle changes mentioned are actually very difficult to implement (especially weight) and would take a long time to pay off. They won't solve anything in the short term.

Defunding contraception would be the classic cutting off one's nose. Contraception is one of the most cost effective services. Pregnancy and childbirth are much more expensive.

We somehow need to make hospitals easier places to work. It’s a nightmare being a HCP at the moment.

More admin staff would help.
More health care assistants would help.

In my darker days I think that nursing home patients who are incontinent / bedbound / need full care should not be treated other than to prevent pain/ distress.

No hospital admissions/ IV fluids/ Antibiotics/ blood tests / ECGs etc. Simply GP reviews and pain relief good nursing care .

If the country stopped paying for every old frail person to be kept going til they are in their 90s we might have better health care for younger people.

My elderly aunt has been ambulanced into a/e from her care home. Turns out she has a urinary tract infection. She is still there in admissions suite - Consultant hasn't been back to see her since admission. That's a bed blocked for 2 day so far. When in the past a GP would have been called out and no admission needed. Once in a care home GPs don't seem to want anything to do wiht patients, a district nurse would have helped but they are the same.

I doubt the public
would agree to a lockdown now the issues surrounding the last one have come to light - MH issues etc

If the country stopped paying for every old frail person to be kept going til they are in their 90s we might have better health care for younger people.

My grandmother is in her early 90s and still completely sound of mind. Still cooks, goes shopping, etc. Has always led a healthy lifestyle and never been overweight in her entire life.

By contrast, I look at some of the unrepentant fatties that comprise our young and don't really feel they should be automatically prioritised based on their age.

Obviously, keeping a barely sentient person alive with expensive treatments doesn't seem a great use of resources, but where do you draw the line? If somebody is experiencing lots of health problems at a young age you could also argue that we just nip it in the bud rather than allow a whole life of expensive treatments. Unlike most elderly people they may not ever pay into the system if they're too fat/ill to work.

The public need to take some responsibility for only using emergency services if it’s a genuine emergency. I’ve been to A&E a handful of times over the last decade, with acute pancreatitis. That’s a medical emergency and can kill you, and is also extremely painful so needs urgent medical treatment. I’ve always been triaged within 30 mins of arriving in A&E and am never sent back to wait in the waiting room to see a doctor as I’m genuinely too sick by the time I get to A&E and it’s obvious to any triage nurse. In those 30 mins waiting each time I’ve witnessed people coming to the reception to tell them why they are there. At my local hospital they have an out of hours doctors there too, nearly everyone was told to go there instead, very few got told to sit down and wait for triage. I don’t know why someone would turn up at A&E with a bad cough for example, call 111. There’s so many services now where you can get an out of hrs GP if needed quite quickly there’s no need to go to A&E at all. The clue is in the title, accidents and emergencies. Not run of the mill medical issues

‘Immediately increase the amount councils are willing to pay for care packages, care home beds and carers wages. As soon as we can help more patients that are well enough to leave hospital with a decent care package we can free up beds in hospitals to allow patients to flow out of a&e and ambulances.

It won't fix everything, acute beds are limited by lack of nurses and clinical staff to safely care for patients but it would give a bit of relief.

Care workers pay is awful, it's a really hard job and horribly under valued, recruitment and retention is dreadful because of that. Make it more desirable and you help the health service almost immediately.’

Very much this.

This has been flagged up so often at Govt. level so often & yet nothing has changed. The employment & operational framework for care workers is corrupted by low wages, poor training, under rated skills, career progression, bad management of resources & institutional indifference.

The call to improve care worker recruitment & retention goes ignored.

This is a critical step improvement that the NHS needs, but fit-for-purpose social care does not have the political & cultural imperative of the NHS.

Who stood on their doorstep clapping for the care workers who kept things going during the Covid crisis?

Are care workers unionised to withdraw their labour to increase their pay & conditions, highlight how essential their work is, how broken the system is & the risk to vulnerable people’s safety?

Sorry but I agree with this and I've done an advanced directive. For some reason we seem determined to keep people going past any kind of quality of life. Smoking and heart attacks tend to kill quickly , dementia which is projected to become the number one cause of death takes years to die from! Dysphagia assessments, treatments , weight management , artificial hydration , all the equipment , antibiotics, double up care, turns. The costs mount up yet relatives howl if the medics discuss a DNR or stopping treatment.

