What is it people want with the NHS?

[stripyleopardsleep]

Had a lunch gathering this weekend and as often is the case, covid comes up and the vitriol towards the NHS was quite a shock to me.

• NHS is awful, not fit for purpose
• NHS staff are lazy, time wasters
• NHS staff waste appointments and don't know what they're doing
• NHS staff waste money, they shouldn't get any more
• no one wants any more money going into the NHS

The discussion went on....

I'm a hospital worker who has worked through the pandemic and I was quite bruised to hear what they thought about my work life and colleagues who I believe work incredibly hard in a huge unwieldy organisation.

But no one could say what they wanted? What would make it better? What does everyone want from the NHS and how can it be achieved?

@tangyandsalty

I would like the nhs to be funded properly, so that they have enough staff that it's not always on its knees. I'd like those staff to be paid a good wage so that people want to actually go and work in the nhs. I would happily pay increased taxes for this to happen.

Isn't that pretty much what anyone would want?

Not according to the people I was with - they didn't believe the NHS should have a penny more because all the money they have is wasted anyway....

This has been an interesting read, thank you all for replying.

There's so much to change but HOW? Where does anyone start with such a massive organisation. I can't see it changing drastically in my lifetime.

I would like the NHS to provide basic care. But we must define basic care as it can't ever be an unlimited bottomless pit of money unfortunately.

I want it run efficiently and be accountable like any other business. By accountable I don't mean profits but it should not waste money and look for ways to improve care for the money it has.

We need to stop thinking of it as 'free' and then maybe people would respect it more in terms of not missing appointments but equally some of us have received appointment letters last minute which doesn't help.

@wanttomarryamillionaire

Your comments about the public are completely fair. In response, I would ask why the NHS isn’t organised with a 24/7 GP clinic & pharmacy on the same site as the A&E dept so that a nurse or paramedic could triage patients at the door and direct those presenting with colds / toothache / period pain etc etc to the appropriate place? The words ‘not rocket science’ spring to mind….

A normal system like in other countries. Where if you need to see a doctor you can. If you need an operation you can have one. Where its not free for the whole world to use.

The nhs is great in an emergency and serious illness. It may have long wait lists but again something that can be fixed will get done.

Where I think they are poor is chronic conditions (particularly pain conditions)/neurodevelopmental disorders. I don’t think this is an nhs problem per se, but a thing in medicine (although if say you can afford it I can envisage you would have much more investigators and options).

If they can’t see something on a scan or tests, if they can’t fix then you should stop wasting their time. Some people criticising will be the sort that criticise everything, but I envisage many feel utterly abandoned they or their children are living with symptoms that impact the quality of their life and are being told to just get on with it.

I think that a lot of people working within the NHS work hard and I respect what they do but that doesn't stop those comments being true. They DO waste appointments, it IS full of dead wood, GPs WON'T see their patients, and it's generally inefficient. We need rid of it really, it can no longer deliver what it promised at the start so it fails miserably trying and costs a bomb.

No hard feelings towards staff though.

Also the idea that it's the 'envy of the world' - not true.

Not the staff's fault at all, but we need significant and wholesale reform.

We need proper, nationwide conversations about ...

What we want the nhs role/remit to be?
How we're going to fund that?
What are our own obligations to the service (to what degree do we start taking responsibility for poor decisions about our health)?

Huge, necessary questions that need to be answered if it's going to remain viable.

I think the NHS has good staff and bad ones, like anywhere. I've certainly had my share of crap GPs however I did have a wonderful health visitor.

We need to lose our sentimental attachment to the NHS. Perhaps replace it with a system which is partly funded through health insurance but free to those in greatest need. There have been problems for many years with the quality of provision but covid has sped up the decline.

