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?

A completely pointless exercise. We already had a 10 year plan, with input from the public charities, Clinicians, etc etc.

Guess what, it already contains all the issues and proposed changes that Labour are now talking about. There is also already a Digitisation plan.

Just like the Darzy report, they are regurgitating the same reports over and over. What's needed is compulsion on Trusts and GP's to deliver the changes needed.

I think systemic change has to happen. Not just directly with the health service, although there is plenty to be done there as I've already mentioned.
But also things like the surestart vouchers, cycle lanes, better public transport, safe pavements for a 2 mile radius outside of primary schools, mental health provision and careers advisors that help get people back to work.

There's definitely a line to be toed with people not working due to sickness. I certainly wouldn't want the genuinely ill and incapable of working disadvantaged, but I also know people in my life who are more than capable but social anxiety or a very low grade and well managed health condition has them permanently out of work and on benefits.

I would happily pay more for better services but I want to see the government being responsible with our money first and foremost and everyone pulling together.

Fordian
But how do you know you need an X-ray without being seen by someone who examines you, takes your history then makes that call?

@Wellingtonspie - I’m in at a&e fallen off my bike arms in agony can’t move/bend it. I need a X-ray not an ear exam.

How do you know you don't need a CT or an MRI?

Yes. 111 doesn’t always help - answer is “if you’re worried go to A&E.” My relative went to A&E after this phrase a few weekends ago, adamant 111 had “told her to go to casualty.” She could have waited until GP opened on the Monday.

Following this

Yeah, I’ve had a couple of notices of appointments that were in the past.

I imagine the stats record the patient not attending.

There is still a whole generation who cannot/will not use technology of any sort.
There are still many places and people who have no access to internet. So paper systems can't be eliminated just yet.
Hospital appointment systems are hopeless much of the time. It is often not the fault of the patient if they don't know their appointment has been booked/cancelled/rearranged. Choose and Book is a nightmare.
Getting a blood test done, for example, can be a huge undertaking, even once you get the request forms.
Different systems and rules apply even between GP practices and hospitals in the same town. We need consistency of practice and IT systems.
I would remove under qualified staff from GP practices and use the money to fund actual doctors and nurse practitioners who can prescribe.
I worked in a couple of GP practices who offered weekend surgeries and the take up wasn't even worth turning on the lights.
I would bring back cottage hospitals for elderly and convalescing patients, walk in centres, community hubs run by clinical nurse specialists for chronic disease management.)
Hospital and GP IT systems should connect with all of these places.
Receptionists should not be triaging patients.
All practices should offer e-consults.
Bring back apprentice style nurse training and make it longer, with more practical experience.
Work place first aid courses would be a worthwhile investment.

They don't call because no one answers an unknown number on their mobile; they tend not to leave messages as a throw-back to family landlines for confidentiality reasons, they don't do it via mobiles/emails at all because of excluding the tiny percent of people who can't access them. 🤷🏻‍♀️

Darzi spent one month ‘analysing’ the NHS, the most complex health system in the world and the world’s third largest employer. I can’t believe anyone takes that report seriously.

The report, the ‘conversation’, it’s all just political manoeuvring.

I had to take my DS to A+E a month ago as he'd had a lump come up on his chest, I was told by his nursery he needed to be seen that day. All good whilst I was there, there was a wait which was to be expected. He was x rayed which came up clear. I was told he needed an ultrasound but it would be an outpatients appointment. 6 days later my GP surgery called me, needing to see DS before they could make the referral. Took him the following day for a 2 minute appointment for the GP to say yes they'd send the referral. To me this just seems like a huge waste of time? I presume A+E couldn't refer due to funding, but then to have to waste a GP appointment to get the referral sent off is bonkers to me. Every question the GP asked me was in the letter that A+E had sent over. Questions like oh has he had an xray? And they didn't find anything? Well no, I can see the letter on your computer where it states they've done an xray which came up clear, I'm not sure why you need me to confirm it? Then the GP said oh it feels like bone. The description on the letter stated 'a hard bony lump'. Absolute waste of time. How many others have to go through this stupid procedure? The amount of wasted appointments doctors surgeries must use up leaves me reeling.

