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?

@Kendodd for junior fellow jobs (doctors not in training) there can be 400+ applicants. But only 3 are eligible as don't need a visa. But staff still have to go through all applicants which they don't have time for. So jobs close within 24 hours of opening.

https://www.reddit.com/r/doctorsUK/comments/1g8wp10/anewlyqualifieddgpwassforcedtoosignonnfor/

We as an NHS department will always use a UK candidate (UK citizen or has leave to remain) over a candidate who needs a visa, as we have to pay for the visa out of our staffing budget. But in 4 rounds of interviews recently, the only candidate who had the required skills and experience was from abroad, so we had to go with them to fill a post which had been vacant for 8 months. On previous vacancies we had a similar experience. Recruiting from abroad is expensive and time-consuming, so it's never our first choice.

My parents are in their mid 70s and I know/knew people who are 15-20 years YOUNGER who have worse health than them. Combination of self infliction (excess smoking and alcohol), illness and accidents.

Then looking back at relatives that died, some of them were younger than my parents now. DM was talking about a great aunt and she realised that my GA was 4 years younger than my DM when she passed

For training posts though the recruitment is central. Not sure what your job was but must have been quite specialised.

And doctors from anywhere in the world can apply on equal footing for ALL jobs. Even for F1 posts out of Uni. That's why 1,000 5th years didn't have a job straight away this year - some only got one 2 weeks before starting, on the other side of the country.

There is an apprenticeship route to nursing, physio, OT and various other non medical health professions. These are usually health care assistants, physio assistants etc already employed through the nhs. They need a route where they get a varied learning experience across different specialities, age groups etc, so wouldn't work in a care home.
From my experience these candidates are often the best, their course funding doesn't get agreed until they have proved themself as compassionate, organised, a good communicator, team player etc, so they thoroughly earn their place.
I did my training straight out of uni, and I think with hindsight I didn't have enough life experience to really support my patients in a holistic way. I'm excellent at my job now, but looking back I was probably not always as compassionate as I should have been as I did the 'book learning' before the 'patient learning', and patients don't always fit the textbook.

You ve got that now, my DD worked with many Carers/HCA's who have gone onto apprenticeships.

The problem is they don't stay, until retention is addressed and that often means how we, the public, interact with the staff, then nothing will change.

ie pp who cannot see how her being threatened with Police action by nhs staff, is in anyway wrong on her part.

Agree @Bushmillsbabe my DD did care work throughout her Uni degree, set herself up for working the NHS but she left anyway, mainly because of the way management treat NHS front line.

Yet asthmatics in England not claiming any form of benefits to qualify for free prescriptions pay. Yet 3 people a day die of asthma attacks and related issues. Since covid, that has gone up to 3.5-4 people a day.

All asthmatics above should get a prepaid certificate as its around £11.30 a month for 10 months of the year . Know asthmatics who take 3-4 daily meds for their asthma. If they didn't have the prepaid certificate, they would be about £500 out of pocket. Based on 52 asthma medications plus a few more such as one off things like antibiotics and other meds they take regularly.

I think it should be compulsory for health professionals to work for a year in the nhs in a supporting role - porter, health care assistants, admin - anything with patient contact, to fully understand that this is really what they want to do, that they have the 'soft skills' to be good at their job.
Yes, it's important to have a certain level of intelligence, but what separates an OK health professional from a great one is their soul.

I agree we should be allowed to but more paracetamol as this is half the problem with it that we can buy but two boxes at a time

You can buy more if you ask the pharmacist and answer a few questions.

Think ourselves lucky! Most countries do not sell paracetamols in their supermarkets and other places. You have to visit a pharmacy and some question why you want them. A friend ran out of paracetamols whilst on holiday and was charged €2 for a box and that was in Italy,

I have family that live in France and when they visit here, they buy about 30 boxes of the 40p ones in supermarkets.

You cannot be stopped doing a "paracetamol crawl" - similar fashion to a pub crawl, you go to every shop in your area and buy 2 boxes. Done that many times when full of cold.

Can I apologise to @PinkFruitbat that some silly woman is derailing her really quite fascinating thread by her endless jibes at me? And this, @Bushmillsbabe exactly this. You can't teach this. I was called a 'people person' only last week by my boss, and you've either got it or you haven't. You need to be able to get what's actually going on with the people you're dealing with immediately and not just go by what's on a piece of paper in front of you. There's so much variation in the way human beings handle a situation and healthcare professionals need to a, be able to handle that and b, understand that sometimes what they offer falls short through circumstance and they literally have a duty of candour at all times. Many would be a lot better at what they do if they actually understood people.

I disagree to an extent, I think you can learn how to be better with patients, I know I have definitely learnt over the years, and that becoming a mum has made me better at supporting families I work with as I understand better how hard it is to be a parent. But you have to be prepared to learn, admit what you dont know and seek training or support, and actually acknowledge when you haven't got things quite right, not for blame, but for learning and to try to make things better. I say sorry to a patient several times a day, as the nhs isn't perfect, and I'm not perfect, and we are all human and make mistakes, but I think just acknowledging that makes people feel heard.

Ah, now I will agree about being a mum helping you understand families, I found similar as a teacher. But I do think you've either got the personality to deal with scared stressed people or you haven't. And if you haven't, then the NHS may not be the place for you just like education isn't if you can't deal with children and young people. You'd be amazed at how many very clever people left teaching becauase they didn't like kids! You can't change your instinctive behaviour and personality in my opinion.

Clearer pathways to treatment and joined up thinking.

