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?

And it is lies about me and what I think.
You could have just raised sensible and thoughtful points and the ethics of treatment or non treatment for elderly people with terrible and painful quality of life.
Actually, maybe you are not capable of such a discussion.

@ruethewhirl
I'm actually quite glad you've been posting because it's the perfect example of why we can't have these difficult and ethically challenging discussions. No politician would dare stand up in Parliament and ask if we are really acting in the best interests of our extremely elderly in very poor health giving them life extending treatments. The Daily Mail and a big chunk of the public would be screaming 'THEY WANT GRANNY DEAD!'
These are really important questions though and somebody should be brave enough to raise them. I think one way forward is to make sure people get their own house in order and speak to family and have paperwork in place well in advance stating what treatment we do or don't want for ourselves and in what circumstances. If that is every antibiotic going and kept alive as long as possible regardless of and level of suffering (as seems to be the default now) well so be it, people are free to make that choice.

Show me one single lie I've told about you or what you think. You can't, can you.

And you're claiming I'm the one not capable of sensible discussion, when you've been name-calling and hurling insults at people who are simply trying to get you to clarify your views on other aspects of this debate besides how people with dementia are treated? Um, OK, then. 🤷‍♀️

Looking back over the earlier parts of this thread I think I can see where you might have got the impression I was arguing for elderly people to be treated regardless of dementia. To clear up any potential misunderstanding, if the dementia isn't yet severe or significantly detrimental to a person's quality of life, I do think they should still be treated. However, nowhere have I said that I think the lives of people with advanced dementia and no quality of life, who are suffering terribly, should be prolonged. Because, newsflash! - I agree with you. Of course they shouldn't.

But you have also stated 'I actually think there will be a tipping point soon (globally) were we have to start prioritising the working population over the elderly for healthcare', by which you presumably mean people without dementia as well as with it. So it's not really that outrageous, on a discussion forum as opposed to an echo chamber, that I wanted to know whether you agreed with elderly people without dementia being deprioritised for treatment.

You may feel people are trying to shut you down on the dementia angle, but don't project that on to me because it's not what I've been doing.

OK, we've cross-posted. Read my last post and then tell me if you still think I'm the scapegoat you so clearly need to point your finger at.

You said that I think elderly people all have dementia and are screaming in pain. This is a lie! You lied!
As for a tipping point, yes I do think there will be because of changing demographics. Have you seen the birthrate in places like South Korea? 50% of the population there will be over 65 soon. They will have to priorities the working population for healthcare and frankly I think they/we already should. Let's say you have a care worker who needs a new knee, can't walk or work without one. Now you might argue she/he should just take their place at the back of the list, behind the people she/he cares for, who also need a new knee. This might leave nobody left to care for them or make things very difficult. And that is a viewpoint worth discussing and not without value. I think care worker should be put at the front of the queue so they can get back to work ASAP. I don't think my argument is complete without merit or shows me to be a terrible person and not even worth considering because I clearly hate the elderly. You might disagree.

Cut down on middle management, and have pharmacy with the same shifts as nurses. So patients seem on ward round at 8am don’t have to wait for the pharmacist to start at gone 9am. Or 10 at week ends. Freeing up beds quickly.

Charge a small fee for GP appointments, A&E attendance and clinic appointments (exemptions would apply). Charge for more prescriptions. Introduce some hybrid health insurance model to include elective surgery.

but the biggest thing is sort out social care and also inappropriate admissions.

Ooh yes also agree cutting down on ‘management’

I said that by the looks of things, your thinking hadn't changed. And I consider that a valid comment considering the way you've been posting on this thread.

Your accusations are getting old now, though. That post from me might have been inflammatory, I get why it might have put your back up. You've refuted the accusations I made in that post and I've clarified that I actually agree with you on what seems to be your key point, but you still want to hurl more baseless accusations at me and I'm bored of it now. I'm off to enjoy the rest of my Saturday.

Ooh, you stomping off

1. Charge for GP appointments for the over 18s
2. Better fund elderly adult social care/ rehabilitation
3. Change our language around mental health and neurodiversity to better differentiate what needs actual formal diagnosis and what is just being slightly different and/or having slightly difficult feelings about normal life
4. Tax the absolute fuck out of cigarettes, alcohol and junk food. Make them a treat not a daily default.

NHS has proportionately less management than private business run with.

I’m an NHS manager who runs the website, patient information service (local leaflet development), trust intranet used by clinicians and deals with media requests. Do you think doctors and nurses want to do that? I, like many managers, work with front line clinical teams to find solutions and support their work. I’ve never felt anything but valued by my clinical colleagues. “Cut the managers” is just a lazy sound bite that shows a total lack of knowledge about how large businesses/organisations run.

Fuck yes.

Tax the bloody fried chicken joints.

@TeenLifeMum I mean, the divisional nurses, deputy divisional nurses and all that type of management. The level above matrons. We seem to have loads of roles, that no one has any idea what they actually do.

You're both only addressing half the issue... staffing who need finding and paying, an issue in itself...

The other half, neither of you have addressed... Discharge to where???

Easy answers, not even begun to be thought through, rarely are successful.

Yes for charging but would the exemptions mean hardly any money is recovered?

Social Care needs funding but it also needs staff, where from? not everyone who is "apparently" scrounging on the dole, is suitable or even able to do SC, you need a clean DBS, be healthy and physically able, a car for most roles, empathy, a caring attitude and intelligence.

Not everyone has nowhere to go after being discharged.

The majority of patients want to go home but are stuck waiting for the pharmacy.

My DD has been involved in patient discharges across 3 trusts in the SW, the predominant block is Social Care and the roles around it.

Most patients are still ill, they need support, care packages, home adaptations, waiting for community services to assess need, mtce teams to facilitate this.

Bear in mind, time in hospital has been cut to bone, people are sent home that just a few years ago they would not have been, they need additional care... and families are often unable to do this.

For example, a friends mum was deemed fit to discharge, with a care package, none available, she cannot toilet her self without assistance, my friend didn't want to do this for her mum, Mum stays in hospital.

There are multiple reasons patients stay in district hospital when they should be either at home or in a community hospital.. or a Care home, something that is getting ever harder to get as more homes close of refuse none self funders....

On Pharmacies, if we have a shortage of dispensing chemists, what do we do?

@ruethewhirl
I'm sorry I was a bit hard on you.

But of course, if your DD says so, why are we even discussing things?

Why bother?

DD says no. End of.

No one ever has witnessed patients waiting for 7 hours to be discharged because the pharmacy can’t get their act together.

Oh yes- totally agree with all your points here. Especially the staffing of care homes. It is of course hugely undervalued (and underpaid) work. If it was paid well there would be more people willing to do it. And do it well. However… then the cost of social care to us the tax payers rises exponentially. It’s an unsolvable problem isn’t it?

I used to work in a small trust and we weren’t amazing with paperwork. I’m not meaning patient notes but business cases were rare - we’d just have a chat, use common sense, speak to relevant people and get shit done.

I now work in a big trust and everything is by committee with no one brave enough to take individual responsibility. Some people go rogue but do bonkers shit that I never came across in my old trust.

I never understood the nhs narrative until I worked where I am now. It’s a deeply embedded culture and senior execs can’t change it because the organisation is just too big.

Its about someone who has done this sort of thing for living & sees the problems day in day out vs your layman's opinion....

A pharmacy delay is 7hrs, maybe a day, compared to weeks to get a double care package.... or wait for a none existent Care Home bed.... or have a family refuse point blank to have their Mum/Dad back home until a ramp is in place or hand rails...

Yeah, no one else ever has done anything like this for a living.

Ditto. No worries.