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?

I had a reminder for my flu jab. Within that text was a link to change my appointment. I don't understand why this isn't the norm. So much easier than trying to phone up and change it.

...and they might have just 10 or 20 appointments per day...

Roll that out to 1000s of appointments across a trust and the IT costs become huge plus you still need a manual letters system for the patients that don't have a phone/keep it charged/update numbers etc.

Because everything nowadays is IP based, these sorts of systems are licenced per IP, so a business buys 100 or 500 or 10,000 licences whatever but it all costs and someone somewhere has to justify spending 10s of '000s on a bit of kit to save how much over 7 years of its supported lifespan.

That assumes they even have a budget for new IT.

What an interesting role! It seems considerably more complex than the original poster had described it and those suite of responsibilities would be inappropriate for a volunteer role.

Thommasina It was more the 15 anti bullying managers that I was dubious about.

I can't find any listings with the word "bullying" in them on the current site. Freedom to Speak Up doesn't feel like quite the same thing although there may well be some overlap.

Windchimes I guess that would be a sort of HR job?
ETA. I found this
https://beta.jobs.nhs.uk/candidate/jobadvert/M9990-24-0438

That makes a lot of sense. The staff surveys seem to indicate that there is a culture of bullying in the NHS (for all sorts of reasons). The NMC, RCN and other professional organisations have all commented on this in recent years.

I'm a GP. If we work weekends ( and we do work Saturdays) people need a day off in the week to compensate - means less appointments in the week ... unless you have more GP's.

GP surgeries are by far the most efficient part of the health service, we have to be as our salary comes from running a business that actually produces a profit.
There are a lot of extremely simplistic answers above that assume everyone uses the health service appropriately, uses home remedies for colds and doesn't have health anxiety / has the skills and knowledge to manage a child with chicken pox, an anxious elderly person etc. Many many people do not. So they want to see a doctor. The system was set up with the idea that the average person would see a GP three times a year. Its more like eight times ( on average) now ... more and more demand. Do you want to see a GP who has seen 50 people that day before you ? Do you really think they can give you the same attention that patients 1-12 got ?

If you could self book into eg ENT or neurology, how quickly do you think the waiting list would grow ? and how many of those people who confidently diagnose themselves with the aid of Dr Google actually need to be there ? Stop and think about that. Obstetrics is different. If you are pregnant you need a midwife - easy. the rest, not so much

We are people too, with lives and families and needs or our own. In the 'old days', and I am old enough to have done my own weekends and nights on call at the start of my career, people would only phone me at night if they were really sick. That time has gone, health care is expected to be like Amazon, order it an it appears with no thought for the cost. health care is free at the point of use, but it is NOT free.

@Flixon

If you could self book into eg ENT or neurology, how quickly do you think the waiting list would grow ? and how many of those people who confidently diagnose themselves with the aid of Dr Google actually need to be there ? Stop and think about that. Obstetrics is different. If you are pregnant you need a midwife - easy. the rest, not so much

But "some" things can be self diagnosed and the provider can triage themselves. It already works for dentistry and opticians. You don't need a GP referral to see a dentist or for new glasses.

Take hearing aids. I knew I needed hearing aids, because my hearing deteriorated. Why couldn't I self refer to the audiology dept or Specsavers? I "had to" see a GP who had a quick look in my ears (that Specsavers or an audiology assistant could have done), and then refer me. Only they didn't I waited and waited, only to eventual find that they'd forgotten to do the referral. Because a few months had passed, the receptionist insisted I needed another GP appointment to check my ears again! So two wasted GP appointments.

Same with our son's ingrown toe nail. Saw the practice nurse a few times and given the usual advice (that we'd already googled) such as salt baths, cream, antiseptic, etc. Just got worse. Finally got a GP appointment that the nurse said was needed for the podiatry referral (weirdly she wasn't allowed to do that, even though she could see it was getting worse and infected). GP had a quick look and made the referral!! I've had ingrown toe nails and knew it needed either removing or the sides removed. Yet, numerous GP nurse and GP appointment to get through the "gatekeeping" to where we knew we wanted to be. In the end, podiatry removed the sides within a couple of weeks of the referral, despite the GP telling us to expect a wait of up to six months!!

But you could've gone to Specsavers for your hearing..

It was a few years ago. You also have to be over a certain age, even now, to self-refer to Specsavers for NHS hearing aids. Apparently, some trusts still don't do any referrals to Specsavers, and some do it based on age. Just checked for our area and apparently the trust have stopped the Specsavers NHS service completely, so you can't self refer anymore, regardless of age!

