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be met, over-diagnosis and medicalisation of some mental health conditions, a shortage of clinical staff, and outdated facilities all seem like far bigger problems.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

But why shouldn’t patients pay for missed appointments? I’m not saying legitimate misses. Or even a couple. I’m saying perpetually missing appointments. This is so offensive to Brits because any thought of any payment for anything is so offensive. And this is what can cause abuse of the system.

If they want my OM who has type 2 to excersise they need to pull their finger out and do the knee replacement hes been waiting six years for. A lifetime of manual work involving heavy lifting caused this. Now he just gets a big Fuck You and a load of gaslighting

At the sharp end, in hospitals, the main issue is older folk. If someone, somewhere, had the balls to sort out community based health care, most elderly could be managed at home, or in assisted living.

At the moment even care homes are incredibly trigger happy in getting in paramedics for poorly old folk. Treat them at home, or in their care settings, nothing good ever comes out of taking old folk into acute hospitals.

DH went in for Sepsis a few weeks ago, he was the youngest by some 30 years. Everyone on a trolley in that corridor was extremely elderly and on their own. Very sad actually.

It's the unnecessary tests I'm referring to, not small ailments, why scan someone's heart annually if they are unable to undergo surgery? Why scan to see how much worse their osteoporosis has progressed when they can't undergo surgery? The consultant has said they've exhausted the drugs available to them so why keep testing and scanning ? To what end?

It isn't plausible that this would work the way you clearly think it would.

For one, there would need to be an assessment process for what's a 'legitimate' miss. How many reminder letters or emails, what happens when the hospital transport hasn't turned up, that kind of thing. This would take staff and resources, at a time when the NHS struggle to recruit. Such decisions would also be subject to legal challenge, if only judicial review, and the usual involvement of elected representatives to try and influence the process. Dealing with this would cost money.

People who miss multiple appointments are also going to be those who lead the most chaotic and unsupported lives. We already know this. Which means they're the ones least likely to actually pay. Chasing that up costs money, and if you eventually have recourse to the court system, the amounts owed will spiral without any corresponding ability to pay it off.

It also means people in that position will avoid presenting to the NHS until their conditions worsen further and they become more expensive to treat.

This is one of those things that sounds nice in theory but doesn't stand up to even cursory examination.

And................once more with feeling!!!!!!!!!!!!!!
Do.you.also.think.it.should.work.the.other.way. Should the NHS pay patients for an appointment cock up caused by them

It's a reasonable point. If this ridiculous idea were implemented, it wouldn't take very long until people started attempting to invoice the NHS for the losses they've incurred attending a missed appointment.

Which isn't to say they'd succeed, but it's another reason why a charging policy would cause more problems than it would solve. It would become a political laughing stock very quickly.

Over the counter iron is very low power and usually if there is a genuine clinical need for iron tablets, then a prescription is the only way of getting the strength needed.

Yeah it does it works very well in other countries. And in some you have to pay a deposit if you miss a number and you get back the deposit if you attend.

Quick Google if my experience isn’t enough….
In Canada, while many healthcare services, including most doctor's appointments, are covered by public health insurance, patients may be charged a fee for missed appointments, especially if they don't provide sufficient notice of cancellation. This fee is not covered by provincial health insurance and is intended to offset the cost to the clinic or physician for the missed time.

France will introduce a €5 penalty for people who fail to turn up to doctors' appointments, Prime Minister Gabriel Attal said Saturday, April 6. The fine was one of several measures
announced by Attal to boost a health service struggling to keep up with increasing demands from an aging and growing population.

Yes, in the Netherlands, you may be charged a no-show fee if you miss a doctor's appointment without canceling it in advance, typically within 24 hours or a full working day. This fee is not covered by your health insurance.

In Germany, doctors can charge patients for missed or cancelled appointments, but usually only in exceptional cases and if they can demonstrate financial loss. A common scenario where a fee might be charged is when an appointment is cancelled with less than 24 hours' notice, or if a patient has a pattern of missed appointments.

In Australia, patients may be charged a cancellation fee or a "no-show" fee for missed doctor's appointments, especially if they don't provide sufficient notice of cancellation. The specific fee amount can vary between clinics, but is typically between $50 and $100. If you repeatedly miss appointments or fail to cancel, the clinic may refuse to schedule future appointments.

Legal euthanasia will solve many of the problems the OP outlined, especially once the so-called 'safeguards' have been reduced and diminished over time. Perhaps once folk reach the age of, say 50, we could start the process of slow brainwashing to persuade them to undergo the procedure by their 60th?

Quite. My sister is a nurse and the health advice they give to people re diabetes/obesity etc is largely ignored as "it's too much like hard work" and instead everyone wants dome drugs to do the hard work for them.
Thus taking endless NHS appointments/time/drugs/costs meaning less care for people that actually nee dit.

