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?

The one thing I would change is to pump loads and loads of money into primary care (GP) and instruct GPs to spend as long as needed with each patient - 3 minutes or 3 hours, whatever it requires. 10 minute GP appointments are the source of pretty much every other problem in the NHS and I'm saying that based on actual research, not just gut feel or bias.

The recent focus on prevention bothers me hugely. It's one of those ideas that sounds so obviously good on paper and yet when you try to implement it, it becomes so incredibly complex as to be almost entirely unworkable. In theory, at this moment, everyone in the entire country is on their way to becoming ill - we all suffer some sort of ailment at some point. So where does prevention begin? Do we prevent people from driving cars? Prevent them from eating chips? At what point does prevention tip over into control and interference? At what point does prevention become so costly and ineffective that it actually creates more problems that it solves? Why prevent someone from eating cake when someone else needs mental health support but can't access it?

People need access to timely appropriate care when they need it so that when they do become unwell they have the best chance possible of recovering quickly. Solid, effective primary care is the key to that.

The key thing anyone posting here must remember is that THERE IS NO NEW MONEY. Anything you propose must be either cost neutral or cost saving. And no, getting rid of managers doesn't work - that just means the management of finances and staff is worse!
Personally I think we need central government decision making on what is and isn't funded - so everyone has the same rules on IVF, skin procedures, weight management pre-op etc. Proper conversations about what the NHS will pay for. Ramp up taxes on alcohol, cigarettes and high calorie foods. Compulsory insurance if you have private surgery so the NHS can reclaim costs of treating complications.
Fundamentally modern health care is too expensive for our current model and the level of public expectations.
Co-pay works well elsewhere.

I think the phrase is, 'I wouldn't start from here'.

The problems are so huge and there is so little money that there really doesn't seem to be a quick fix, or even a slow fix.

I don't want to rubbish anyone's opinions, but surely politicians/the highly paid NHS managers have some good ideas for reform and cost saving? Or is it just down to us now?

Every much older person with multiple health issues should have a personal first point of contact (like a health visitor) to deal with issues and take a joined up view.
Don't boot women out of hospital after major surgery (hysterectomy) until they're properly ready and have all the information/drugs they need. Have come across lots of incidences recently where they need further help from gp/a&e because of the keenness to empty the bed and lack of proper info.
Improve admin and provide working phone numbers for people needing to change appointments/chase up results
Have a drunk tank to divert Friday night problems from a&e.

I've taken the survey. As someone who makes surveys for a living, I have to say it is truly, horrendously awful.

They need to do something about the discharging. When I gave birth I was ready and able to go home after a few hours but ended up staying for two nights and most of the last day as well cause they couldn't get the people the needed for the discharge paperwork.
So inefficient and a horrible experience.

DNA rates are also super high across services which is a massive waste of resources.

Also, NHS is not included in 'no recourse to public funds.'

Before citizenship, I had a 'no recourse to public funds' visa which meant that I couldn't have housing support, jobseekers allowance, certain tax credits, etc. I paid an NHS surcharge (£1,035 per year of the visa, paid as a lump sum) and had access to the NHS (in addition to paying tax like any employed person).

Totally unfeasible to demand that people on visas use private health insurance and not the NHS because (a) there aren't private health services available everywhere across the UK, have fun trying to find a private GP in rural scotland (b) if you have an accident or serious injury, you are going to an NHS hospital straightaway.

Mismanagement over decades is one of the root causes so it’ll take a huge overhaul to fix.

They need to adopt modern computing and data management systems for communication looking after patients details and for organisations. Their systems are massively disjointed it’s utterly ridiculous. For example, making appointments is so out of date. We have to wait for a letter for an appointment date/time which we probably can’t attend then call a number to say we can’t attend and then wait for another letter with another date/time. Totally ludicrous!!! Why aren’t calendars made public so people can pick a time that suits when they get a referral.

Getting people out of hospital beds and into care homes/their own homes is a huge issue. Bed blocking because social care is a mess. These need to be addressed side by side.

The NHS has also outsourced so much so now they have no control over it. Bring things like cleaners back under the organisation and manage properly.

Obviously staffing levels needs to be increased

Lots of good suggestions already.

I would make training for HCP roles much more apprenticeship-like and/or the courses fully funded, so that finances are never a barrier people to wanting to join the NHS workforce either straight from school or retraining to do so.

I would tie people in to working for the NHS for X number of years if an investment had been made in their training.
In my industry if my employer funds a £10-15k qualification you are expected to work for them for at least 3 years or pay back those fees to break the contract. I'm not sure why we don't do the same and lose people to other countries or careers like aesthetics/injectables technician.

