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?

Clearly depends on the individual surgery. That's the problem really. No consistency.

Considering they're all run under the same rules/guidelines and financed by the taxpayer via the Dept of Health/other quangoes, there should at least be consistency. Should be more like a franchise, such as McDonalds, where you have consistency and there's little difference which "branch" you use.

I know GP surgeries are mostly independent private businesses, but so are most franchises. Even Specsavers are mostly franchises and provide consistency, "open" records available between different branches even though they're not owned by the same owners, etc., so one branch can see the history of eye tests, prescriptions and spectacles done in another branch. Even some motor dealerships have common access to some data, such as service history of a car bought and serviced by a different dealership franchise hundreds of miles away.

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!

Definitely. I feel very uneasy when sent to wait in a hospital department because I've had both the following scenarios happen more than once:

Option A: appointment at 10 am (I know everyone gets the same time) so when it gets to 10 45, I go up to reception and politely enquire...only to be barked at and told be patient. I am patient! Very.

Option B: having been scolded for the above on previous occasions, I sit and wait and wait. Finally go up to reception only to be publicly scolded for having sat there for an hour and a half when I should have come and told them I hadn't been seen yet. You can't win!

Also, a friend of mine found a lump in her breast and was sent to the hospital breast clinic. She sat and sat for well over an hour only to be then told by the consultant 'Oh - it's a bit late, isn't it? Please come back in 2 weeks". Understandably she burst into tears - she'd already had 3 weeks of sleepless nights worrying and was absolutely desperate to be seen and checked. These people have no empathy - did they ever have any, or has it been lost somewhere along the way?

How would you see that working in practice?

Going by my experiences with elderly DM, the elderly are already being 'discouraged' from seeking treatment. It wouldn't surprise me if that soon tipped over into outright refusal to treat.

@ruethewhirl that's rubbish. The elderly get far better treatment than anyone else.

I think that depends who you ask. Certainly wasn't/isn't the case for either of my parents.

@ruethewhirl so they probably just got the standard NHS care these days.

My elderly dad had a stomach bug and he's been given every test going to "make sure he's fit and healthy". Every single test has come back clear, most were a waste of time! Shit like that should stop

I was booked in for a minor surgical procedure last year, when I got there I had a short discussion with the Dr and they advised doing something different (more minor) and it has worked as it should. I had a follow up apt after 6 weeks, and thry said there would be a 6 month follow up. Which I got a letter for.

I took the day off work, drove 40 min to the hospital, waited about 1 hr 20 after the appointment time, only to go in and the Dr said she didn't know why I was there, and apologised profusely for wasting my time. She explained that if I had had the original procedure, then I'd need a 6 month follow up but as I had had a more minor procedure, I didn't. She said the booking in for the original procedure would have triggered a letter, but when that was changed, the letter was not cancelled.

I felt bad that I'd taken a space someone who actually needed it could have had but also a bit miffed I'd wasted a morning on a pointless appointment.

A lot of people who work within the NHS are getting defensive about it, I'm not criticising the Dr, I felt bad for wasting her time....but there are so many examples of things not working.

As patients we're constantly told how much missed appointments cost the NHS (there's never any breakdown how many of those are due to admin errors or inefficiency rather than patients fault, but easier to pretend it's definitely all due to lazy or disorganised patients) ...on a different thread about waiting ages for GP or hospital appointments it was an almost an expectation that the patient had an infinite amount of time to wait

massive investment in social care. the NHS could function quite well if not for all the bed blocking

I had to cancel an appointment that i had last week because my dad died
and they were trying to spring a surprise hysteroscopy without anasthetic on me Read the hysteroscopy threads on here Saving money coming above patients right to a pain free/low pain procedure.
I phoned and was seventeenth in the queue so e mailed.

I don't agree. Surely it would have been better to know if he had something that needed dealing with?

And my parents have only had 'standard' NHS care if 'standard' involves heavy hints, on multiple occasions, that they should opt to do nothing in the case of serious illness, even down to not bothering with diagnostics in the first place. I somehow don't think people in the prime of life are being given that advice.

That's terrible. I can't believe what's been happening with these hysteroscopies. Sorry for your loss.

@ruethewhirl a man with bad diarrhoea and therefore dehydrated doesn't need a CT scan of his chest because he has a cough does he? He's had this cough for years. Every so often it'll get a little worse, because he is getting older. They will always rush the scans and X-rays and it's always the same. All clear.

Resources should be focussed towards working people first and foremost. Make clinic times longer and on the weekends, because that's when people can attend.

I think they need to take a systems approach.

It's staggering number of friends and family who had test - x-rays/blood work etc done - so paid for by NHS - and to assumed someone looked at them and adjusted treatment only to find no-one had. In some case it went of for years - meaning money wasted on inappropriate treatments and original problem now cost more to fix.

