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?

Eu style social insurance

The same can happen in different hospitals within the same trust. When my OH finished his first course of chemotherapy at our local hospital, he was referred to a more specialist hospital in the next town, same NHS county trust. First thing the specialist consultant at the other hospital wanted was a full suite of all the tests again, i.e. MRI scan, skeletal x-ray and bone marrow sample - all had been done at the first hospital 3 months earlier but he said he had no access to the results/scans, etc. All he had in front of him was a two paragraph referral letter from the haematologist in hospital one and he said he couldn't access any test results, history of what drugs had been given, nor the monthly blood test readings showing the effect of the first course of drugs - he said the two hospitals used different systems - just 20 miles away, same county, same NHS trust. The cost of having to repeat those test was a ridiculous waste, not to mention me and OH having to make 4 more special journeys to the other hospital to have all the tests done (again). Why the hell aren't the computer systems linked within the same trust, and if they can't manage that, why the hell can't they just send the results in paper (or email) from one hospital to another. Paying a sodding taxi to courier the paper file would have been cheaper than doing all the tests again!

Far too sensible for the NHS.

In the cases of me, oh, MIL, father, etc., who've been languishing in a hospital bed over a weekend, there was no care package needed. All were being discharged home to be looked after by spouse/family. All we were waiting for was the discharge drugs and someone to tick the boxes in the NHS's own paperwork to approve discharge. Fair enough, there's no urgency if a care package involving carers/care home is needed and that's going to take weeks, but in my case, we're talking about simple home discharges where there's no need to "bed block" all weekend at all.

It’s senseless waste like that, replicated all over that we’re all paying for and that’s clogging up the system.

Well there is a reason for that. My dad died back in October after having an accident on the stairs because he was weak from prostate cancer
In my parents case they didnt want the adaptations but the reason that people refuse is because of accidents like this.
Maybe family members dont want to risk a life changing injury by helping someone with limited mobility up and down the stairs.

Will the NHS AND benefits system be there for them if they do Pffft

This is a huge problem. I have regular blood monitoring because of meds I am on. I also have a yearly test ordered by a different consultant, same hospital, for something else. I have tried in vain to get both tests put on the same form so I can have just one appointment. It is such a waste of resources.

I was not being critical of these families. Looking after someone who is frail is very very hard work, many of these people should not be discharged but we don't have the staff or Hospital beds for longer stays.

I was answering the PP who said that its all down to Pharmacy delays, the main problem is care packages, lack of care home beds and also funding decisions... these are keeping people in Hospital for weeks or on a separate short stay ward away from the main hospital but that is a huge cost, also needs staff.

I'm sorry about your Dad.

No one is saying it’s all down to pharmacy delays.

You choose to read it that way.

The problem with saying 'just make it visible across all sites' is that actually that would require a massive IT project - they tried, spent millions then abandoned it.

Pharmacy hours - we can't get pharmacists to cover current day shifts! There is a real shortage and trying to force people to work late wouldn't help.

Also - inconvenience to the patients is not a cost to the NHS. It's annoying and frustrating sure, but not an expense. Running clinics out of hours or on a weekend so you don't have to take time off work is financially idiotic- healthcare professional & receptionist overtime is a direct cost to the NHS. Your employer should provide paid time off for healthcare needs, it's their problem not the NHS's.

Personally I think we need to move to an EU style co-pay insurance model. We also need central government to take decisions on what the NHS provides to remove postcode variation.

Performance related pay. No happy medium with NHS staff (both clinical & clerical), they're either incredible or shocking, with the former needing to work even harder to carry the latter. So many employees doing the bare minimum, waiting to retire. It's why I left the NHS & will never go back. Properly rewarded, supported & motivated staff will automatically improve efficiency & outcomes.

I think the risks with performance related pay/publishing results is that the ‘easy’ patients are cherry picked. The more complex/risky patients no one will want as it will affect their stats. So the people in most need will be in no mans land.

its already happening in a way- especially linked to surgery

PRP...

Measured on what?

Performance review/targets are already here and it causes the exact opposite to what you want.

AE, among others, has targets etc, the easier patients dealt with, the ones with complex need, left... if you add in financial reward, the temptation to "cherry pick" will become greater... as said by the pp, then there is favouritism, who measures the measurers?

Equally, poor quality staff need dealing with too but why not address this as a separate issue?

Your employer should provide paid time off for healthcare needs, it's their problem not the NHS's.

The employer and the patient are already paying for the NHS.

It’s the health service that should be taking into consideration the needs of the patients, not the other way round.

OH has the same problem, but it's the same hospital and for the same treatment. He has his chemotherapy via the oncology dept who want a blood test a week before. He has a zometa infusion (part of the cancer treatment) in the day treatment unit and needs a blood test for that a week before in the day treatment unit. Guess what, each dept wants it's own blood test! They won't accept one blood test for both. That means he has to traipse to the hospital twice, often just a day or two apart depending on when each dept can give him a blood test appointment. Different depts seem to be working in isolation, even for treatment for the same condition. The amount of duplication of time, tests, etc is enormous and completely unnecessary. Too many separate fieffdoms.