It's going utterly humane the last few weeks I've had to watch someone progressively waste away until they look like they were in auswitchz it's fucking horrendous and we wouldn't put pets through it. The taboo around dying needs to go , people should want a good death. The public need to discuss it there should be adverts on TV. Who cares if people intially get upset this cannot go on , I also want the public educated on what CPR actually means and why putting a frail person through it is cruel as hell!

Exactly what I’ve just posted. It’s actually unbelievable what people go to A&E for. Most of those things I’d debate if I even needed to see a GP let alone go to A&E

Flow in and out of hospitals needs to be restored.
social care needs to improve and accommodate the medically fit patients, freeing beds for sick patients.
I have no idea how this could be achieved ☹️
better pay and conditions for NHS/ambulance/ care workers to encourage recruitment.
better access to GP/minor injuries/walk ins
Mask wearing to drive down infection rates.

Yes new year new health. Let's get exercising,

This.

Staff need to see that something will change, and that something is enough staff.

It's only the start. But it is the start. This isn't greedy unions like the govt have tried to make out. It's absolutely desperate staff who know that unless their wage is viable a horrific situation will only get worse.

Ffs educate yourself putting a young healthy fit adult through CPR is a massive strain and outside of hospital setting is very very unlikely to work. The chances of a 75+ year old surviving and regaining a good quality of life no brain damage , 100 percent mobility is very very low. I do not want CPR when I become elderly because I've seen it and it's fucking brutal. You want your nan having her ribs broken and assaulted instead of being comforted in their final moments? Is that kind?

The biggest issue is the absolute entitlement and inability to self care by the general public. The numbers who come in within hours of an episode of vomiting or they’ve coughed over the last day and think there’s a magic cure is worrying.

Yup, the doctors in my family (there are several) say that the level of ignorance and lack of ability for sensible self-care in looking after their health is shocking.

But we see it every single day here on MN. Ludicrous fears which are called ”health anxiety” and people’s lack of common sense pathologists as “anxiety” and medicalised. Lack of ability to think rationally: anxiety about what, exactly? Anxiety is often a consequence of ignorance and sometimes that ignorance is wilful. There’s an awful lot of learned and deliberate helplessness.

Brilliany summary, expressed exactly what I have been saying for years. The NHS isxa victim of its own sucess.
Within 2 years of it being launched, the LABOUR govt realised it was too expensive and introduced prescription and dental charges.
People stopped taking responsibility for their own health as the NHS became better at keeping people alive - we have more overweight/obese folk than at any other time in history, pre-term babies are kept alive, many of whom have life-long health issues, older people live longer, and cancer, and many otherpotentiall life limiting conditions are managed. Basically, people are not dying, but then again, people think the NHS should be managing all their ills, so don't care; won't diet because they wantca gastric band, won't worry about being fat and/or getting T2DM because the NHS will take care of it
And then there's thecabuse of staff by those who believe they are their personal servants..
This is not about money solely - it's about our selfish attitude to life

Increase hospice beds and reopen ‘rehabilitation’ wards, which can be staffed by HCA’s, for those needing social care/assessment.

So how do you explain the health problems in the US then?

Because they don't have a National Health service and their population isn't exactly a shining example of self control and health management.

Tory bullshit.

That was to @EnyoClytemnestra

I think we need to increase social care support to get patients ready for discharge but needing extra support at home out from hospital beds. When my Dad lived in Bolton, he had 2 stays in a great rehabilitation centre after having amputations due to type 2 diabetes. My Mum was in hospital last year & spent an extra 2 weeks in hospital whilst a care package was put into place (even with family support post hospital stay). We’re in the south east.

On type 2 diabetes (which I also have), I’ve seen the plethora of hospital stays for my Dad after he refused to take the illness seriously. I was chatting to a guy whilst taking my Mum for a Covid booster at the weekend. He was also a type 2 diabetic, and professed he “could eat & drink anything he wanted because (he’s) on Metformin.” That’s not how type 2 management works!

Judging by attitudes from the post war generation like this guy & my Dad (and wards full of older guys who were having amputations & were shouting about not being able to eat what they wanted during dad’s multitude of stays) putting faith in a pill so they could continue their normal lifestyles absolutely doesn’t work.

