To think the NHS’s biggest problems aren’t management but an ageing population, unrealistic expectations and over-medicalisation?

[NaiceBlueSquid]

People often blame NHS management for its ongoing crises but isn’t the real issue much deeper? An ageing population, increasing patient expectations that can’t realistically be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.

AIBU to think that while NHS management could probably be improved, it’s nowhere near the biggest problem the system faces?

Yes this is how I feel. Management is an issue but this is a big distraction away from the real issue which is expectation vs reality. I am NHS and have witnessed people having an unhinged meltdown that public systems do not work instantly like Amazon or Uber. This is not to say I blame people for having this expectation I think in an on demand society today it’s actually very difficult to process the concept of having to wait

The European model for healthcare is what’s needed. The NHS is not fit for purpose

I agree about unrealistic expectations: the NHS was set up to serve a much smaller population which died a lot younger and had far less complex needs. It hasn't evolved to keep pace either with what the population demands or what medical science can offer.

I'm not sure I agree on mental health though. If anything I think there is under-diagnosis of medical health conditions: there certainly is under treatment.

I think the NHS needs to be radically reimagined and probably brought into line with what European countries have. But it will have to become even more crisis ridden before any political party will admit that.

The European model is having the same problems with an ageing population.

We need the European funding model. We should have to pay to access some services. Then appointments wouldn’t be wasted.

What is most needed is some people taking responsibility for their own health. I have lots of GP friends who are very frustrated that so many people drink and eat all the wrong things, then expect the NHS to sort out the mess they get themselves into. If you eat lots of junk and are heavily overweight you are going to get type 2 diabetes and all of the grim knock on illnesses that goes with it.

Overpromising: the NHS was always only intended to provide "basic" medical care, not the trillion specialisms now on offer.

I work in the NHS and it is very top heavy with management.
But I agree that that’s only part of the issue…

1. The European model would work better and make people hopefully less likely to overuse the NHS just because it’s free and they can.
2. Patients need to take more accountability… the number of patients that are obese, smoke, drink, don’t exercise etc and are then surprised they are unwell. If everyone got the basics right, there’d be a lot less ill patients!
3. So many missed appointments! There should be a fee for this
4. Health tourism is frustrating and very common in my department

There are loads of other factors, but those are my main few 😂

@Colango public systems do not work instantly like Amazon or Uber

This is a good point. Public health is a huge problem and many don't help themselves. However, I do think that the NHS could also learn from these companies (and other retailers) in terms of their joined-up systems.

But, for me, the biggest issue is a lack of consistency in staff attitudes - many NHS staff are professional and polite, but some are ignorant, lazy bullies. I've got cancer, lots of appointments, and I experience both far too often.

So, it's a basic, 'shop floor' management problem. Managers who are too afraid to challenge their subordinates for fear of sanction. Managers who can't manage sickness and absence, casual bullying, etc... this is basic leadership.

I'm a patient who does everything to help themselves. I'm fed up of it.

What is most needed is some people taking responsibility for their own health.

This. If everyone took the NHS’ advise they’d be less demand. People act like a trip to the GP should be some sort of health reset. I think this is true of society generally, everything is a problem for someone else.

@MidlifeWondering part of the issue with health tourism is the NHS aren’t equipped to assess entitlement at the point of service. If you walk into a private hospital, and no doubt aboard, your ability to pay is established prior to receiving treatment. They also have no teeth in debt recovery.

It's perfectly possible there's a management problem AND all the other stuff you know.

For one thing, in a complex situation, you tend to get stressed managers with no other credible job options (plus a few saints). Who'd want to manage a failing service?

Health is approx 1/3 environment 1/3 behaviour 1/3 genetics. People can do little about the genetics (except not reproduce I suppose), not much about the environment (in which I would include the quiet privatisation of a large chunk of the public sector) and I refuse to blame all ill health on behaviour. There's a huge element of luck.

The first of my elderly dad's friends to die (in his 50s) was the teetotal, veggie, cyclist. Most of the smoking drinking fun loving types are in their 80s now.

I think part of the problem is that the NHS is reactive because it is resource constrained. My endometriosis was diagnosed privately after years of back and forth with the GP that just gave me strong painkillers (which may well have contributed to my developing a form of IBD).

A family member has just been diagnosed with advanced prostate cancer in his late 50s, regular screening may have picked it up at a much more treatable stage.
Things that could be spotted and treated earlier are left until they reach crisis point when the treatment is more extensive and the outcome less certain.

You hear plenty of stories of people struggling to get referrals and then waiting ages when they do get them for an appointment. By the time they are seen some of them will have deteriorated and require more time and money to treat.

The big issues for me are underfunded social care and a lack of effective public health initiatives.

Demographics is certainly an issue. There's a lot of magical thinking about dependency ratios and a naivety about what an ageing society looks like.

It’s really easy to blame people for getting ill. Until you get ill yourself…. And honestly it’s not a road that leads anywhere good. Added to that, in my experience the specialisms, once enrolled in the treatment, are very good- it’s the general wards, GP services and Emergency that are failing.
I don’t know if it’s the individual managers of departments that’s the issue. But the overall high up management, at the point where processes could be joined up and change managed properly, then yabu.
The fish rots from the head.

