How would you fix the NHS?

[PinkFruitbat]

The Government is asking for ideas on how to fix the NHS.

https://change.nhs.uk/en-GB/

What would you do to fix it?

you should edit your OP to add add this is for NHS England only.

That's so interesting. I would map it so I knew what was delivered where and how - eg what's outsourced and what's in house and where the gaps were.
I think there should be a core offer of service like a and e, cancer, etc and we should have separate areas that join up - assessment and diagnosis flows to triage to ongoing treatment or not. Mental health should be revamped completely and clarity on pathways.

Focus on prevention, too many people are unwell due to lifestyle, this can be very complex at times so I would invest hugely in family support, education around health, access to early years services etc. It would take years to see any benefit from this but would make a significant difference in preventing people becoming unwell both physically and mentally. Much better joined up thinking between social services, health services, education etc

I also think that there should be hospitals just for the care of the elderly, sadly this group take up huge amounts of staff time, have long hospital stays etc if they had access to specialist services in dedicated hospitals it would make a significant difference to the way in which hospitals operate for other patients.

Better forms of discharging patients. How many people had surgery cancelled on the day due to no available beds? As they are being blocked by patients who are ready to go home at 10am and by the time their paperwork (sick note if required, letter to GP etc) and any medication, dressings etc gets given to them, its more like 5pm. My DM can tell you many times this has happened to her - both having surgery cancelled on the day and waiting for hours to able to go home.

When I had surgery on my eye, before the procedure, patients sat in a day care room which had a chair, hospital bed table and area partition curtains. A similar thing can be used for discharging patients. The bed can be freed up so less likely surgery is cancelled last minute.

We need to tighten access.

"Anyone in England can register with a GP surgery to access NHS services. It's free to register.
You do not need proof of address or immigration status, ID or an NHS number."

The above is from the UK Government website.

Millions of people with no access to public funding register and use the system.
Others use A&E for general health issues. Coughs, BP medication, lower back pain.

Change how government works, for instance a Dr as health secretary, teacher as education secretary etc.

Why is this in AIBU?

@Cornercandy this does exist but often patients don't want to move there and believe me I try. They want to have their breakfast/shower/sit around in hospital PJ's and have the lunch they ordered. I dread telling patients I need to move them to the discharge lounge.

A big overhaul of elderly care is what is needed, we get patients admitted as an emergency, treat them, but then they have other issues which means whilst they are medically ready to go home, they can't leave because they need OT/PT or package of care.

Patients need to take more responsibility too that includes all ages, we get younger people with preventable conditions admitted and elderly people who have taken no action to modify their life or living circumstances. We can't fix everything.

I agree that elderly social care should become a separate thing. Totally separate budget, policies, facilities etc. It would have to be carefully managed so as not to become a second class service and just a holding or dumping ground, but a parallel service. Ringfence the funding for this and the rest of the NHS separately and get the message across that the original concept of the NHS of cradle to grave is not feasible in the 21st Century with people living decades longer than in the post war years.

Focus on keeping people out of hospital and getting them back home (or other suitable place) when they are fit to leave. Acute hospitals will suddenly work much more efficiently.

Direct services with dedicated teams, so rather than A&E for a X-ray you go to dedicated area required to take an X-ray.

also and this was done during covid get it flowing. Sign in, get called in, checked, taken to X-ray, X-ray read there and then, treatment done, you leave. Not this whole wait 4 hours for X-ray, wait another hour minimum for it to be looked at. Just clogs up the waiting areas.

Self referral to certain clinics. Just like we no longer have to prove we are pregnant to book in with the midwife, I should be able to apply straight to the ent for say sudden loss of hearing not fight for a go appointment to then wait to be referred.

Bring back cottage type hospitals for those well enough to leave the bay but just needing a little rehab before going home.

No insurance if not entitled to free, no treatment and make sure people are asked to prove entitlement.

Fund social care. Return of rehabilitation hospitals. Provide enough jobs for the doctors and nurses we have trained (many are struggling to find work in this country, hence the flight abroad - while we employ staff from red list countries instead). Employ doctors not PAs (who cost more for less training). Would then need less locums.
More staff, more beds.

I would have a tougher stance on aggressive behaviour and non attendance.

As a health professional I am considering moving into private practice after 20 years in nhs, many colleagues are thinking the same, and it's not due to salaries (which are not the best but ok) but due to feeling I could use my skills better as more likely to be respected and listened to. I have lost count of the number of times patients have been rude, swearing, shouting at me, and I have had about enough of it.

We are loosing skilled staff from nhs either to private or abroad due to the working conditions, and you cannot run a good nhs without good staff.

Prevrntion - Get more people moving, more walking and cycling, get people out of cars , and less sedentary life styles

Social care needs to be sorted out. In Scotland we have joint health and social care partnerships which are designed to increase the links between council run social care and NHS run medical care. This works better in some places than others.

