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?

The nhs is funded better than any other European healthcare system. There is huge waste in the system, staff sickness, payouts due to bad practice leading to scandals. Reform is not popular or easy because the nhs is so large and it has a religious like status. It needs to be reformed but I doubt any politician feels they can touch it with a barge pole.

People are being primed to turn against the NHS are argue for privatisation, so when it gets privatised it's because the public want it. Like British rail and the utilities companies.

And then, when it goes tits up (and it will) the government can say "well you wanted it".

And whilst there are a number of semi privatised systems across Europe which work reasonably well, they aren't being considered by government. The ONLY model being considered is an American model - how do I know that? Because they only companies courting the NHS big wigs and government are American insurance and pharmaceutical companies.

The medical staff are mainly wonderful.
The management staff are wanting (compared to private management).
There are a lot of perks in pensions, holidays, flex working etc that other people don't get.

Most of the irritation at the NHS comes from the consequences of bad funding. It's so bad now unless it's life or death or very severe. Things which would have been treated in a few months are now either not tested or the wait is ridiculous. My DD (13) has a bad knee referred in Sept 2020 and cannot do any sport. She can walk so it's ok. She is due to be seen in Jan 2022 (we shall see).

And I'm absolutely not against NHS reform. I think it needs a huge overhaul BUT reform DOES NOT mean privatisation.

@GoodnightGrandma

My DF had an appointment at our hospital one evening, it was to help catch up from Covid. Three patients turned up, the others DNA’d. They didn’t even bother to cancel their appointment.

A couple of posters have mentioned people not attending appointments and not cancelling. The system of randomly sending appointment letters and making it virtually impossible to call in and change the appointment is archaic and needs to change. I want my appointments of course, but I also want the option to schedule them at a convenient time. There are some online booking options but it’s not the norm. I’ve also had a very rude letter about missing an appointment when I’d taken the only available option and left a message on the number they gave me after wasting a considerable amount of my own time trying to ring and speak to someone. Unacceptable.

@Badbadbunny I'm sorry that's happening, it sounds very stressful for your DH and the absolute last thing he needs. It's terrible.

I work in it, and it’s not fit for purpose, sadly. Enormous amounts of money are wasted because it’s so big, unwieldy and inefficient. Most NHS staff are hardworking but by absolutely no means all. And it was designed for a completely different world to the one we now live in. No amount of money pumped into it would ever be enough … it’s a leaky bucket. And yes we need to have a frank, national and dispassionate conversation about the future of health care in this country, but that’ll never happen because it’s such a sacred cow. No politician would ever dare to instigate it. And that scares me because without a coherent plan we’re sleep walking towards something no one wants … so that’s what I want for the NHS. A coherent plan for its future, because it can’t really continue with its current model. COVID has shone a harsh spotlight on this, but it was inevitable anyway.

@HaaaaaveyoumetTed

People are being primed to turn against the NHS are argue for privatisation, so when it gets privatised it's because the public want it. Like British rail and the utilities companies.

And then, when it goes tits up (and it will) the government can say "well you wanted it".

And whilst there are a number of semi privatised systems across Europe which work reasonably well, they aren't being considered by government. The ONLY model being considered is an American model - how do I know that? Because they only companies courting the NHS big wigs and government are American insurance and pharmaceutical companies.

Comments like this is the issue. People have been saying the nhs is being primed for privatation since I was in my 20s. We need to have an open and honest review and look at all the issues that it has and stop saying its underfunded and needs more money.

I wish we would just copy the french system - its so much better.

Comments like this is the issue. People have been saying the nhs is being primed for privatation since I was in my 20s. We need to have an open and honest review and look at all the issues that it has and stop saying its underfunded and needs more money.

An open and honest review IS needed. But it isn't happening. Instead small bits are being sold off to private companies.

I absolutely agree that failure to address the issues is what will lead to privatization.

‘Privatisation’ is not a swear word.

Like millions of other people, I have myopia. I get excellent treatment from high street opticians at the time & place of my choice. I can purchase my glasses at reasonable, affordable prices, or I can spend more on designer frames if I choose. Competition & choice in a free market makes me a happy & satisfied customer.

Why can’t similar models work equally well in other sectors of healthcare?

Funding. And a fundamentally different approach to treating mental health that doesn’t involve the utter crap that is IAPT.

