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How would you fix the NHS?

969 replies

PinkFruitbat · 21/10/2024 07:37

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?

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

OP posts:
Thread gallery
16
oakleaffy · 21/10/2024 09:20

ChardonnaysBeastlyCat · 21/10/2024 08:06

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.

This 100%.

AlaskaThunderfuckHiiiiiiiii · 21/10/2024 09:20

Be more realistic about life and death, stop treating people merely just to keep them alive with no quality of life and I can see this becoming a bigger issue with the rise in number of the elderly population coming but applies to everyone. HCP being more able to have frank conversations with patients and their families etc about treatments, side effects, quality of life etc. This all has a knock on effect on social care as well

Leniriefenstahl · 21/10/2024 09:21

AlaskaThunderfuckHiiiiiiiii · 21/10/2024 09:20

Be more realistic about life and death, stop treating people merely just to keep them alive with no quality of life and I can see this becoming a bigger issue with the rise in number of the elderly population coming but applies to everyone. HCP being more able to have frank conversations with patients and their families etc about treatments, side effects, quality of life etc. This all has a knock on effect on social care as well

Edited

If anything it’s got worse since Covid. Who knows, residual guilt ?

Abra1t · 21/10/2024 09:21

RhaenysRocks · 21/10/2024 08:11

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.

I'd have been anxious about my elderly mother being
parked in some kind of geriatric hospital when she needed exactly the same treatment for her leukaemia-related admissions for neutropenic sepsis as anyone younger did.

Hatfullofwillow · 21/10/2024 09:22

Pat888 · 21/10/2024 09:13

I had treatment in the US. Everyone was fit, walked in checked details sat on chair or went straight in, took your clothes off ,lay on trolley, given relaxant, had procedure, left on trolley til medication wore off, sat outside in chair 10 mins, went to car driven home. Only staff were 2nurses and surgeon.
Obviously unfit patients went elsewhere but we were treated in about 2 hours-rattled through like a production line.

you were expected to get yourself there and back and have the intelligence to speak up or contact them later if any problems.
Upshot 90-120 treated per day.
Doubt it happens here.

The US spend much more on healthcare.

https://www.bbc.co.uk/news/uk-42950587

placard in march reading nurses will fight for the nhs

Reality Check: Does UK spend half as much on health as US?

Donald Trump said the NHS was "going broke and not working", but the NHS chief executive hit back.

https://www.bbc.co.uk/news/uk-42950587

DancefloorAcrobatics · 21/10/2024 09:24

Before we can do all of the above, I suggest the government invests into a better infrastructure for the NHS.
That's update buildings , a better supply chain of goods needed for patient care. Competitive wages for all staff to attract the best of the best. Less middle management, more nursing apprenticeships, ...

meercat23 · 21/10/2024 09:24

Sort out duplication and overlap in management and administration. Currently management operates at hospital, trust and regional levels. Rationalising that could release funds for frontline services

ImWearingPantaloons · 21/10/2024 09:24

Link social care to health care so the left hand knows what the right hand is doing.

More walk in centres to take pressure off A&E.

Have a grown up discussion about the realities of dementia / old age instead of continually kicking the can down the road.

Focus on prevention much much more. Not early intervention with meds, actual prevention starting in childhood.

Newgirls · 21/10/2024 09:25

I agree with jobs, poverty etc. Though other countries have that too. The UK seems to pour petrol into this with alcohol. And that impacts on so many people, of all ages and weights etc

Namepound · 21/10/2024 09:25

ThatCalmHelper · 21/10/2024 08:39

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.

This

we trust health professionals with our lives therefore we should trust them to put in an order form for things they actually need.

surely all this ‘trusted suppliers’ is causing more problems than prevention. Didn’t an artist do an exhibition with the nhs paying over £200 for a light bulb that was sold for £3 on Amazon.

Also, thank you for not taking advantage of the NHS. I’m sure lots do especially knowing that it’s pissing money everywhere else.

itwasnevermine · 21/10/2024 09:29

Yes waste is also an issue.

after my nan's hernia surgery she was sent home with buckets full of medical supplies - none of which she needed! Jugs, syringes, funnels, scissors. They had planned for her to be sent home with a drain and so they sent her with it, even though she wasn't sent home with a drain. We were told to put it in the bin!!!