The NHS is a victim of its own success. My dad was cured of cancer in his 60s and also had heart valves replaced. His normal life span would have been 60s but he's now late 80s and a heavy user of the NHS. He has lots of friends and neighbours with a similar story. Generally the older you get, the more heavily you use the NHS and we are living long lives now (generally)

There absolutely is a management problem within the NHS. I have had wonderful NHS care, but have also come across really poor attitudes. Primarily from admin staff.

The ageing population is also an issue, there are a variety of others which are also putting a strain on the NHS. They are separate issues to the management problem and don’t make it less of an issue though.

This. And a European model. If we want world class services, we have to be prepared to pay more tax.

I have extensive experience of the NHS both as a retired nurse having worked in a variety of roles from student nurse right up to senior management and more recently as a patient because I now have cancer and chronic pain/ disability.

I am constantly appalled by the judgement made by uninformed and smug people about others so called “lifestyle choices” draining the NHS.

The vast majority of patients I have seen who are overweight or smoke do so in large part because of enormous stresses and disadvantages in their lives.

Food or cigarettes are a (just about) affordable comfort when you are, for example, looking after your severely disabled child or elderly parent who has dementia. Or you have lost your job in your fifties and can’t find another one despite your best efforts. Or your husband has buggered off and left you with nothing. Or your childhood was an endurance test of abuse which left you chronic trauma and because therapy is unavailable you have to make do with chocolate.

It’s all very well for too many mumsnetters sitting a lovely home in a leafy idyll congratulating themselves on sensible choices and accountability after their latest gym session over a bowl of quinoa but don’t make the mistake of thinking life is equal.
It isn’t.

It can be both.

when I worked in the nhs it was top heavy. Lots of non-medical management making decisions with little clinical knowledge.

Blair’s labour threw millions into an IT system that was never fit for purpose.

my own department saved millions in preventative and effective care, but as it didn’t “make” money, it was dismantled.

costs are saved on clinical staff. Which is counter productive. The above non clinical management see the dept working with one less staff member, because everyone else steps in to provide cover. So they don’t replace that member of staff. Money saved, but now that dept is running on empty, staff are burning out and no one has the time to do a proper job.

imo the nhs needs staff. Lots more staff. From admin and HCA up. Start employing medical and nursing students- we had a particularly good manager once with the foresight to employ 3 students. They covered staff holiday at peak times, and got through a shit ton of admin backlog, without needing to employ full time staff. After a couple of years other depts would borrow them to get on top of their admin too. But then he left and it never happened again.

sod all the high tech computing and shit that is supposed to make staff more efficient. Just employ more staff.

I agree. The NHS is no longer fit for purpose and has to be changed. Lots of European countries have far better health systems.

But I bet those fun loving 80 year olds have myriad health problems.

Ive worked in the NHS most of my adult life. The aging population is the biggest issue within the NHS. A&E is the vast majority elderly, urine infections/urosepsis, pneumonias, chest infections, hip fractures, falls with a long lie, and unexplained new confusion generally from an infection yet to be idetified, care homes sending in patients that they cannot care for and now require nursing, they will send them in and refuse them back etc etc etc, account for well over 50% of admissions.

They the go to wards, often not fit to meet their needs due to staffing, and are unable to be safely discharged. This then backs up the entire process, right down to ambulance wait times as they are all holding outside of A&Es, as theres no beds to offload into, as A&E is full, because they cant transfer to wards, because patients cant be discharged. Wait times at the front are the same, cubicles filled with patients waiting for beds, no theres no where to see a relatively minor patient from the front.

Wait times for referrals, again, because so many people are waiting. because the amount of adults has increased. wait times for surgeries constntly delayed due to bed shortages.

GP's surgeries, becase more and more people are in areas needing to see GPs. hospital admissions go up as people attend A&E, or they have waited longer to be seen and then require inpatient care as a result.

We have too many people and not enough rescources to go round. So we need more resources.

Now the first issue is solvable, with better social care, and reopen cottage hospitals, nurse led units for patients not well enough to go home, but not requiring Dr led care. These hospitals were great for recovery, with communal dining and social areas if the patient wished. But they have al but closed down now. Its would relieve the pressure on acute inpatient care massively. The cost of them may be massive,but its vital to healthcare of all. In turn we would see waitlist for surgeries reduce, as beds would be available. GP visits reduced as on going health conditions would be seen too quicker. Less failed discharges and ultimately re-infections and falls would all reduce.

But it would have to be funded. Which seems like in impossibility at the minute.

People often do have health problems in their 80s due to their ageing body. My dad has and he's lived a healthy life. Never smoked, slim etc.

I’d go with both. DM and DMil are in and out like a fiddler’s elbow with one complaint or another.

At 85 and 81 they are doing really well and are unreasonable to expect to have the body of a 50yr old!

The 85 yr old keeps going but refuses the offered treatment. She probably needed anxiety meds decades ago, truth be told. The 81yr old has had decades of severe health issues and dementia, but somehow keeps pottering along complaining at everyone’s inability to keep up with her or indeed the limits on her own energy levels.

To be honest I get very frustrated with them asking for support that I haven't got the capacity to offer. I wish they’d slow down a bit!