@PlanetNormal

‘Privatisation’ is not a swear word.

Like millions of other people, I have myopia. I get excellent treatment from high street opticians at the time & place of my choice. I can purchase my glasses at reasonable, affordable prices, or I can spend more on designer frames if I choose. Competition & choice in a free market makes me a happy & satisfied customer.

Why can’t similar models work equally well in other sectors of healthcare?

I wouldn't mind privatisation IF it wasn't an American model. Healthcare costs are the number 1 cause of bankruptcy in the USA. People have to choose between paying their mortgage and paying for their kids insulin. And we aren't looking at other models, it's only American companies interested in us.

The NHS employees 1.6 million people - that’s nearly 3% of the population. I think about 1/3rd are medical staff / doctors and nurses. A fair few of the rest are admin. The NHS is not under funded in my view - it is a money pit that absorbs far too much of the public purse. It needs a huge structural overhaul. When people complain about the NHS - they usually complaining about the wait lists for treatment and how much money it absorbs. Not to be confused with the lovely dedicated people that work there. It’s not their fault they are working for an organisation that needs a massive structural overhaul. I believe the government is wrong to put up national insurance to pay for more funding to reduce waitlists. Waitlists won’t improve.
Someone needs the dedication and strategic thinking to roll their sleeves and overhaul it. But previous attempts to do this have been met with public opposition. The general public are used to having specialist treatment - maternity wards / heart specialists etc on their doorstep and are outraged if they gave to travel to access these services. There are over 400 trusts. Every trust has separate administrators - that leads to waste and duplication. In fact we would all be better off travelling to larger regional hubs with specialists - the treatment we would receive would actually be better. The other issue is the large numbers of old people that are repeatedly staying for weeks or months in hospital due to lack of home care & elderly care in general. The NHS needs drastic measures. But the public need to get behind these measures that might necessitate a change in what we are used to. But it’s a huge mess & no one is even attempting to fix it.

What I want from the NHS is for it to be adequately funded, and for that funding to be managed properly to provide value for money and good care. I don't think either of those things are happening. I'd like it to be what it should be - a service for health, not a political battle ground, so decisions on funding and policy made on health needs not on what wins votes and then a failure to deliver.

I laid on the floor with an elderly resident who had fallen for nearly 3 hours a couple of weeks ago, they were fine, but I'm not qualified to say that, so we had to go through the ambulance service etc. I started off wishing the ambulance would hurry up, but then actually I started thinking that were there an appetite to train people like me better, to deliver more than immediate first aid and then hit the three nines, a lot of pressure could be lifted from the NHS. If we had better back up services like social care, with better training in things like catheter care, diabetes (insulin injections), wound care etc, evaluation of falls etc then we'd ease the pressure on NHS community services and people may not need to be admitted to hospital at all, or can be discharged faster. Social care could support people more and that would ease pressure on NHS services, the problem there is social care is mainly privately owned and obviously to train care workers in those things costs money and would mean increased wages which would come out of profit - as it is these services are provided by the NHS, so likely there'd be an argument about who pays.

I'm sorry you had to listen to those things OP, it's soul destroying to hear such negativity when you're working so hard. I feel the NHS is like a sinking ship and the majority of the staff have been given tea spoons to bail the water out which they're doing with dedication and commitment, and then being shouted at by the passengers and Captain for not doing enough while some of them bail water back in with buckets.
I think we also need to have a collective attitude change towards anyone in a public funded service, and realise that they don't just exist to service the needs of the population and nothing else. We should of course, expect them to do their job and do it well, but we should also understand that they are human beings who signed up for a job, not to give every single part of themselves to 'the cause'.

It's sad that people turn like this, if the staff and the users joined forces then change could happen, it could force change, but instead they're pitted against each other and those who need to make the changes from the top slide out of the picture quietly and let the rest of us squabble.

I just want to get a GP appointment. It doesn't have to be face to face, just an appointment. I haven't been able to get one in a year.

Every morning 50 people are placed into a phone queue for a few coveted slots, which go. If you're at work, the wait time is long.
If you call later in the day, the average wait time is obe hour and then the receptionist tells you to ring back at 8am for appointments.
There are no e-consults.