We still use the jugs and funnels in the kitchen

Nannyfannybanny · 21/10/2024 09:31

Where to start,, I was nursing over 40 years,trained in the 70s. Matrons were brought back,they just tottered around with a clipboard. Waste is ridiculous, some years ago, patients would hand over any meds they were on, they were discarded, you then waited for the Dr to come and write them up for the same meds. The health tourism I saw was shocking, they were given a bill, never heard of anyone ever paying. We used to laugh about the "Sainsbury's manager" being in charge of the hospital. Uniforms were changed and binned for no good reason, complete waste of money. Teaching people to take responsibility for their own health doesn't work. Back in the 80s, doing cardiology, patients with blocked arteries and amputation caused by smoking,all saying they wished they had never started. My last ward, strokes,guys in their 30s, drugs mainly occasionally heavy drinking, being the cause. 5 years in the ED drunks,at the weekend,nasty aggressive demanding. The cottage hospitals were a goldmine,we had a little local minor injuries unit in a nearby town,it was brilliant and closed. I would glean down a lot of management,yes, charge for missed appointment unless there's a very good reason. I went to an opthalmic consultant at the local hospital and they had 30 no shoes!

reallyalurker · 21/10/2024 09:34

There are some really good ideas here by more expert people than I am. Just adding my support for a separate elderly care service. I had to go to A&E with my father last Friday because the GP surgery thought he needed an MRI scan - sudden inability to walk and other symptoms. We were in an ambulance, tying up the ambulance and 2 staff, outside the hospital for 7.5 hours. We were one of 40 ambulances in the same situation - the paramedic showed me on their system that all had missed the 4-hour timescale. When we got in, I heard one of the doctors saying "I have 20 patients in this area, all are over 80 except one and she shouldn't be here". Over a week on, we're no further with a diagnosis or treatment, there have been failures of basic care and kindness - probably partly because he's in a renal ward because that was the only one with a bed, so they have no expertise in care of elderly people - and he fell yesterday and has a fracture so is worse off than he was before going into hospital. And he still hasn't had the MRI scan.

Sorry, that's a rant, but the experience really brought home to me that the hospital's resources are focussing on older people but failing to give them a decent service or satisfactory outcomes. I'd support a separate pathway for older people and the development of research-based expertise in this area.

Nannyfannybanny · 21/10/2024 09:34

No show, not no shoes!

TigerRag · 21/10/2024 09:40

If we're going to charge for missed appointments what about when the consultant cancels without saying? I got a text on Monday reminding me of my appointment on Wednesday. Turned up and it wouldn't let me check in. It had been cancelled. They'd sent me a letter Monday. My appointment was Wednesday morning. I got the letter after I turned up. Can't understand why I wasn't called or sent a text

Carriemac · 21/10/2024 09:55

Targeting money for infrastructure and IT - and keep pay attractive. We need more training posts for doctored, we train enough medical students then they can't get on a training scheme scheme and head to Oz

Notasunnydayhere · 21/10/2024 09:57

I think the government will get many answers on this such as quicker access to diagnostic scans/x rays, get rid of middle managers, more local hospitals setting up, and so on. The reality is that it's just not that simple.

For example, the infrastructure for higher capacity to scan/ X ray isn't there. Aside from the lack of physical space, there's a shortage of radiologists nationally. It takes a minimum of 12 years to 'grow' a consultant, so increasing capacity in any specialty will take years. And how would we staff more local hospitals - you'd need at least 6 - 7 doctors just to offer a 24 hour service if minor injuries was Dr led.

So my first thought is:
Get workforce planning right across every staff group in the NHS. No government has ever bothered to do this, however much lobbying many of us have done. We've been told by successive governments its 'too hard'. We need to get the right numbers of the right sort of staff being trained to deliver an appropriate level of service. It's so basic, and it's outrageous that it's never been done. Some consultant vacancies never get filled because there aren't enough qualified people in that specialty. It's the same across the NHS - we need to train more physios, radiographers, ODPs, midwives, nurses etc, probably by reintroducing a bursary system. Yes it will cost, but the amount saved in agency staff, cancellations etc will offset some of that and most importantly of all, care will improve.