As soon as I was diagnosed I bought a glucose monitor (not given to type 2s unless you need insulin support) & took further control of my already good diet & exercise to bring my illness into check. Maybe being diagnosed with diabetes exactly a month after Dad died with diabetes as a cause of death, and with him being the poster child of how not to manage type 2 was a huge, unfortunate advantage, but by my first 3 month’s HbA1c my levels had gone from 78 - 58 mmol/mol. I pay around £20 a month for test strips/lancets, perhaps having a scheme where test kit is given to type 2s so they can monitor themselves would help.

Metformin is brilliant, but type 2 isn’t a “take the pill & keep eating shite” kinda illness!

We have to take responsibility for our health beyond the pills & potions we are prescribed.

We must acknowledge that the ‘Boomer’ bulge generation has been marching towards hitting the elderly category since 1945. My folks, born in 1946, both hit 75 a couple of years ago. During both of my folks various hospital stays, especially Mum’s stay on Sept/ Oct last year, every person in the packed A&E beds were elderly. She then had to wait for over a week in AAU for a bed in a gerontology ward.

Statistically, there is a population bulge in that age group that universal healthcare has helped preserve, but the closing of hospitals (2 in our Trust & the remaining A&E unable to expand due to restrictions on buildable space on site) has only compounded pressure for beds, especially now the 1945-64 generation are hitting ages where NHS intervention is more likely. A new Urgent Care & outpatient hospital built on a site of a now demolished full A&E equipped inpatient hospital with 500+ beds was simply a ridiculous decision.

But no, they sold the land for a couple of hundred or so housing units, and a care home, which have increased local population, while the hospital beds have depleted by a factor of 500+; it doesn’t make sense, does it?

I’m also an advocate of learning basic first aid. Know how to deal with simple accidents, know how & where to go to get the correct treatment & what you can treat safely at home.

We all must take responsibility for our physical health, and not think the NHS is there to deal with simple illnesses we can treat at home or basic accidents, especially as the service is under such huge pressure today.

We also need to get away from treating nursing & healthcare as a caring vocation, because friends in the service say management take the piss as they rely on their medical staff having a ‘calling to help people’ to guilt staff into taking extra shifts, leaving hours after shifts finish & even covering double shifts dumped on them when they arrive for the day because heck, you’ve trained because you want to help people & patient care will suffer due to under staffing. It’s madness if this happened in other professions (although as an ex teacher, that’s another job where they get out the emotional blackmail out to guilt you into extra responsibilities & hours of work if staffing levels are tight).

Med staff have just come off of a 2 year pandemic (which is still fuelling admissions this winter) where they’ve seen colleagues get sick & die, seeing people of all ages dying, using poor PPE that now we see Tory cronies made millions out of. Talk about a kick in the bollocks when inflation is running at a 40 year high & their wages mean they have to supplement their income with food banks & universal credit.

I have no solutions, but right now, it’s fucked.

I can only really speak from my own perspective. I have CPTSD, BPD, Depression,GAD, Health anxiety and OCD. My mental health has never been treated properly.
I've used food to deal with my MH issues, the medication and shorter courses of therapy do not help.
I've paid for as much treatment as I can privately- including bariatric surgery, lifestyle coaches, and therapy from counsellors.
Without the right targeted therapy my efforts are like pissing in the wind.

I've been begging for a referral from my GP for help for my eating disorder for about 4 years. A psychologist who works for the eating disorders service triaged me, and wrote to my GP asking for them to refer me, in October of 2021- 3 weeks ago that referral was finally acted on.

Since the initial letter from psychologist to my GP, I have put on 3 stone, and am sick upto 4 times a day that I've binged to the point I throw up...but still, I am not the 24 stone I was prior to surgery.

I do believe that people need to take some responsibility, which is why I didn't try to get help with surgery from the NHS, also why I paid for counsellors and a lifestyle coach, who guided me through exercise, nutrition and hunger management for long periods of time before I asked for help.

I do agree that mental health seems better when eating nutritious, non crap food, and exercising- but is that because my MH was good enough to manage to take care of myself in the first place?
I am guilty of not realising I had a problem with food before it was so ingrained, and not seeking out professional help of some sort 10 years ago..