Bring back convalescent homes for those who no longer need full on medical care but aren't ready or able to be at home yet.

1. Have everyone in the UK read Ben Bikman's book, Why we get sick.
2. In every NHS waiting room have The Public Health Collaboration's Real Food Lifestyle Course playing on an endless loop. (https://www.youtube.com/playlist?list=PL1J9GrLlUYVJQ9LUWZjp05ShyAeat5Aw- )
3. We all start taking more responsibility for our own health, and the prevention of chronic disease.

To save the NHS and to put it bluntly, the entire western world from collapsing due to health costs, people need to learn or just remember that what we eat affects our health and lifestyle diseases are caused by our own actions.

People have learned that smoking has negative health outcomes, and we are working on accepting that drinking does too. I say working on because we all know that drinking is cultural phenomenon in the UK, and we can happily accept that drinking causes health problems, while chugging a pint or sipping a glass of something.

The next big thing is diet. We need to face the fact that the modern diet high in carbohydrates and processed foods causes ill health over the long term.

Check out the PHC for more information on steps you can take for your own health.
https://phcuk.org/

Agree about prevention better than cure. Sadly, I suspect Govts won't go for that, as they want quick results aka votewinmers

If I were in charge, I'd focus on social care, to release beds for new patients

And perhaps social prescribing

And perhaps throw shedloads of money at the system for a while, to clear waiting lists, get people back to work and prevent their conditions from worsening while they wait for treatment

You can't fix the NHS without fixing social care.

I'm a social worker. I was recently in a job working on hospital discharges. I've seen so much delay in discharge due to lack of social care provision, or when proole come back into hospital really quicky. This costs so much money.

I would have some kind of step down nurse led units where people could be looked after whilst robust social care arrangements are made.

More people should be prescribed weight loss drugs if they want them. Having an obese population and all the related health issues is costing a fortune so maybe we should start believing people who have been dieting for years and are unable to lose weight. Giving them medication to help get them to a healthier weight while also educating people on what a healthy diet is would probably help a lot of people.

I would also charge people for missed appointments. It seems to me that if people had to pay £10 if they didn’t turn up to a GP appointment then it might help aid their memory.

A and E should be for emergencies only and people should be turned away to more appropriate places for care.
GOs should be open longer and at weekends.
We should be looking at prevention in the community and what people eat, what exercise are people doing. There should be personal responsibility for our health and that starts with many loosing weight, and not eating processed food

Scotland so some differences but the same

Reintroduce prescription charges

NHS administration is stuck in past - still very paper and post oriented. Wastes so much time.

Charge for missed appointments.

Put GPs onto salaries (instead of self employed) and that way they can be required to work evenings and weekends

They should reopen the walk in centres for minor injuries to save people having to go to A and E. There are none now near us.

In hospitals, I would bring back matrons and proper uniforms. The amount of times I have been visiting a relative and not known who the hell I'm talking to, when I need to see a member of staff, aggravates me.
A firmer approach to DNAs at doctors surgeries. I rang every morning, at 8am , desperate to see a doctor for something that definitely needed treating. All I got was a message saying that the lines were full, not even telling me to ring back later!
When I eventually got an appointment, two weeks later, I sat in an empty waiting room, staring at a screen telling me there were 438 missed appointments the previous month!!! You can bet that a lot of those were serial offenders. I accept that there are genuine times that people suddenly can't attend, but the majority of them clearly aren't ringing to cancel, as those appointments could have been offered to other people.
To me, it should be 3 strikes and you're out!
It's a massive abuse of the NHS system.

It needs to stop wasting money hand over fist, I run a small business and supply the NHS - the amount of waste I see, in terms of disposal of perfectly good, serviceable equipment and spending money for the sake of it is amazing. I recently pointed out a £16K piece of equipment that was being scrapped and replaced with an identical unit, needed only a part that cost under £3, in that case they had the work done, but its rife.

As an example, another supplier I know was asked to provide £25K of sanitary fixtures, to which they said, well yeah, but what, basins, toilets, what do you need. The purchaser didn't need anything, just needed to bin off the final £25k of a budget in a period. - so they had a delivery of stuff they didn't need and wouldn't use.

Better technology, it's outdated, clunky and wastes so much staff time. There has been a huge push to paperless, but the systems they gave us were done cheaply and are slow. Before I left I felt like most of my time was spent inputting information into a computer instead of nursing.
Dedicated discharge coordinators. Nurses shouldn't be spending hours on phones trying to sort this out.
Better procurement.
Remove internal markets within hospitals.
Convalescent and rehab hospitals. These could be nurse led.
Remove government interference. Every time a political party got into power they implemented reforms based on their political beliefs that cost millions and made no real difference.
Better GP access. Treating people early before conditions become chronic.