Also not booking people in when equipment or people aren't there - happened to brother got there equipment was at another location he'd taken day off work losing money and was shrugged at get to other end of county with no car and no money. Another example my house bound father - Mum had to arrange hospital transport - got up early got there half the people they were supposed to see were on a department training day.

Stopping sending appointment by second class post that turn up after appointment times then blaming patient and sometimes discharging from service- half the NHS service use text and e-mail - rest should as well.

Actually making it easier to cancel appointments - it can take hours of time trying to get through - and if the reason the appoints been canceled is hospitalisation or death it adds to distress.

Not giving care in hospital - so basic thing like getting existing prescribed meds given - or even pain relief - yet can wake up for blood pressure readings that just get noted. Often feel no one is in charge and communication with patients and family is lacking.

TBH though social care the big issue causing flow in hospital to back up - and that need money and a plan.

I agree with your last sentence, but that's about it. And although I can see attending for a CT scan with diarrhoea isn't really workable, if I've understood your posts correctly, they're trying to make sure the cough isn't anything more sinister. If that's the case, I'm surprised you'd be complaining that they're being thorough. Not everything experienced by the elderly can be written off as 'getting older'.

Fully agree. There needs to be better priority. The "precautionary" tests such as your chest CT scan example should be at the bottom of the queue, and other tests prioritised, for both working people and those with potentially more serious or more likelihood of something serious, and for things that can actually be fixed. We need a better kind of "triage" for tests etc rather than a first come first served waiting lists. Yes, I know there's fast track for really urgent things like suspected cancer, but there needs to be other levels of urgency/importance too.

@ruethewhirl what I disagree with is the fact that my father gets rushed through as a priority with a long standing benign illness. It's also the fact he had a coughing fit while in hospital and so got referred for all tests. They even wanted to do bone marrow biopsies "to be sure" when they had already ruled things out! It's ridiculous.

@taxguru it's maddening. Yes it's nice for my dad to get a health MOT but surely the better thing to do would be to encourage him to go private for that sort of thing.

I’d focus on prevention also, I do think making these weight loss medications available to overweight people on the NHS is a bad idea. Along side it you’d have to tackle the food industry and put a stop to food deserts in deprived areas, places where it’s easier to buy a bag of chips than an apple.

Im sure there is much more but yes prevention is key.

what I disagree with is the fact that my father gets rushed through as a priority with a long standing benign illness. It's also the fact he had a coughing fit while in hospital and so got referred for all tests. They even wanted to do bone marrow biopsies "to be sure" when they had already ruled things out! It's ridiculous.

🤷‍♀️

Wow! Do you even like your dad?!

@Thommasina adore him. Even he said that it was totally OTT and not needed at all. When the NHS is on its knees, ordering unnecessary tests because you've cooked up previous care for the person isn't really ideal. And putting him at the front of the queue is wrong?

Better control of expensive prescriptions too. My OH with his long term chemotherapy gets a bundle of drugs issued every four weeks whether he needs them or not. He has no control over them. They're automatically issued by the oncology dept. Some he never uses. Others he uses "as needed", so has built up quite a cupboard full of boxes of drugs. Worse are the two chemotherapy drugs. Per the NHS website, one costs over £1k per tablet, another costs £300 per tablet. (Yes I know these aren't the real costs, but clearly they're expensive!!). The one costing £1k per tablet, he gets 3 per month, but only takes 1 (as per consultant). The one cost £300 per tablet, he gets 21 but only takes 10 or 11 (every other day instead of every day - also as per consultant). So he's got thousands of pounds worth of chemo drugs in his cupboard. He has to rotate them himself to stop them going out of date, but it's a battle and some do go out of date. He's asked the oncologist many times to reduce the prescription and to remove the ones he never takes, but the oncologist just shrugs it off and says "he" gets funding for the prescription so it doesn't "cost" his department, and that it's "too much hassle" to change the prescription as apparently any treatment changes of expensive chemotherapy have to be sanctioned by some kind of "board", so rather waste time going to the board to get the treatment/prescription changed, it's easier for him to just keep pressing the "approve" button on his prescription system! Things like that need to be changed.

I’d focus on prevention also, I do think making these weight loss medications available to overweight people on the NHS is a bad idea.

Two very contradictory statements there

YES!!!

I remember my nan used to just get every drug she'd been prescribed over the last five years at one point. Antibiotics, painkillers, supplements. We tried to tell the GP every time, but they wouldn't listen and wouldn't change it. The amount of waste!!

In some ways it works really well. My physio noticed I had an infection near the wound after surgery. Called my gp, sent them a photo , saw a nurse practitioner and they prescribed antibiotics within the hour. Amazing

On the other hand the hospital discharge process is horrendous . People wait for hours and sometimes days for their meds from hospital pharmacies. Imagine if you could speed that up and free up every bed 2 hours earlier what a difference that would make to the poor souls sat in AandE waiting to be sent to wards.