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?

I think people forget that the NHS generally works very well. People are seen and cured, and operated on, and looked after, and diagnosed every day. Not everything is a shambles, not everyone who works for the nhs is overworked or underpaid. I agree it needs restructured but we are so lucky to have it. I agree with charging people for missed appointments.

To be properly funded, staff paid well, willing to pay more tax for this, don’t want an insurance system that only protects me - want to pay into the pot so everyone protected.

To be able to have a family doctor who knows me (did have this as a child).

Health workers prioritised for entry to / residence in the uk.

Prompt treatment for emergencies and serious illnesses.

@ufucoffee,

So your argument boils down to the NHS does actually employ qualified doctors and has enough money to buy (some) equipment.

That is a pretty low bar to have for them.

Charging for missed apts seems a sensible first measure. You could have to give your credit card details pre apt to 'secure' it, and it only gets charged if you miss it. This would get round the inevitable faff and cost of chasing people

A number of appointments are missed by "the system" not working. Example: an elderly relative missed an appointment because the letter informing him of it arrived the same day as the appointment. Why should he be charged for that?

My DD had a series of non urgent medical treatment a few years ago. The appointments were always made 6-8 weeks ahead and during school hours. On 2 or 3 occasions I needed to cancel or rearrange them due to her having exams at school, or being unable to take that particular day off work. Each time, with 1-2 weeks notice I called the number given on the letter, to cancel. Sometimes I spoke to a person, other times I left a message. Every time I cancelled, at the next apt, I would be given a lecture by the receptionist or Dr about "not turning up" for the previous apt. It was annoying being treated like a naughty child when it's their incompetent system that had not logged or registered my phone calls, there would be no bloody way I'd be charged for it.

If a GP trainee (doctor with several years experience) is on a basic hourly rate of £15/hour and doing home visits through their lunch breaks.... maybe we need to treat the staff BETTER to improve retention and attract more candidates. If I had my time again I’d sack of the NHS and work in IT instead

I am 100% in favour of the NHS and happy to pay more tax towards it. For decades it has been a poor service and it is worse than ever.

It is totally unacceptable to have people dying waiting hours for an ambulance and dying in ambulances in the car park after waiting there for hours. Utterly appalling in a wealthy country.

My DDad is seriously ill, but has not been able to see a GP since March 2020. Whereas I have seen my GP a few times, it is so inconsistent.

I have also experienced cruelty in maternity care and witnessed horrendous cruelty and bad feeling from nurses towards my sister when she in a coma 14 years ago.

TBH, I really struggled to clap for the NHS on the Doorstep, due to those experiences.

I appreciate it is an awful situation for front line workers, slogging themselves to ill health for the country. People dying unnecessarily and going untreated are the biggest victims of the NHS.

If a GP trainee (doctor with several years experience) is on a basic hourly rate of £15/hour and doing home visits through their lunch breaks.... maybe we need to treat the staff BETTER to improve retention and attract more candidates. If I had my time again I’d sack of the NHS and work in IT instead

I thought GP’s were all on private contracts now? They aren’t employed by the nhs but by themselves, contracting their services back in.

So who pays the trainees? Are they employed by their GP practice?

If they are paid by the nhs does the GP practice then have to pay the nhs for their services?

Many “nhs employees” aren’t actually, but employed by private companies contracted to the nhs. Which is a massive part of the problem.

I think the NHS should be run like a business but instead of being measured and accountable to shareholders it should be measured correctly by patient service.

We shouldn't be expected to 'save' the NHS. We shouldn't hero worship the staff (I worked in the NHS in a patient facing role for many years and fine that attitude very strange). We do pay through taxes and deserve a competently run health care but transparent in the costs and wastage rather than thinking everything is 'free'. L

Rationalise the estate- sell off the buildings no longer being used and look at what buildings could be overhauled to be better fit for purpose. Local walk in and out of hours units for example in communities have been closing, but they're so valuable and help take some of the burden off of A&E (as well as being better for users)

Rationalise staffing- we need more HCPs but that will take time to remedy, in the interim.can anything be done to help? Some spend hours doing their admin, sometimes staying after a long shift to complete it, could more ward admins do this safely?

Centralise procurement- doing it at a trust level is largely a waste of time and costs more. Not only do you pay for separate procurement teams to carry out largely the same functions, but you don't secure best value for money. For example, most trusts use the same beds for patients, if I work for x trust I buy 500 and secure bit of a bulk discount, I've also spent x hours running the competition. If this was done nationally you'd save time but also save ££££ by ordering thousands at a time and getting a better bulk discount. If inventory management was better things could be shared easier as well without being tangled in we have y equipment we no longer need, but can send it to you because a) you don't know we have it and b) it'll confuse the budgets (when it's all the same money at the end of the day).

More responsive to challenges- if A&E is getting busier with minor ailments, look into what the common cause is. If its say that the local area has a lack of GPS, see how that could be remedied rather than just putting posters up about when to go into hospital.