The current NHS is a disaster. We were in a few years ago with my sick daughter. When I asked them about the blood in her urine the nurse seemed confused, I said "it's down in her notes, blood was detected in her urine a few days ago." The nurse just laughed and said "as if I have time to read notes!!"

Genuinely scary.

Appoint managers who have worked on wards rather than bring in from industry.

All management who are not front line have to spend 1 or 2 weeks as a HCP or similar so they get an idea of want goes on and what their decisions make bad / worse.

Offer (free) retraining to staff who can no longer do the job they trained for. Eg after 20 years nursing you might be burned out but you could do something else.

Set up a system where staff can give idea that would save money or make things better that actually gets to management.

This actually started in a place I worked while I was working my notice, I got £25 (20+ years ago) and my idea saved the hospital a ton.

Staff who are on call or working hours where public transport doesn't run should not have to pay for parking.

It doesn't need fixing. It needs completely redesigning. If you were faced with having to provide a healthcare service from nothing, how would you approach it?

It's a massive task, it needs buy in from both those within the NHS and the service users. My experience has often been that patients were an inconvenience. If provision were more patient centric, it might engage them more in their own health outcomes.

I agree with PPs about social care. The current system of it being provided by Local Authorities does not work. Convalescence within a medically supported environment, where recovering patients' needs can be assessed properly and appropriate care packages put together, would be a good way to unblock beds.

I am also not against moving towards a more continental funding model. If people had to pay upfront and were reimbursed, there would be fewer time wasters.

Agree with the funding of people trained in UK who then leave the UK. Similar to US system where your student loans are forgiven if you then work for a public hospital for X number of years.

Instead of up-front bursaries, I'd cancel student loans for anyone educated in the UK who works for the health service for 10 years. So you are free to go work in Canada, Australia, NZ if you'd like, but then you must pay back your loans.

1. Joint up working with Social care. The elderly should never be left in hospital when they could be discharged because there is no provision for them out of hospital.

1. Focus on outcomes. My 86 MIL has yearly heart scans and yearly osteoporosis scans. The doctors have told her she is too frail to have an operation. Why is she having scans?

1. Make treatment as easy and accessible as possible. Don't make people trek across county to have physio/routine tests/minor surgery. Put physios/nurses in local hubs so people aren't travelling miles. This would make treatment more 'joined up'.

1. Bring back school nurses. Not a nurse in every school but a team of nurses visiting local schools regularly.

My two first stops would be:

• Sites for different specialisms, spread out instead of the over-facing size and utter chaos of major hospitals
• More rehab facilities in place, to avoid beds being held by those who need additional care to be fit to go home, but not specifically ongoing medical attention.

My son-in-law, a nurse, was walking around with a new born baby inside his shirt to keep it warm because there weren't enough neo natal incubators, when he saw a top hospital administrator getting out of his top-of-the range car (a perk of the job). Son-in-law lost his rag and told said administrator just what he thought of him, then resigned from the NHS and now works as a martial arts instructor.

Soilent Green

What could the government do to actually give people a say other than ask people to have their say?

When did the Tories ever ask people to have a say on the NHS?

What have the tories got to do with anything, they are not in power?

1. Listen to health care professionals
2. Stop bed blocking by the elderly, who do not need to be in hospital - overhaul elderly care
3. Put more resources into preventative strategies
4. Stop health tourism completely - no insurance = no treatment
5. HR strategies to retain staff

They are wholly to blame for the state it is in now, of course they are relevant!

Eight hour shifts

A lot of critically important hospital staff work 12 hour shifts - after 37.5 hours, it's all overtime

An eight /7.5 hour shift 6-2, 8-4, 10-6, 11-7, 12-8 etc, means shifts can overlap more easily, one nurse or doctor will be seen at least 5 days a week on one ward and weekend cover may be easier to find

Doctors working 24-48 hour shifts is fucking dangerous

Also, prevention of lifestyle illnesses

A public ‘say’ is useless. It’s to a party’s credit if they recognise that and avoid it. We elect politicians to use the state’s resources to know more than we do and make best-value changes.

How long as a whole have the tories been in power over the last 80 years ? Isn’t it 3/4 of that time ? They've had ample opportunities to fix it. Labour did quite a bit of tinkering which helped but all undone by the last lot. Brexit messing up the NHS big time is a good example.

I'd stop paying so much for pointless drugs. There's lots on the market only marginally different to old non patented drigs which would be much cheaper. I'd also bring drug development in house. That way once a useful drug is developed it can be produced and issued at cost price. Look at how much is wasted on drugs with often negligible benefits.