I feel for you OP but try not to take it personally, the vast majority of the population would hands down support the staff themselves. I am ex-nhs and have seen the wonderful, caring, amazing side (as well as the running on empty, give only the basics, tired, over-worked, under-resourced staff leading to neglectful care side)of the NHS....and have had both good and extremely negative experiences as a patient and a carer BEFORE Covid .I do totally agree with the first point(but not the others).... the NHS is truly no longer fit for purpose . I ended up working in cancer care and our cancer outcomes are poor compared to other equivalent nations and that is mainly to do with the convolutions of the initial referrals/diagnostics and follow up process. I never thought I'd say this but we do ,sadly ,need to move to a form of insurance /direct- contribution based scheme as we cannot consistently meet the needs of patients who rightly expect more. How on earth can any GP practice cope well with the current practise lists....all the preventative health care, well timed health care ,time to actually listen to patients needs goes out the window. Hospitals are faced with a get people out asap, bloody hell these people are bed blocking as there is no one to take them/support their home care.... we can save peoples lives but can we provide the rehab/support to allow them to return to a good quality of life? there have been amazing achievements in extending peoples lives with various new drugs, treatments, surgical techniques but it is meaningless if that doesn't correlate with improved quality of life

I think the problem is everyone think the nhs is for their own personal issues so boob jobs, IVF, weight loss surgery!

It should be for serious illnesses only so for Heart attacks, strokes and cancers Etc. If you have fertility issues because of serious illness then yes of course we should fund it but we can’t fund every little problem everyone has unfortunately as we can’t afford it!

I feel genuinely sorry for people who can’t conceive or need weight loss help and many of the other non serious illnesses the nhs are expected to deal with but we just can’t afford it (my best friend falls into the struggling to conceive category but even she admits how can the nhs keep affording it) plus the salaries of the top management should be capped and not go over say 100k and the HCA and nurses should be on more than they are on now especially if they are on call or do unsociable hours! I think the whole organisation needs a reshuffle and made to focus on serious illness for everyone like it was originally created for! Mental health and sickness is high in the NHS and that too needs investigation as to why? Is it bullying, pressure or people just knowing they have a good sick package so use that to their own advantage? Private sector companies have a very different working method to the nhs so maybe some of that needs to be installed into the public sector

I obviously use the nhs and think the work that do is incredible but it also needs reassessing to find where they can make serious changes to a broken system

As an NHS worker I love the NHS and am incredibly proud of everything that they do and how they responded to Covid.

As with anything you will get complaints and lots of ignorance, particularly people who don't know or understand how it works.

Personally I have a relative who has received amazing care for a long term condition in the hospital during Covid. I have managed to speak to my GP about my children and for my self.

The biggest impact on the NHS is the government and the ridiculously changes in policies all the time or the performance targets.

Also people have no idea what it would be like if we had private health care like other countries

I think a small charge when booking an appointment, that is reimbursed if you show up, is wise

I used to do admin for a consultant clinic.

What was worse than the no shows were the idiots who’d turn up late or very late with a wink and say oh I know I’m late, hospital appts always run late so I figured I wouldn’t have to wait as long.

That would throw the whole clinic out as we’d have to slot them somewhere, which made everyone late, then they’d snigger and say ha good job I didn’t come on time, told you you’d be running late!

In the end we’d send out appointments but do first come first served on the day. If you got there early or late you’d get the next free consultant.

The no shows at least got discharged from clinic and gave us more time for the patients that do turn up.

I would like a shitload more money going into the NHS and I hope it would fix it because, despite the valiant efforts of those working in it, there’s only so much a basically skeleton staff can do. When my terminally ill MIL waits six hours for an ambulance on a freezing night, gets taken to the wrong hospital and her children are met with snippy choruses of well, I don’t know who sent her here, not my fault we don’t have a bed etc then it’s not fit for purpose.

I want medical treatment for myself or my loved ones in a timely manner.

I don't know what to say about the media accusations about NHS being a bloated and inefficient organization that wastes money because I don't work for it but I hear that one regularly.

I know that the NHS generally treats you once you're sick rather than investing in care that will prevent the sickness in the first place and that is a problem- especially if preventative medicine is cheaper anyway.

Government have set up this discourse as they are trying to shift the overton window n favour of privatisation.

@Lamentations

Also the idea that it's the 'envy of the world' - not true.