Second thought:
Health promotion. Obesity, smoking cessation, sexual health etc doesn't currently fall under the remit of the NHS, it's the responsibility of local authorities - most people probably dont realise this. A healthy population is the most important thing of all for the NHS, yet we're getting less healthy

We need to reintroduce and expand Sure Start. Healthy, happy successful children is fundamental to an effective healthcare system. Alongside that, fund health promotion properly and move it to a core NHS function (as it used to be). With the right funding, we can make a huge impact on the heath and wellbeing of the population, starting with the youngest children. Teach children what good heath is, how to cook properly, that there is exercise that they will enjoy (eg many teenage girls don't like traditional outdoor sport so teach them something different). Improving access to health promotion (eg health support for parents especially in areas of deprivation, obesity/smoking, drugs and alcohol cessation services and so on) is vital if we're ever going to have a healthier population. Focus heath promotion services in areas of deprivation to reduce health inequality.

Third thought:
Care for the elderly. The NHS will never function in anything like an efficient way until the care system improves. Maybe that will need people taking out insurance to cover future care needs? I haven't worked in the care sector so no ideas on detail, but it's a key factor in 'curing' the NHS.

Alexandra2001 · 21/10/2024 09:57

Namepound · 21/10/2024 09:25

This

we trust health professionals with our lives therefore we should trust them to put in an order form for things they actually need.

surely all this ‘trusted suppliers’ is causing more problems than prevention. Didn’t an artist do an exhibition with the nhs paying over £200 for a light bulb that was sold for £3 on Amazon.

Also, thank you for not taking advantage of the NHS. I’m sure lots do especially knowing that it’s pissing money everywhere else.

Yes a £3 bulb, in a fitting which is 4m above floor level, needs access equipment and can only be done when the corridor can be closed off & power to the fitting switched off........ie at quiet times.... private company who does this, needs to book a technician and electrician..

Our company would charged Morrisons over £1k to charge a £50 wifi extender, 2 techies (no loan working) access equipment, 1am in the morning and could be 4hours travel in separate cars/vans.

Do you really want a AHP doing equipment ordering instead of patient care?

The issues i ve seen are down to private sector involvement ie Milbrook prove all the access equipment for the trust, they deliver too!!! but charge a separate delivery charge for each item, even though its come from the same place and uses the same van....
Livewell provide community services, but have totally separate/duplicate back office functions HR IT payroll and of course a board of directors.... and need to make a profit.

Snackpocket · 21/10/2024 09:58

I agree about social care being linked, it’s so important the two work hand in hand to keep the flow moving so people don’t stay in hospital any longer than necessary.

The NHS needs to move away from m
letters. If you are registered for the app then you should receive all correspondence through that with text/email notifications. Letters being printed and posted is a waste of time and resources. Most people get irregular post now so it’s not a reliable method of communication. But should still be an option for those exceptions who want it.

Procurement needs to be centralised so the NHS gets the best price for everything. It would have huge buying power. Currently I believe different trusts can pay wildly different prices for items like gloves etc. Costs should be consistent across the organisation.

Alltheprettyseahorses · 21/10/2024 09:59

Labour have had 14 years to come up with a plan. Streeting is extremely well paid and has a huge team of well paid staff working for him. To beg the general public for ideas is desperate and incompetent. Either do the job you're paid for or resign.

That said, I'll still give an opinion. Do not privatise the NHS. It will finish it. I know the same people scaremongering about the Tories selling it off will clap like performing seal if Labour actually does it, but don't. I'd go as far as saying it would be treasonous.

Rummly · 21/10/2024 09:59

The NHS (in England or elsewhere) can’t be fixed in its present state. It needs to be stripped back and expectations need to change.

