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?

Good? That's what you sign up for when you become a doctor.

The waste I have seen and the response from drs and nurses is always “It’s the way it has always been done”
There isn’t even acknowledgement that what they are doing is wasteful

I have watched as patients are told they are going home today

They then get up and dressed and 2 nurses arrive to strip the bed, clean the bed and make the bed up

Patient and family then sit on the bed waiting to be discharged. Patient is then discharged. Then 2 nurses arrive to strip the bed, clean the bed and make the bed up. The bed they only made up a few hours before.
Not one nurse understood how much of a waste of time and money what they had done was as “It’s what we have always done”

Exh went to have chemo, the practices in place made so little sense given the NHS is always bleating about the amount of money it needs.
Before patients would arrive in the morning nurses would set out trays and label them with the patients name. On each tray would be placed a bag of the chemo needed, a new box of gloves, new box of antiseptic wipes and any other things they needed.

When a patient arrived the nurse would take the bag of chemo and because it had been out of the fridge for a while and throw it in the bin
They would then collect a fresh bag of chemo from the fridge.

At the end of the session anything on the tray (I.e box of 50 or 100 pairs of sterile gloves where one or 2 pairs had been used for that patient and the box of antiseptic wipes which are in there own packaging and again only 1 or 2 having been used would be thrown in the bin.

I would say that the NHS doesn’t need more money. It just needs to stop chucking stuff in the bin and doing unnecessary tasks

I agree with all that. Far too much of the attitude of "it's a drop in the ocean" when it comes to unnecessary waste and inefficiency. Far too many staff just don't care about waste - it's endemic - they see no one else around them cares, so they don't care either.

@itwasnevermine actually you don't. You sign up for a 40 hour week. But because of under staffing you are required to do 78.

Facts are important. Not 'well you signed up to be treated like crap so you deserve it'. That attitude is why Australia's biggest medical school is the NHS. That and we don't employ our own doctors so it's down under or drive an Uber.

Probably not a popular opinion but we should stop treating people over 85. No more operations, no drugs, no more extending existence at the detriment of wider society

Some absolutely disgusting ageist bigotry on this thread. And goodness what a slippery slope. Start at 85, then slide down to 70, then 60, then before you know it 50.
And younger long-term ill or disabled people - including children, and sick babies.
What a horrible dystopia!

Re
I agree - and I've lost many lovely elderly relatives and friends. Many hated the near-torture of constant hospital visits, scans, investigations, treatments etc etc and just wanted to be left in peace! Some said 'You've got to go some time!' and others 'I just want to be left in peace'.

If they hated it, nobody was forcing them to have it. They didn't have to go for hospital visits or have the scans and treatment etc. Others do want the care they're entitled to and deserve - and have benefited from the improved quality of life and cherished extra time with loved ones it's afforded them.

I used to strongly support legalisation of assisted suicide - but recently I'm beginning to rethink that because of the increased amount of bigotry towards older people. Worrying signs it won't be a free choice. And assisted suicide is something that should never be a coerced one (including coercion by neglect).

I think it depends on the fitness of the person concerned, clearly some 80 somethings are very fit and may live another 20 years with treatment. But I don't actually think medical staff are stupid, they won't operate on someone who's frail for no good reason.

Yes this is the case - for all ages.

I think there would be a lot more beds available in hospitals and less overall cost to the NHS and the country if GPs would not try to save money by putting off and putting off patients from getting tested for anything and then only sending the patient for a blood test or test to test for 1 condition at a time

I have seen a ward of women who had different illnesses. If they had been sent for all the tests for things involving their symptoms at the same time then it would have come back within a couple of weeks exactly what they had wrong with them and they could have all been treated with prescriptions/outpatients or at worse 1 or 2 days in hospital. Instead by the time they were tested for their illness, months of
going to the GP,

getting a piece of paper to go have blood tested etc

Making an appointment to see the GP a couple of weeks later (if they were lucky).