Darzi spent one month ‘analysing’ the NHS, the most complex health system in the world and the world’s third largest employer. I can’t believe anyone takes that report seriously

No-one is taking it seriously. Linked-in went mental when it was published. Both the healthcare and IT sectors were scathing in that it was the self same report he produced years ago, with a bit of AI thrown in.

The NHS needs more back office staff and better processes in place to free up clinicians time. The public needs to take some responsibility for itself too and stop expecting their lifestyle to be fixed by a few tablets at huge cost.

Able to attend appointments for different departments and different hospitals the day after the first one.

After experience of DM not able to have her appointment the day after attending one at another hospital as her notes were not available. This is why I make sure at least 3 working days are between appointments at different departments now.

My friend who uses the hospital hopper as she lives 10 min walk from the bus stop it serves, was horrified that a records officer boarded the bus with a trolley of about 50 patients' records bound for the other hospital the route serves. There was no attempt to cover the notes especially using public transport AND it was stormy winds too.

While there won’t be funds for this - if it was up to me I would roll out training on how to actually listen to patients and how to treat them politely and respectfully as this is also sadly lacking.

I would have a financial incentive tied to feedback from patients for GP surgeries and hospitals depts.

Nothing to do with finding, just stupid rules.

You can't be referred by certain services. I had a course of physio and was told I needed a scan, but only my GP could refer. So I booked the appointment and the GP said no because they didn't believe the physio. Pointless

Several things. Fix primary care. I don't actually have an issue with the PAs - it makes more sense for them to eg see people who need repeat prescriptions or are asking for tests before further investigations are made - eg if someone wants a FIT test before being referred for bowel cancer. You don't really need a GP for that.

I would also introduce insurance for the nice to haves and keep the free NHS for core services - maternity, children's healthcare, A&E and life threatening conditions like cancer. Insurance would eg pay for an elective hip replacement. Everyone would have insurance.

And as a pp said on page one, sort out discharge and ensure that (a) people have help on discharge - some areas are better at this than others, and (b) they are properly supported by the hospital that did their procedure.

Also fix admin so if you phone a hospital someone answers the phone and has the knowledge to answer your question or find out.

Finally stop wasting money. The NHS is well funded - it needs to use that money better.

As for wasted appointments at GPs, given nobody can get an appointment, I fail to see how they are being missed. Are they talking about phone appointments? If so, that does not count. If I am told I will be called sometime between 8 and 6 and happen to be driving when the doctor calls, that is NOT a missed appointment. Only face to face count!

Yes also very true. There needs to be a more holistic approach - invest in pedestrians and cyclists and do something about junk food. I'd ban the likes of Deliveroo and drive thrus. if you want a takeaway go out and get one!

If you are talking about Physician Associates they cant prescribe

PAs are absolutely useless and I've had nothing but bad experiences with them, as have everyone I know. They need more doctors.

Why don't they start with the White Paper for social are that was published a couple of years ago? No need to spend m8llions starting consultancy from scratch.

But joking apart - that IS a massive problem!

It's like the problem with the state pension - it was meant to support people retiring at 65 when life expectancy for say, manual workers, was nearer to 70. The architects of the welfare state probably never envisaged us all expecting to live to 90. And it's a problem for governments.

Just as the NHS was set up with a very limited brief - it was more about dentures, specs, orthopaedic surgery and drugs to treat chronic illnesses. Just contrast that with what we expect of it today!

Not saying it shouldn't cover our vastly different expectations but it's going to need massive reform and appropriate funding.

And societal changes have to be factored in - 40 years ago most old people expected to be cared for by their relations, often actually living with them. Now few of us live near our elderly relations and most women work outside the home.

@sharpclawedkitten PAs can't legally prescribe so if they are giving you repeat prescriptions they are breaking the law.

@itwasnevermine we have enough doctors. But there are not enough jobs for them.

People get the "service" they deserve.... survey after survey show staff are the NHSs biggest asset.

I'll ignore your attack on my DD but it really is no surprise you were threatened with removal by security staff, not something done lightly.

But you have inadvertently highlighted a huge problem that the NHS has to deal with... patients attitudes to staff and their sense of entitlement this is driving very good people away to work overseas or to the UK's large private healthcare sector

I had a PA for my asthma review last week. She changed my medication but couldn't prescribe it.

Someone prescribed it and along the way someone had made a total cock up by removing my reliver and telling me to only take my preventer twice a day

And if I'd seen the asthma nurse I would have been out with my prescription