More recently, it's exactly what I've done, and the whole process was much smoother than the long winded and protracted delays of going through the audiology dept. After waiting a few months for the referral, it was another few months to go through the initial consultation, hearing test, fitting and adjustments - 4 different appointments in different places, different people, each a few weeks apart. With Specsavers, all done in a single appointment! Also very easy to get an appointment at a few days' notice if any tweaks to the settings are needed.

Sorry for anecdote - but it's an example of something being very wrong.

My husband was having tests for prostate cancer and had an appointment to attend the hospital (6 miles away) for biopsy results. This turned out to be on that day 2 years ago when the temp was over 40 degrees and people were being asked not to travel unnecessarily. We packed water and damp towels and set off. Horrible journey and then a hot hike from the car park.

Sat sweltering in the waiting room for over an hour past his appt time. They told us that someone was late and they were waiting for them (weird - we were already there!!?) The person then arrived and was taken in - he was 45 mins late.

We continued to wait, and when he finally got to see the consultant, he said 'Oh sorry - we haven't got your results yet. I'm afraid you've had a wasted journey.'

It's not always about funding! It's about rank stupidity and hopeless administration. Travelling to a hospital unnecessarily is stressful, tiring and expensive - it should never happen.

Make it easier for patients to cancel appointments. People aren’t showing up even foe operations on the day!

There are also many, many, people, my family, who go maybe once every two or three years. My Dad got to 68 without any medical visits. Amazing. My Mum was there all the time though.

Do you think there is a way that "frequent fliers" can be handled differently? It is a well known stat that 1% of the population account for a third of all ambulance call outs, and 20% of all A&E visits, I assume these are the same folk tipping up to your surgery every month.

Happens far too often. When my OH was first diagnosed with cancer, we were referred from our local hospital to a specialist hospital some 90 minutes drive away. It was to discuss a stem cell transplant and was with the consultant/specialist and the transplant co-ordinator. Appointment time 9.30.

We were there in good time, having left home at 7am to allow for the traffic. Waiting room absolutely jam packed. Not good when everyone there was a cancer patient, and most would have suppressed immunity! Soon became obvious everyone had the same 9.30 appointment time.

We sat there and watched a slow succession of patients being called through. Fewer and fewer of us were left. OH went to reception every hour or so to ask about the delay etc just to be fobbed off saying they'll get to him when they're ready. Got to lunchtime and very few left in the waiting room. Then the receptionist closed the window and went off, presumably for her lunch. By about 1.30, we were the last, and all the HCA's calling people through also disappeared! Marie celeste in there, there was no one but us. OH and I decided to walk down the corridor to the consulting rooms, and we just knocked and entered one of the rooms. It was a doctor having her lunch. Not the person we wanted to see, but we asked her where everyone had gone and why we were being ignored! She was actually pleasant enough and went to the consultant's room to see if he was still there. He was having his lunch too! Hadn't any idea why we were there, didn't have a file, but he did find a single page A4 referral letter in a tray, but it had no details other than a brief introduction. He said the transplant co-ordinator never works on that day! So basically, a completely wasted day - he couldn't "consult" us as he had no records, and we couldn't even have the meeting with the transplant co-ordinator!

It's that kind of administrative stupidity that causes the inefficiency and wasted time for all, not to mention the blatant disregard for patients when they're messed around like that. Someone should have been held to account for it. The idiot appointments clerk who should have know the transplant coordinator doesn't work that day. The admins/consultant secretary who should have checked and seen that there was no file/test results for the consultatation. And the receptionist who didn't give a shiny shit about us waiting there and showed no interest whatsoever that we were still there after morning session had finished!

We do sent text reminders 48 hours before (or Fridays if a Monday appointment) and on our highest cost/highest demand clinics a member of the admin team calls everyone on the list the day before to confirm attendance to try to reduce DNA's, which is hugely time consuming. But even when people confirm attendance they either don't turn up, or turn up really late after clinic has finished and then shout at us when say we can't see them.

They should use their data to look at who doesn’t turn up and possibly why

I keep saying this. It's all well and good the way they keep coming up with statistics as to raw numbers, but it's meaningless without proper analysis and context. What about the ones who are too ill to attend, or who tried to phone to cancel but the phone was never answered, or the ones who've died, or who've been admitted to hospital, or the elderly/dementia patients who simply forget, or the ones where their lifts didn't appear, or the ones who never got their appointment letter, etc. So many "valid" reasons. If charging for missed appointments is ever brought in, you can bet those most likely to miss would be exempt (elderly, unemployed, disability claimants, etc) and it would be back to penalising the usual suspects, i.e. workers who got stuck in traffic or stuck at work and were five minutes late!