Going to the GP

Getting a piece of paper to go have blood tested etc etc

By the time the doctor had the test results which indicated a problem, the problem had grown to needing much more invasive treatment and a much longer hospital stay

Whilst the GPs surgery is congratulating itself on being frugal with how much money they have saved by not sending people for tests it fails to realise that the overall knock on effect has cost the NHS millions and the country overall millions more.

I was denied an MRI (£300) on the NHS for what I thought was a hip problem

7 years out of work in constant pain and claiming sickness benefits plus the consultants appointments for 7 years. The 7 years of fortnightly physio appointments
The cost to the NHS and the country was probably around £300,000

So to save £300 they spent £300,000

I went to see an osteopath privately

After taking my details and exactly how I came about to be in so much pain, 15 minutes into the appointment I was told that hip pain was sometimes deferred pain from the back. She asked me to show her my back

Apparently I had bones sticking out where bones shouldn’t be sticking out.

I was referred for an MRI and to the Bupa hospital as she recognised it was more than she could deal with.

Apparently I had been walking around with a slipped disc for 7 years

I agree @Yalta

The false economy approach is a problem

*Windchimesandsong *
I think each department thinks of itself as a separate entity and if they save money then that is all that matters. No one looks at the bigger picture

Everything is to be passed on to become someone else’s problem and the more it is passed on, the more costly it becomes

Alexandra, who said they should work weekends AS WELL AS weekdays?

The railways, the buses and the tube lines run and are manned 7 days a week.
Cinemas, theatres, restaurants are open 7 days a week.
Gas, electric, internet, water board staff work 7 days a week.

But the staff only work a 5 day, 37 to 40 hours week. Can you work out for yourself how that can be done or do I have to explain it to you?

Also @Alexandra2001 at my GP practice there are 6 GPs and they all work part time. One only does one day a week and another 2 days, the others only do 3 days. WHY?????

If they would just work a normal 5 day week like the rest of us have to, and like the GPs used to when I was a child, it would no longer be impossible to get an appointment without phoning every day for a week.

@Ladyof2024 one word. Cash. They won't be getting enough money to afford the GPs working more days.

Or do we expect GPs to work for free ? And a 5 day week from them is usually 60+ hours. So not like the rest of us.

The GP funding model certainly needs to change. With them getting a fixed fee per patient, there's no incentive for them to offer more appointments etc as they get paid regardless. It needs to move to a "pay per consultation/treatment" model, so the GP practice gets paid for what they actually do, like virtually every other business model, such as NHS opticians, NHS dentists, etc etc. The idea of the "fixed fee" was to encourage GPs to provide preventative/proactive services, but it's failed, so time for a change. If they got paid for what they do, you can bet your bottom dollar, they'd make more appointments/services available. Time for change. Even if it costs more short term, it would probably save the NHS money in the long term by getting a grip on problems before they develop into more expensive/complicated treatments needed.

Not too sure if this is a problem with the chemist. During my late DGF’s last illness and other health issues which was about 2 years. My late DGM ticked what repeat prescriptions that DGF needed. Every single time they got a box of 100 soluble paracetamols in his box of prescriptions. Even though my DGM didn’t order them. There was no issues with other medication that wasn’t selected as wasn’t delivered,

The cost of these paracetamol is (today’s prices) £20 a box. That is 26 boxes of them in two years and about £450-470 in prices when my DGF was alive. These weren’t wasted, They were distributed in the family and DM took a box to her work with a note “help yourself”

Heard of other pharmacies just reissuing the patients’ entire prescription list. So that costs go to the NHS.

A friend of mine is a 'part time' GP. She's on 60% of fth, she works 40 hours a week, misses loads of evening and weekend social events because she's at work.

My nan used to be given paracetamol and vitamin d every month for no reason at all

If a supermarket gets loads of waste, the store manager gets investigated. As the supermarket my friend was working at ten years ago there was a fridge failure and the store managers ignored it and all the food has to be disposed.