How will it be monitored? Targets and outcomes can be easily manipulated as we saw under Blair in the noughties where the NHS staff pulled trick after trick to "meet targets" on paper like changing a diagnosis, moving a patient between hospitals for no reason, fiddling ambulance response times by having single paramedics on motorbikes, fiddling A&E waiting times by creating separate holding areas between A&E and a ward, etc.

I think the problem with co-pay is that so many people would be exempt from paying the amount of money raised would be much less than the admin cost. If paying was based of prescriptions around 95% would be exempt.

Yes targets can be manipulated but public satisfaction in the NHS under Blair was over 70%...

Its now under 30%...

So whatever the issues in the 2000s, the NHS was working for most people, a 12 hour wait in AE was a rarity, now its the norm...

Ambulances turned up within target, we did not have 20 or 30 Ambulances treating patients outside AE and we did not have corridors & waiting areas turned into emergency "wards" to treat patients.

The Tories for whatever their reasons, wrecked the NHS.

Ban all DEI activity. One of my children was taught to swim by a specialist AIDs nurse who left because she became fed up with all her colleagues leaving her without support on the ward to attend endless DEI meetings during shifts. It was just a way of avoiding real work. She became fed up. Her 20+ years experience lost because of colleagues being allowed to avoid doing their actual job.

It's false economy shutting down huge areas of the NHS in evenings, weekends and Friday afternoons. When patients are left bed blocking because they can't be discharged when the pharmacy is on skeleton staff and won't issue discharge meds.

Take scans/x-rays, etc., it's cheaper to run them a few more hours each week rather than have to buy additional equipment/new buildings etc to duplicate/triplicate the machinery to cope with demand when it's only open office hours. In the real economy, i.e. factories, etc., they don't build a new factory when demand increases - they make better use of the existing factory and ultimately a 24/7 shift system - yes, it costs more to pay overtime and then shift workers, but it's cheaper than buying a second factory, a second set of machinery etc.

In both pharmacies and radiology, etc., offer to pay enhanced rates for evening and weekend working and the staff WILL work. The managers just have to actually communicate between departments and top managers need to reallocate funds/resources between departments "for the greater good". As it is, there's no benefit for the radiology or pharmacy managers to bother paying more for overtime working as they won't see the benefit of the costs saved by reducing bed blocking. Same with social services who could save the NHS a fortune if they invested in more social care to reduce bed blocking. We need people above the management in individual departments and separate PS organisations to look at the bigger picture. Of course, if a pharmacy manager is only looking at their own budget, there's nothing in it for them to open longer, so they won't do it. It needs people above them (civil service and policitican level) to knock heads together and reallocate funding for the greater good.

As for the point about it being up to employers, No, it really isn't. The NHS isn't providing anything "free" to anyone. We're all paying for it, individuals are paying taxes, companies are paying taxes, all employers are paying employers NIC. We're ALL paying for the NHS. Part of it's problem is too many NHS staff with the attitude of "it;s free, so you should consider yourself lucky you're getting treatment at all". That attitude has to change because it is part of the problem!

Well immigration took off during Tony Blair’s time as PM, we got nearly a million immigrants last year -there may have been less previously but 25 years of it is going to make a huge difference.

Performance related pay would see surgeons refusing cases with higher risks or complex problems,
How do you measure nurses? They aren't hospitality workers. The smiley, pleasant nurse who doesn't make you mobilise post op is actually not doing her job over the nurse who insists you need to get up for your own good. Which one would patients score higher?
Sometimes patients are their own worst enemies by failing to comply with physio, medication regimes, dietary changes. Who's going to want to take the patients with worse outcomes if they risk a poor performance rating. Because the people who set the targets usually set them on outcomes or patient satisfaction.

To the person who mentioned paramedics on motorbikes. I think that was a brilliant idea given the traffic. As always though, it could turn out that it wasn't a brilliant idea, only when the data is analysed would we really know.

Elderly population with more chronic diseases and requiring input from four or five different consultants, carers and district nurses

People with chronic or congenital issues, barely able to look after themselves, having children with the same or similar issues, requiring input from NICU, Social Services, Paediatrand their children's consultants and specialist nurses

Increasing incidence of alcohol and drug dependencies

The elderly parents of special needs adults dying off and leaving their children stranded, as they 'didn't like labels', didn't get any diagnosis, refused all help from social services and now their fully grown adult children are socially, economically and medically fucked, with social care straining at the seams

Many of the immigrants you blame for our problems are the medical and care staff used to look after our increasingly sick and helpless population

Are you saying these didn’t exist during T Blair’s prime ministership as that was what I was replying to.