I have Fibromyalgia and CFS. When I first went to the GP, she advised it sounded as if I had Fibro and referred me to Rheumatology on the off chance that the pains in my legs were arthritis and to the Chronic Pain Clinic to manage my (awful) pain levels. Pain Clinic wouldn't even accept me onto their list until Rheumatology signed me off. Waited 18 months just for a first apt, two years until they signed me off from their services (confirming Fibro and CFS). For six months every random GP I saw (didn't actually see them, it's all phone apts now) "kept forgetting" to re-refer me to the Pain Clinic. Finally got an apt through for Dec 2025!! Thats four and a half years after I first went to the GP with indescribable pains in my legs and worse fatigue than someone with newborn twins with colic!

I can't work, I can barely walk, my pain is not managed by Pregabalin, Gabapentin, Duloxetine or Amitriptyline which are the only medication GP's can prescribe without input from the Pain Clinic (none of the above are actual painkillers, two are anti-depressants and two are anti seizure meds prescribed off brand for Fibro).

My son was under CAMHS as a younger teen. Refused to work with Adult Services when he was transferred over because of his experiences with CAMHS. Was told that because of his diagnosis he would have access to the BPD pathway when he chose to engage. For the last YEAR he's been trying to access help. GP says there is nothing they can do and no other medication alternatives - these have to be prescribed by AMH Services. AMH Services won't see him (has multiple diagnosis and is therefore not an "easy fix") as he doesn't fit any of their narrow criteria pathways (despite still having BPD) and keep sending him back to the GP. GP shrugs shoulders and re-refers to AMH - who then send him back to the GP. He just wants help to manage his worsening OCD and Agoraphobia. OCD team won't see him because her has BPD, BPD Team won't see him because he has ASD, ASD Team won't see him because he has OCD and BPD. It's fucking ridiculous.

I hope you're all sharing this here, below. Because the government will not be reading this thread!

change.nhs.uk/en-GB

Allthecatseverywhereallatonce, correct. People need to take responsibility for their poor lifestyle choices instead of expecting the NHS to treat their myriad of preventable diseases and co morbidities. The NHS wasn't set up for self indulgent patients but to treat genuinely ill and disadvantaged people.

We need to accept that the tiny number of people who do not have access to a mobile or a PC today do not justify the pen/paper/post appointment and booking systems we continue to use.

We ought to be able to book AND CANCEL appointments directly online, reminders should be texted to us, and links to 'what you need to do prior to your appointment' sites. And fines for non attendance. People would soon be nudged to not DNA, especially if there is proof you received or made your appointment.

GPs need to be put on the NHS payroll.

Every item should have a price tag on it so people, including staff, know that they just poured £125 of drug down the sink because they drew it all up before the patient arrived, who then DNA'ed.

Robust recruitment drives, maybe 2 year diploma courses for very specific skill-sets, but with the upholding of pay. We moved to degrees as the only way to attain 'professional' status and pay.

We need to stop hiring sometimes dubiously trained 3rd world staff.

And the biggie, the NHS, and education, need separating out from the government of the day, to remove the 'quick fix', on repeat- cycle with every change of political party.

One of my colleagues is from New Zealand and apparently if you are in hospital there over a certain amount of days they have to pay a small amount per day to cover the cost off their meals, electricity etc. I’m sure there’d be uproar here if that was suggested but if people were at home they’d have to buy their food etc so I’m not sure why it would be so awful.

I live in New Zealand and it's the first I've heard of it! My mother was in the rehabilitation ward of our local hospital for nine weeks, after breaking her hip, and never paid a cent.

I can't work, I can barely walk, my pain is not managed by Pregabalin, Gabapentin, Duloxetine or Amitriptyline which are the only medication GP's can prescribe without input from the Pain Clinic (none of the above are actual painkillers, two are anti-depressants and two are anti seizure meds prescribed off brand for Fibro).

This sound horrendous and I mean this kindly, but what do you think the hospital pain team are going to be able to add to this ? Your pain clearly isn't responding to most of the meds they would use. Opiate based drugs are likely to be a disaster. You almost certainly woukd benefit from some gentle exercise such as chair yoga or pilates, swimming or physiotherapy. I am concerned you are waiting for a magic bullet that just doesn't exist.

Another one - make the blood test, urine results to be seen by all doctors. I have heard of people having a routine blood test at their GPs then a couple of weeks later, at hospital, they want more blood tests and most of them are the same things that got tested on two weeks ago.

If just one or two more things need to be tested, just do a blood test on those. Especially if the other factors remain fairly constant. It would be cheaper and probably quicker to test one or two more things than the whole rigmarole each time.

Absolutely this.

GP appointments should be charged for.

A& E triage should send away anyone that does not need that level of medical intervention.

I think we need a state insurance system.

I also think health checks, MOTs , weigh in, liver check.

All these people that are sedentary with poor diets, taking a myriad of medication to counteract it is the problem.

We need a huge public health overhaul. Normalise exercise. Our activity levels in the UK are appalling.

Childrens diets are laughably bad. People feed children with growing bod8es are brains nuggets, waffles and beans for dinner. It's incomprehensible. People genuinely believe you can't feed children whatever the adults are having.

We need people to look after themselves and also use health services properly. You don't need a GP every time you have a cold. My mother in law Co stably wants my baby to "get antibiotics " every time she's got a fever and runny nose. So many think like this.

I also believe we need more weight loss, alcohol support and if you don't lose the weight your access to weight related issues (type 3 diabetes, joint problems) becomes fee paying.

Every time I get an appointment letter for a department which I have had many appointments for many years, I get additional things like maps, "what do you expect from..." leaflets.

How much money is wasted on printing all this? Just send this stuff first time or after a period of no appointments after 5 years,