Agreed. If it’s the envy of the world why has no other country adopted the same model? NHS staff are by and large fantastic, committed, able and incredibly hard working, but they are working in an outdated system. The NHS was set up when people didn’t live as long and treatments were far more limited (and relatively cheaper). The system now needs a complete rethink however no political party is brave enough to even suggest this.

Copayments.

It works for the vast majority of the rest of the world, but they can be tiered for GP appointments perhaps from say £35 for those on minimal incomes (as per Ireland) up to full market cost of a private GP consultation for those on £45% income tax.

Perhaps £100 for a hospital outpatient clinic bottom tier, £300 top tier.

£80-450 for A&E attendances as they have to be less appealing than GP appointments

£40-£100 a day inpatient stay, a partial rebate if providing own personal care (in much of the world family do personal care or buy it in, the nurses do drugs, ivs etc and look after larger numbers of patients).

Maybe £100-£1000 depending on complexity of surgery.

Prescription charges that can’t be dodged by the vast majority of the population.

In one swoop a load more funding is generated without the political toxicity of raising taxes.

But it’s the NHS and it has to be “free” apparently.

I want for it to be funded and staffed properly (frontline not management consultants) with joined up streamlined links with elderly and social care which also needs proper funding and staffing. I want it to have proper planning in place for how society demographics are changing, mitigations earlier in education to help children and families live a healthier lifestyle than they are now.

Theyre right that the NHS is not fit for purpose. However comments about the staff being lazy, wasting money, not working hard etc are obviously rubbish. I haven't ever heard this sort of opinion from friends of mine so maybe its just the people you know OP.
Almost everyone I know has a friend or family member working in the NHS, I wold be amazed to hear those kind of comments. Apart from the fit for purpose / underfunding ones which are not the fault of the staff but the government.

As a former NHS worker I want it to be a 7 day operation, and not just Mon-Fri. Most Doctors work mon-fri 8-4 of 9-5 and its a very limited number on duty after that. God forbid you get ill in a weekend and there is virtually no one working.

There is huge amounts of waste and 10,000s of people doing nothing but pushing bits of paper around or going off on long term sick.

We hire in locum/agency consultants and pay them £150 an hour and then also pay their accomodation costs on top of that.

Its not underfunded - its badly managed and its systems are a total joke. There is insane amounts of waste and if it were a private company lots of people would be sacked.

Yes @FitAt50 what you said

It's become far too fragmented with too many pen-pushers who've lost sight of the prime purpose, i.e. to treat staff, and instead concentrate on meeting targets, and sod the patient.

My OH has cancer. It's a monthly battle for him just to get a blood test which the haematologist needs before issuing the monthly chemo prescription. Haematologist tells him the GP surgery "will" do it, but when he phones to ask for it, they refuse telling him it's nothing to do with them and to ask Oncology dept instead. Every sodding month, the same things happens. The oncology dept and GP surgery won't communicate directly, so it's a battle of wills with OH in the middle until one or other relents and gives him an appointment. Every sodding month.

Same when the blood test throws up something like an iron or calcium deficiency. Haematologist tells him to ask for a prescription from the GP. GP surgery refuse and say it's the oncology dept's responsibility, so he has to ring back to feed back, and so it goes on.

There's just no "joined up thinking" - every dept seems to want to pass the buck to another dept, made worse because they refuse to talk to eachother directly.

OH has mentioned this repeatedly to the haematologist but she just shrugs and agrees it's a nightmare system, but she keeps referring him back to the GP.

Honestly I’d like the service totally dismantled. It may have been suitable for Britain 70 years ago but it no longer is. I’d much rather see a German system, or honestly anything else. The NHS terrifies me, it’s so sub standard in patient outcomes that it makes me want to leave the country purely so I can access better healthcare. I pay an extortionate amount of money every month for private healthcare for my family and I, and I would only use the NHS as a very last resort if no private options. It’s the worst part about living in the U.K. for me and I do everything I can to mitigate the risk that comes from it.

I realise I have very extreme views and never voice them except to my family.