I hope you have written to
PALS about this.

TBH I’m convinced that they do this on purpose to put people off using the service - so that they give up and pay privately.

They know it’s poor, causes delays and probably worsening of conditions. They don’t care because it means you are less likely to trouble them again. Deliberate incompetence.

I think OH has PALS on speed-dial on his phone. He's had cancer for six years, and now on permanent chemotherapy, but it's all a shambles. He turns up for appointments only to find they've not got the drugs to issue him. Or he gets an appointment letter for drug collection the day before his appointment letter for the blood test - he knows they won't issue the drugs without the blood test results, but the admin bods keep doing it, so he has to phone to rearrange one or other. He's on a 4 weekly cycle, but sometimes the appointments come through for 3 or 5 weeks. It's all an absolute shambles. And that's life saving cancer treatment! His first PALS complaint was during the covid lockdowns when they cancelled his chemo infusion on the morning it was due to start and then forgot about him, week after week, month after month, he kept phoning to ask when the chemo would be started again, they just fobbed him off and glibly said someone would call back, but they never did! It was six months before it got restarted and because of the delay, they had to do all the tests again as the "approval" had lapsed, so another MRI, another CT scan, another skeletal x-ray, another bone marrow sample etc. Bonkers!

Break it up into manageable portions. At the moment it's an impenetrable mess of unclear and incomplete processes and paperwork. Far too much time is spent on this and not enough time on actual healthcare. It will be extremely painful, but much better than where it's headed - oblivion.

I've just Googled, hearing tests at Specsavers are free for everyone. You could have just booked it yourself. Even if this was a while ago, and they weren't free, I bet they wouldn't have cost much. I don't know why you're first thought for a hearing test would have been to go to a GP.

I think that was the idea with the fragmentation into loads of separate trusts, i.e. different trusts for different groups of hospitals, primary care trusts, ambulance trusts, etc. But it seems to have caused huge amounts of admin and management and lots of internal bickering/fighting about which trust is responsible, i.e. in my OH's case, the hospital argue with the GP who should be doing blood tests and prescriptions for things like iron deficiencies which are usually the GP domain, but in his case caused by the cancer, so the GP argues they should be done by the hospital trust as part of the cancer treatment. Not helpful for the patient when the GP refuses to issue a prescription saying ask the oncologist, but the oncologist refuses and says ask the GP - they won't communicate directly with eachother to thrash it out so OH ends up piggy in the middle - not helped when he can never actually speak to the GP nor oncologist due to gatekeeping receptionists blocking him!

This is bizarre.... why would they do this? i mean why on earth do they want 20 or 30 people all turning up at the same time??

You should forget PALS and contact their CEO.... for an explanation.

I have been taking both in laws into Hospital for many years now, for various reasons which i wont go into, i have also been to quite a few outpatient clinics myself too.

Never have i seen what you describe, well not since the 80s, when one appointment time was common practice.

Our Trust is one of the worst performing trusts in the country.

Yours sounds like it might be even worse!!

So sorry to hear all this.

It’s a waste of time and resources for you and for the service. Add to that the danger to the patient’s health and the loss of trust in the heath system.

Yet no one’s bothered and they keep carrying on like this.

Maybe if shops had been more responsible we still would.

One hospital I worked in had a shop, as many do, they were asked not to sell boxes of paracetamol. The thinking was if you have a headache you could buy a pack of 2 or 4 but no the shop refused.

People would literally leave A and E after an overdose and walk up to the shop and take another packet.

GP surgeries are by far the most efficient part of the health service, we have to be as our salary comes from running a business that actually produces a profit.

@Flixon This is certainly my experience. We feel very lucky with our GP surgery - they've been brilliant for over 30 years.

I had a swollen elbow, went to GP without an appointment, was seen straight away, given antibiotics and told to come back the following day, i did, told to go to AE, GP phoned ahead, i waited an hour and was on a ward, with IV antibiotics, within 90mins.

Spent 2 days there, faultless, which is more can be said for some of the entitled patients i had to put up with.... the staff have the patience of the saints.

The GP was fully aware of the dangers of Sepsis, as was the Hospital.