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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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?

Bit of both, if an organization is failing then it permeates the culture of the organization. A bad organization attracts bad staff or at best encourages bad habits and discourages good ones. This of course makes the organization worse and the pattern amplifies.

A failing NHS means staff are fed up and not able to do their best. Managers are fed up and know that even if they do their best it will be nowhere near good enough.

The answer is not just throw more money at the NHS, it needs a complete rebuild from the ground up and an acceptance that things need to get worse before they get better. (As opposed to things getting worse then continuing to get worse). A bit like an old building that's no longer fit to live in, sometimes no amount of remedial work will solve the problem, the building needs pulling down and a new one erected.

Actually if we could solve elderly care and obesity, we’d be in a much stronger position!

Apart from the usual A&E issues, the NHS appears to be working very well where I live (semi rural, near a small city), and I and family members and friends of all ages have accessed a range of services over the last few years. Each time I have gone in with low expectations and been pleasantly surprised at the speed and quality of service. So it can work.
The A&E issues seem to be a knock on effect of discharge issues, and that’s the elephant in the room - it’s social care that needs reform.

Ditto. My OH has cancer (non lifestyle related) and has regular awful experiences with utter crap NHS administrators when trying to make appointments, trying to get prescriptions, etc. He's had cancer and been on monthly treatment regimes for 8 years now, but every time he calls to make an appointment or check if his prescription is ready, he's talked to like a child who hasn't a clue. He needs the patient of a saint to have to keep reminding them that he does this every month and knows the date of start of treatment, knows when he needs the blood tests, knows when and where to pick up the prescriptions, when they try to tell him a load of bollocks that he knows is wrong. He always jokes he'd not be alive today if he relied on the NHS to "organise" things for him as nearly all the pre-made appointments are wrong and have to be changed, including stupidity like a blood test appointment AFTER the date of the chemo infusion whereas he knows it has to be 3 days BEFORE - yet the NHS administrators just make up random appointments with no regard whatsoever to the pre-ordained series of events that they have to be in. Not to mention turning up for infusions only to find that they've not been authorised, so left languishing around in the treatment room for hours until the bag finally appears and then the nurse can't start it because she's going off shift or the dept closes at 5 or whatever! They couldn't run a piss up in a brewery.

No, the 80 year olds I know don't have "myriad health problems". Of course their bodies are ageing. The diet growing up in the 30s and 40s of the last century was pretty healthy compared to nowadays. They had access to healthcare free at the point of use when they needed it.

The 50 somethings are in a worse state tbh and whatever healthcare we need, we have to pay for or wait and wait and wait.

I am so sorry your husband is experiencing that @Badbadbunny. I have a chronically ill friend whose life is similar.

It’s not the age of the poulation

iys the general health - too much weight and too little exercise - of the population

age is a red herrring

diabetes and it’s complication atakes a huge percentage of the bus budget ans that’s mostly down to weight

but blame the elderly for enjoying their lives , taking your money, your houses , and having the indecency to look old - right old inconvenience

People seem to think they are entitled to everything on the NHS. Our area spends a fortune on branded medicines, simple vitamins, dry skin lotions, sun screen, GF bread, nutritional supplements, hay-fever meds that can be bought for under a quid in pound shops...

People should expect to manage their own basic needs for food/ toiletries and not expect to get it for free! Patients should have to pay the difference if they insist on a particular brand of a drug. Nothing winds me up more than someone who has the spare cash to smoke/ vape/ have a top of the range iPhone being vile to NHS staff scream that it's their 'right' to get X,Y&Z on the NHS / why should they have to pay?

thank you for saying this, you said it better than I could.

Coeliac poverty is a real thing. Should poorer parents (or adults with coeliac disease and not much money) have to choose between damaging their guts or spending money they don't have?

One of the problems sitting behind a lot of health problems is poverty.

I am quite surprised at that. Many OTC medications should not normally be prescibed by the NHS or GP's. If its true that the guidance is being ignored, is there someone you can raise this with? www.england.nhs.uk/long-read/policy-guidance-conditions-for-which-over-the-counter-items-should-not-be-routinely-prescribed-in-primary-care/

It feels like there are a myriad of problems. But one I never see mentioned is that management don't, as far as my ignorant self knows, have strict (pay linked) targets for preventable deaths, only for waiting lists and spending. Maybe they do and I'm wrong, but if not, then that seems to me a major problem right there. Of course all three need to be carefully balanced.

I'd also introduce uber-style star ratings for staff from patients, also linked to pay. Might improve the appalling attitude from a minority of staff to patients.