NHS managers get no investigated if they waste the same value as the food in the above

Well said. And I hate this patronising/high-handed assumption that no one over 80 can possibly still have quality of life, it's such bollocks. My dad had great quality of life despite multiple conditions, right up until his final illness. And my MIL is 84 and freakishly healthy, much healthier than I am in my fifties. I don't think she's been ill in over a decade. According to pp, though, presumably any time after next year if she has the misfortune to get ill, regardless if she's still healthy overall/has a treatable condition, it'll be 'Now don't be selfish, dear, shuffle along and let the young take precedence.' What a way to treat people who have worked and paid into the system for many years.

We seem to be moving towards a society like those in the kind of dystopian novels that used to seem impossibly far-fetched. If all this writing-off of older people is really indicative of the collective ethic of this country, then as a society I think we really need to have a good hard look at ourselves.

What really worries me, given the levels of ageism I see on MN and in society generally, is that inevitably at least some of the policymakers and decision makers within the NHS will be of the same mind. Oh well, at least the funeral industry will boom and it'll provide extra job opportunities for the young, eh?

Disgusting.

@taxguru the funding models now gives ARSE cash which can specifically not be used to hire doctors 🤷‍♀️. Wes has lifted this restriction very recently but it will take time to filter through.

We gave enough doctors and nurses. We need to employ them. This would offer up more appts, cut waiting lists and help get the NHS back on its feet.

Re
I agree - and I've lost many lovely elderly relatives and friends. Many hated the near-torture of constant hospital visits, scans, investigations, treatments etc etc and just wanted to be left in peace! Some said 'You've got to go some time!' and others 'I just want to be left in peace'.

If they hated it, nobody was forcing them to have it. They didn't have to go for hospital visits or have the scans and treatment etc. Others do want the care they're entitled to and deserve - and have benefited from the improved quality of life and cherished extra time with loved ones it's afforded them.

Except they probably were forced because they probably had dementia.

It shouldn’t take 6 months for a continence assessment… or if it does, at least have the care and concern to find out how often incontinence episodes occur, and provide incontinence pads while they are waiting, the very least the NHS should do.

Wouldn’t it be cheaper to send the questionnaire to the patient to fill in than to wait 6 months or more for paid assessors to pop round to fill it in?

That could apply to many conditions I think.

At least the pressure to reach the toilet at all costs to dignity, life and limb (and the orthopaedic ward etc) will be lessened.

I think GPs should be allowed to work two or three days a week only just the same as anyone else. What practices need is enough GPs to cover the number of patients and appointments, whether you've got 5 working full time or 10 working half the hours. Personally I'd rather see a doctor who is not overstretched and exhausted, but well-rested and fully switched on.

If they had been sent for all the tests for things involving their symptoms at the same time then it would have come back within a couple of weeks exactly what they had wrong with them and they could have all been treated with prescriptions/outpatients or at worse 1 or 2 days in hospital. Instead by the time they were tested for their illness
The NHS can't win! If they don't do every tests in one go, they are wasting the costs of further appts and tests.

If they do all, posters will come and say they were sent to do 10 tests when they only had one issue and it was a complete waste of money to do all 10.

Ah the benefit of insight anonymous posters seem to have!

It depends. I've heard from (and heard of) people in their 80s being urged to give up certain habits (unhealthy ones, OK) and change their diets when those things are there main pleasures and frankly - giving them up isn't going to have a huge effect at that advanced age.

I was glad when one doctor said to my mum 'You don't need to worry about long-term side-effects at your age!' It was said kindly and my mum was cheered up by it, not upset. That's what I mean - it's just common sense not to treat an near-90 year old patient as you would a 35 year old.

I don't think it's always understood just how horrible constant hospital visits and treatment are for us all - but especially elderly people. Oh - and my mum suffered some awful mis-treatment from health staff in her last weeks, some of it most definitely bullying. I know she longed just to be allowed to go home and get away from them all. I don't know if I agree with another pp that 'no-one was forcing them to have it'. Hmmm. That poster needs to put themselves in the position of a very weak, tired and elderly patient. They sometimes haven't the energy to question or to resist what is being done to them.

And don't suggest I should have intervened. The ridiculous application of the 'ooh we can't discuss that with you - your'e not the patient' was really unhelpful.

Quite. That statement is bizarre. Does the pp know any old, sick people?