Which valve? If aortic then they may be offered TAVI if necessary

None of this unsourced googling addresses any of the points I made about the problems. The whole point is that implementing a system like this is one thing, staffing it in a recruitment crisis whilst also making it pay for itself is quite another.

So show us how it would be staffed and pay for itself in the UK. A country with our labour market and shit postal service. I'm sure these Band 4 ish positions having to be done on site with no flexibility would be incredibly popular!

No, full strength iron is available if you ask for it - you may get asked why you need it.
A lot of money is wasted on various skin products moisturisers and soap substitutes - my DSis comes to visit with the children and they always get left (don't worry I'll ask for some more)

Also if a fee to see a GP was implemented people would expect to be seen on time..........not 45 minutes later

Due to her other co morbidities and very low weight, I believe this has been discounted too.

Lol fail to see how this was my fault. I first found out about it when a letter arrived at my house stating i have anaemia and need to ring the gp. A few hours later i then received a phone call about it. I did go to the pharmacy with the letter that stated what doses i needed and was told they wouldn't prescribe that without a prescription feom the gp.

So again, blaming the public for the nhs.

I don't think anyone is 'blaming' the old, are they? Blaming them for what?
The obvious difference is that a premature baby has potentially its whole life - and tax payments - ahead of it, whereas a 90-year-old is, to put it bluntly, a drain on finances.
I have a 87-year-old mum and a 93-year-old FIL, both of who have lots of things wrong with them and are very needy of GP, specialist and on occasion hospital care.
What's the answer? The problem is, we are all living - or existing - far too long now, thanks to medial intervention that in some cases should not happen.
I also have to take issue with the assumption all over this thread that if you take care of yourself you will not be frail in your old age. Spoiler: you will.
My FIL walked at least 60 miles a week (including the Himalayas in his late 70s), went to the gym daily, didn't smoke, barely drank and watched what he ate. He came out of hospital this week after yet another fall.
Taking care may help you until you reach 80, but after that, all bets are off.

@LolaLouise i pretty much wrote your post word for word on a similar topic last week.
I think the NHS needs to be run much more like a supply chain also. The NHS is far too disjointed with too much outside noise on the flows. For example somebody goes to a GP with a pain in their shoulder. Normally a GP would write a referal using their system to a physio. Someone then books an appointment for the patient who may not attend. Why do we not have a system whereby the GP can share the system and books the patient with a physio whilst the patient is sat there in front of them? Cuts down the lead time on the patients condition worsening. An appointment letter doesn't go missing or an email to an unused address. The patient can choose from an appointment from a list that the GP can see.

That made me smile.

On an entirely separate note I wish we had the option to end our lives.

Yes for the first visit then can buy them yourself like I do

I know you are being sarcastic but using valuable NHS resources keeping people alive for longer than they actually want to live for is something we need to consider in all of this. Believe it or not some people (like my darling grandfather) are capable of making a fully informed decision that they don't want to go on any longer. Death for everyone isn't the worst case scenario but I imagine that you simply can't accept that. You will overrule his desires and rights because it doesn't sit comfortably with you and you think other people potentially be coeerced overrules all of our rights to decide how and when we die.

It is even worse because not only as a family are we all left with the most harrowing memories of my grandad and him asking to die, but this would have cost money that now can't be spent on cancer diagnosis and treatment that is woefully underfunded and the reason why my grandad was in this situation in the first place. Late detection, delays in treatments etc. All of these things would have benefited from the money that was used to keep my grandad alive against his will.

No, OH needs the highest strength which can only be given on prescription. It was a right battle to get it. His oncologist couldn't prescribe it. His GP just referred him back to the oncologist. The hospital pharmacy confirmed it had to be on prescription.

Good luck with that idea (with which I heartily agree BTW) when there are idiots who will scream "The NHS is being privatised!" at the first hint of any such reform.

[Looking at you P. Toynbee.]

I 💯 agree here. I work in the NHS and the stuff I see going on in front of my eyes I could sell stories to the tabloids.

1. Doctors themselves showing favouritism

with fellow patient doctors- patients (who are doctors) skipping waiting lists for procedures or appointments purely because they are friends of doctors. This can lead to patients being cancelled off procedure lists (and being told an emergency came in!).

1. patients who are vocal and write complaints been given financial compensations for unreasonable issues.

1. Some services are outsourced eg pharmaceutical companies and there is a lot of wastage with massive expense and could have been easily prevented, These companies are making mega bucks from the inefficient NHS.

The list goes on… it’s a total shit show. I work in one of the biggest London hospitals and it’s just completely corrupt it frustrates me on a daily basis.