WhosPink · 21/10/2024 09:59
  1. Identify a range of metrics by which you can quantify the effectiveness of a public health system
  2. Rank all public health systems in the world using these metrics
  3. Look at the one that comes out top
  4. Do what they're doing
TheSnootiestFox · 21/10/2024 10:03

The last time two times I have really lost my sense of humour have been been with so called 'health professionals' and I am also fed up with it. First was with my then 13 year old with a broken foot, sat in minor injuries for 7 hours watching others walk in and be treated, told I couldn't give him pain relief until he was was triaged but they forgot to triage him. Was told just to sit down and shut up. Then got to see the nurse and when I complained was asked why I hadn't just walked down to the garage (leaving him on his own to do so) to get paracetamol. I told her what had happened and demanded to see a manager to make a complaint. Was told there was no manager, nurse refused to treat my child who was in agony because I was 'aggressive' (no, but i bloody could have been!) and porter threatened to call the police on me as I was refusing to leave until I'd made a formal complaint. Second time was arriving to pick mum up after 4 hours during which time I'd assumed she'd had a colonoscopy. Clinic was running late and she'd not even been seen. This was 4pm a few weeks before Xmas. Was again told to sit and wait even though I had to collect kids, take mum home which was an hour away, get her settled (dementia), go home which was 30 mins from mum's, feed kids, get them off to cadets and me to work all before 7pm. Mum had taken piccolax and was refusing to leave until she'd had her procedure, I was refusing to wait any longer and a nurse stood with her hands on her hips and told me not to worry as if I was lucky I wouldn't lose a whole night's wages. No, I'd just have lost my job for not turning up 🙄. Single mum a few weeks before Christmas and they're telling me I can't go to work to earn money for presents.

I am sick to the back sodding teeth of hearing how stressed everyone in the NHS is. We're all stressed and busy. You're not special. In answer to the OP's question, my answer would be get rid of all the people like you who think the patients are the problem. Get rid of all the translators, eleventy billion managers that can't manage and the stupid amount of things treated. Luxuries such as IVF, smoking cessation treatments and weight loss treatments/gym memberships FOR THOSE WHO DO NOT HAVE diseases such as lipoedema or endocrine issues that make losing weight nigh on impossible. Make GPs work weekends like they used to and go back to family Drs who knew their patients and would visit in the dead of night rather than having to trail a sick child to an out of hours centre miles away. I refuse to believe it's cheaper to keep centres open and staffed. First and foremost start remembering that it's a SERVICE, the clue is in the name, and start treating the patients with more respect!

Alexandra2001 · 21/10/2024 10:10

So no mention of Dentistry what so ever....

@TheSnootiestFox

i'm afraid you embody all what is wrong with peoples attitudes and why staff are leaving and young people not going into health.

TicTac80 · 21/10/2024 10:13

I might be in cloud cuckoo land, but...

-A better focus on preventative medicine/health.
-Law put in place for minimum safe staffing levels (and this increases as acuity/dependency levels increase).
-Stricter rules to protect staff against aggressive and abusive patients/relatives. Over the years, I've been physically and verbally abused. I've been groped by patients, and had threats made against me, colleagues and even my family. Often from serial offenders, who we have to keep admitting and trying to treat.
-Software systems that are universal (across all Trusts and in community etc), which mean if a patient is out of area/repatriated from a different hospital etc, their records/results are easily accessed by the staff who need them.
-Better investment in community care (and make it a more appealing job for people!!), be that more beds in cottage hospitals or nursing/residential homes and better staffing/working conditions. I'm a ward nurse - things are hard for us, but God knows I know how hard it is for my colleagues in community (be they, nurse or carer).
-More OOH/minor injury places.
-More GPs, so that there are enough to staff GP surgeries for evenings and weekends.
-have things like hospital transport made in-house. In my Trust, there are two different transport providers (depending on which county you live in) - each having different rules and regs.
-Have a look at the NHS suppliers. They often charge way over the odds for items that could be sourced a lot more cheaply elsewhere.

There is a discharge lounge where I work. They provide meals and care for patients who are just waiting for meds/discharge paperwork/transport. Patients often refuse to go there, preferring instead to stay in their beds/rooms. We are not allowed to force them to go there. But we get a telling off from senior management when we don't send patients there, and we get complaints from patients and relatives about the lack of beds!!

There are cottage hospitals near where we are, but the powers that be have decreased the number of beds in them. There used to be more minor injury/OOH places, but these were also closed.

We often have patients who are admitted to hospital but then refuse to engage in the treatment or therapies offered. They need it, and understand they need it, but don't want it. There should be a process in place which makes it easier to simply send these people home. I have known of people being in for weeks, refusing physio, OT, medical interventions etc, but then of course not improving....but we can't send them home as it is not safe. They refuse placements and care packages, and stay for weeks in an acute hospital. It's crazy!

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