I can't go to the surgery to wait because I'm at work. Also, the surgery I was at cloaed permanently in lockdown and patients were transferred to this sister site three miles away. I can't just 'pop' down.

Is it too much to ask to be able to get sn appointment?

I just want a health service that wouldn't tell my husband that he can't get an abscess removed cos there is no capacity which meant my DH had to get it done privately. Shorter waiting times at a& E. Not waiting in pain.

It doesn't even need to be free at point of service, just affordable for everyone. Universal healthcare is a right, not 'free' healthcare. It just means that healthcare should be generally affordable and that the people without money should be able to access it with government support/subsidy.

@Mouseonmychair I have lived in 2 other countries with aging populations- Singapore and Germany. Neither have the wait times that the NHS has. Both countries have excellent and prompt healthcare. People in Singapore and Germany live longer than in the UK.

Two very different models- people in Germany spend more on tax and health insurance; Singaporeans have compulsory health savings schemes and health insurance and a complex system of means tested subsidies and price controls on drugs (a lot easier when you don't have a local pharma industry!). The point is that the funding is more liquid and actually goes to the medical care. We need to spend more but we need to spend it actually on the medical treatments; I think a German model is probably more suitable for us.

With respect to people not showing for appointments, often it is because they haven't been informed that they have one.
I have ap appt to attend sometime in January, pretty sure to discuss ct results.

As yet I've not had the ct, but I cannot keep trying to synchronise the admin side of things.

I'll tell you what I would like...

An NHS that can get a referral from one department to another just once without my interference. Ideally it should be same day not any time up to three months later the referral hits its destination.

Not To be marked DNA for an appointment I had absolutely know idea about. ("Opps we forgot to sent the letter" still marked as DNA)

To actually get treatment for anything without having to get a private consultation first. For local providers not to mark you as "not being serious enough for treatment" without even seeing you, only to end up with inpatient treatment at the national specialist hospital after referral is recommended by a private consultant.

For service providers to actually properly look at the paperwork of the the patients they take on and for a proper medical screening when they are meant to. For them not to take on patients they are completely incapable of treating (eg wheelchair users, second floor, no lift). That includes if they have a condition the consultant doesnt know, actually looking it up and checking that you dont put the patient at risk of death by the method your service provides the treatment. Receptionists that dont try to "reassure" you; then label you rude and difficult, and then try and blacklisting you for any NHS treatment of that type when you tell them (correctly) they are incapable of providing treatment and if you dont even know what the condition is any reassurance is a pile of shit (the actual phrase that was so rude and abusive). Then To actually admit you've fucked up and try and fix it as opposed to talking (very flattering) crap and putting the patient back the the beginning of the referral system delaying their treatment for a year.

For consultants to put patient care first as opposed to their mate who completely misdiagnosed the first time round. Also for them not to decide Mum is nuts when they are (correctly) challenged.

To not have had so many negative interactions with the NHS for so long that you know when a consultant
says to another doctor "Mums been doing this for a long time and does it well" means "dont fuck it up again, do actually listen to what shes saying even if the reason isnt immediately apparent because shes proved more senior consultants than you epically wrong"

To have doctors secretary's apologise profusely for your previous experience of getting no response to your query for a month and then the secretary last week failing to get back to you either last week when they promised that would or the week before when they promised they would and didnt; they will definitely absolutely get back to you this week.... only to realise it's the same secretary when you take name and true to form they dont get back to you this time either

Not to be told to go to A&E by the actual GP receptionist for something that can and should be dealt with by the GP. Happening even before covid.

For patient transport to listen when you tell then the journey takes about 45 minutes-1 hour more then they are allowing and that you know because you did it with their company a week ago and got there late, and the week before with seconds to spare. To actually bother to cancel the £200 taxi when you've spent 45mins on hold to patient transport to tell them the appointment is going to be postponed. To contact the patient when you are going to be 3 hours late (which incidentally will only get you hospital after it has closed). In times of covid not to put twenty+ patients some of which are definitely CEV if not all of them, in a teeny tiny unventillated room for periods in excess of an hour waiting for transport.

14 long years of dealing with the NHS on behalf of DS tell me it's a ginormous monolith of mismanagement from the top to the bottom. Dont get me wrong I have seen departments run well but they are few and fair between. I think our NHS is a beautiful beautiful concept, I'm just not sure the execution is up to scratch, that includes many of the staff at all levels of seniority.