Patient expectation is very frustrating. I recently had a heated debate with a patient who told me that it was outrageous that the NHS was not offering a particular service. The service they wanted (or more accurately, expected) was purely of an administrative nature for convenience. The cost of which would be astronomical and for this reason, it’s not funded because funds are going elsewhere, to actual healthcare. The patient was so aggrieved that something ‘so simple’ couldn’t be funded somewhere along the line, to make lives easier and mansplained to me about this not being acceptable in a privatised sector/industry - yes well sir, I’m not in that industry and this isn’t how it works? I also do think it would be a nice thing to have, but you can’t have it, because it costs too much

@LolaLouiseI agree with you totally. IMO people are now living longer than they should, certainly longer than the NHS can cope with. I think sometimes medical intervention has gone too far, maybe that’s why we are seeing so much dementia - because these people would previously have been killed off by other diseases that we can now cure.
It’s a whole other thread but It makes me angry/sad when I see over 80s refusing DNR not only because it’s such an aggressive procedure for people that old but also because it’s basically an attempt to bring back to life a person who has effectively died…

Would you say the same about the amounts spent on very premature babies who once would have died and now don't with medical intervention but often are left with lifelong issues?

So easy just to blame the old.

Yy to DNR. People have a really poor assumption of what it means- they think they’re trying to kill auntie Doris.

expectations of care as well. My sister’s mil has a brain tumour. When first diagnosed everyone was telling her she must “fight” and asking when she started chemo/was having surgery. In her 70’s she was starting to think their refusal to actively treat it was because she was old. The reality was it was benign, treatment would have likely killed her or worse, left her in a vegetative state. She’s still well now at 85.

in comparison a neighbour was in a similar situation. NHS said you’re well (it was an incidental finding scanning for something else) everything’s stable, chances are it’s benign so we’ll monitor and see. Family were appalled. Paid private for treatment, dead within 4 months from the side effects and interactions with existing issues. After spending the majority of those 4 months on an nhs ward treating the effects of the chemo.

People watch to many US medical dramas and think it’s worth treating everything.

@godmum there is a huge gap across the NHS between what should happen and what the reality is - millions of pounds of waste/ poor prescribing each month in the UK.... this is just in primary care... https://openprescribing.net/national/england/
https://openprescribing.net/measure/lpzomnibus/
don't get me started on medicines waste in hospital....

It's everything! The aging population and the continually progression treatments and technology is an enormous and often overlooked issue. But the NHS is also incredibly inefficient and very wasteful. We have put the NHS on a pedestal and given too much power to the unions. Previous governments have been too frightened to criticise the NHS because the media and the public think they can do no wrong. It is a pleasant surprise to see that it is a labour government who is making moves to shake it up. Let's see if they follow through on their words. But, whilst it can be made way, way better in terms of productivity and quality, it will always be hugely challenged as, quite simply, our tax receipts will never be able to keep pace with the progression of medicine and our aging population.

This is not a solution. Yes if you live a heathier lifestyle then you may not get some of the illnesses you listed. But then you live longer and most likely develop other illnesses which require treatment or care.

Agreed. The problem is the whole thing is built on free at the point of use which means it is so open to abuse and overuse. Other countries with universal healthcare have realistic expectations on their healthcare. Health cards for example. Non emergency use of an ambulance there is a charge. Free prescriptions for life on all prescriptions if you qualify for only one (so you get free insulin for example and then you get free antibiotics under the same exemption) is crazy. Using the A&E as a GP surgery…..We are collectively running the NHS into the ground.

The expectations of the British public are wild. People treat the NHS as a one stop shop were they expect all sorts of social issues to be dealt with on admission. People need to start planning for their old age before they get there so they have enough pension, live in appropriate housing, live near a support network etc

But generally the older you get the more you use the NHS. That's a fact. Unless you can provide figures that people in their 50s are heavier users of the NHS than people in their 80s.

More staff and less tech? This has to be a joke. I've just been hooked haven't I?! 🎣🤣

age is a red herrring

No it isn't. This isn't to blame older people, most of us will get there but there hasn't been a plan to address the demographics and set reasonable expectations. On visits to hospitals I've seen over 60% of elderly people occupying wards, many with dementia and this isn't the right place for them. Staff having to cope with nursing needs as well as issues relating to dementia, such as trying to leave the bed/ward etc.

A 91 year old day with advanced dementia was admitted as she had breathing issues. Staff were fully occupied trying to keep her oxygen mask on, when she didn't want it. She was highly distressed and wanted a glass of whiskey and to go home. I couldn't help but think hospital wasn't the right place for her and she should have been at home, having her whiskey and perhaps passing peacefully. Drs couldn't discharge her for fear of repercussions but it didn't feel like her best interests to be there.

Age is nothing remotely resembling a red herring.