^
That too.
All of those wasted appointments and paperwork and time.

The ct I'll be having will be the third one, when it is already established that there is an issue.

I s
Dare not call a halt to it though, as it has been almost 2 years to get anyone to do anything.

I think we just need more of everything. More doctors, more wards, more op theatres, more staff at every level.
We used to go and see our GP and if further treatment/an expert was required see an consultant at the local hosp.
Now I cannot see my GP, get a phone call, and it's extremely unlikely I'll get to see anyone else and if I do it will be weeks /months away. Dictated by the waiting list not the GP.
Obviously things will be missed, things left to become more serious without treatment, cancers becom incurable. Most things are treated but not when they should be.
I'm not sure why it's gone so wrong - I live in a rural area and I'm pretty sure the population hasn't gone up that much. We have poor amenities so I suspect that is why we struggle to employ consultants. (thanks SNP).

For the majority of the staff I have nothing but praise at an individual level. If there's one thing I'd like to see its better communication. Both to me as a patient and between departments. I'll give an example. Last year I had a mental health crisis and ended up in hospital after a poisoning incident. I'm fine now, but at the time I was really vulnerable and not able to advocate for myself. Of course I desperately wanted to go home, and after several blood test the consultant said that my liver and kidneys were recovering but not so quickly as he might like, so he was going to let me go home but I absolutely must ge a blood test next week. Sure I said. Called my GP. GP said he couldn't organize the blood test, consultant had to do it. I didn't know who the consultant was. Called the hospital. (Actually I wasn't doing all this myself, someone was helpnig me. If I was alone I would have given up ages ago). Hospital have no idea what I'm talking about. Told GP. GP told me to go back to hospital. Eventually the person advocating for me managed to get blood tests organized at a different hospital outpatient unit (???). When time for results, they said ask your GP. I asked my GP. GP said I can't tell you that, you have to ask the person who ordered the test. I say I don't know who ordered the test. No-one told me. I call the hospital. Anyway this went on for a few weeks until my GP eventually said 'Look I'm not supposed to tell you this but I have the results in front of me. They're normal'. So...he had the results in front of him the whole time?

Like I say I was really vulnerable at the time and if I hadn't had support I simply wouldn't have bothered. So what happens to people in mental health crisis who don't have support?

@Muminabun

The nhs is funded better than any other European healthcare system. There is huge waste in the system, staff sickness, payouts due to bad practice leading to scandals. Reform is not popular or easy because the nhs is so large and it has a religious like status. It needs to be reformed but I doubt any politician feels they can touch it with a barge pole.

This is completely untrue. The NHS spends less per capita than anywhere else in Western Europe. It's one of the cheapest systems per capita in the developed world. Anyone saying "but we can't afford..." should know how little the UK spends and that they get more care per pound spent than anywhere else.

The problem in my opinion is a lack of sustained investment and constant patching. They can't patch anymore. The UK needed to be investing more in training staff 20+ years ago. Blair made some progress with new medical schools, but that was not continued. It was just so much easier to keep hiring from abroad.

By any objective criteria, the NHS is pretty poor. That does not mean that many wonderful individuals don’t work within it.

The reasons are multifaceted, a combination of underfunding, inefficiency and poor management.

It should be ruthlessly patient focused, but it isn’t.

There are no other first world countries (certainly pre Covid) where you had to wait months (and sometimes years) for life changing operations. Same thing for GP appointments. Family in France can always see a GP same day for an unhurried appointment.

Objectively, when you look at health outcomes in the UK, they are very poor compared to countries of similar wealth, despite a few areas of excellence.

NHS management actually consist of overpaid junior/middle management, generally promoted from nursing and ludicrously overpaid senior managers, generally recruited from management consultancy, who try to fit a one-size-fits-all solution to the NHS, with predictably disastrous results.

And it is also a see-no-evil, hear-no-evil organisation, with complaints hard to make and rarely investigated properly and whistle blowers generally treated harshly (despite ‘policy’).

I think it should be split up regionally and dismantled. We can then see what we want to replace it with. There are many health models which are neither NHS or ‘the US’. Ask yourself whether you would prefer to fall sick in the U.K., France, The Netherlands or Germany. The odd one out is pretty easy (and not in a good way).