All ambulances except solely transport ones are the same, but realistically they are equipped to provide life saving physical care for someone, if going to a mental health crisis for example there should be an ambulance with a mental health trained paramedic and a more reasonable vehicle. Having one tangled up potentially for hours doesn't help shortages, and it could be more fit for purpose for staff snd patients. Also looking into the queues at hospitals, is there chance to have a check in room that's prioritised so they're never parked up. Of course staff shortages are a huge issue...

Pay tuition fees, better funding for access courses, more apprentiships, more access to flexible working hours, sort the crumbling hospital buildings out, look into parking/transport to work- improve conditions to improve retention which in turn will lead to better staffed wards and improve things for everyone. This wil take decades to remedy I expect.

Like anywhere some staff are crap, but lots are misguided into sounding their frustrations towards staff who have little input into the system

The public’s expectations are also ridiculously high. Many want test after test, which money aside, are not clinically indicated at best, and invasive or downright risky at worst.

Trust in dr’s has gone. Dr google trumps medical school. People need to listen, and dr’s need to learn to clearly explain benefit and risk, and make plans if no improvements.

It always annoys me when some poor soul is diagnosed with cancer or other limiting illness, and their first instinct is to “raise money for treatment abroad”, even before the nhs have devised an initial treatment plan. Generally, treatment abroad isn’t superior, as we have world class clinical research and trials here, secondly, if the nhs won’t give you that experimental treatment they do in the US, there’s usually very good reason. It doesn’t work, or the side effects are so bad your minimally extended life will be torture. Or it’s so last ditch you’ll be too sick to travel by the time all other treatment have been tried. If the nhs thinks it has benefit, they can arrange for you to travel and receive that treatment.

We shouldn't hero worship the staff

To be fair this was largely taken over by the government for a purpose. Seeing staff as 'angels' gives a bit of a pass for the lack of ppe and great risk there was because it removes people's view that staff are human with families and fears who are doing just a job. It really perpetuated the ah they're happy to do it and what arses if now we have called them angels they refuse to- it put pressure on to carry on. They could have said well done everyone.

@Fizbosshoes

Charging for missed apts seems a sensible first measure. You could have to give your credit card details pre apt to 'secure' it, and it only gets charged if you miss it. This would get round the inevitable faff and cost of chasing people

A number of appointments are missed by "the system" not working. Example: an elderly relative missed an appointment because the letter informing him of it arrived the same day as the appointment. Why should he be charged for that?

My DD had a series of non urgent medical treatment a few years ago. The appointments were always made 6-8 weeks ahead and during school hours. On 2 or 3 occasions I needed to cancel or rearrange them due to her having exams at school, or being unable to take that particular day off work. Each time, with 1-2 weeks notice I called the number given on the letter, to cancel. Sometimes I spoke to a person, other times I left a message. Every time I cancelled, at the next apt, I would be given a lecture by the receptionist or Dr about "not turning up" for the previous apt. It was annoying being treated like a naughty child when it's their incompetent system that had not logged or registered my phone calls, there would be no bloody way I'd be charged for it.

Well I'd say your experiences show the system needs a complete overhaul and as a part of that bringing in charges. If the system worked with a working cancelling procedure then wilful missing of apts could be charged. Our (smallish) surgery used to keep a weekly tally of missed apts and there would be dozens. Publishing it didn't seem to shame people. I don't think those were all system failures

Underfunded & badly managed.

It is an abused system - missed appointments being one of them but also peoples expectations of it.

It’s is constantly firefighting - example if mental health services where better funded and easily accessible the patients who attend a&e demanding to be seen for something random but who are actually in dire need of mental health support in the community.

Because it’s free there is an ‘expectation’ like I often read on here - Facebook market place don’t give it for free but charge a small fee.

I worry if it goes and is changed to fee paying as someone with medical condition that means I would either a) be uninsured or b) very expensive to insure!!

It needs to stop being a political tool. It needs looking at but not used as a way for fear against the voters.

My daughter has been very ill I’ve the last week, I have been able to contact and speak to a GP, been referred to the out of hours doctors and spoken to and been seen by 111 walk in centre. No massive waiting times and seen by lovely (but very busy staff) I was very impressed by the whole process - I was expecting it to be a lot more waiting/push back but far from it!

And we MUST tackle obesity and health inequality if the type which leads to chronic multiple conditions. I'm not a public health professional so am clueless tbh about where to begin. I know you can't shake a stick at people though. It makes me cross when I think of all the preventable conditions out there. But I know that's wrong of me!
Any bright ideas out there?

Those comments are absurd and should be ignored. The NHS is staffed by kind & committed people. No-one else would stay.

Changes I would like to see are:

• Repeat drunks/brawlers are treated at a drunk tank and NOT taken to A&E. In some places that would reduce demand on A&E and ambulances by 50%.
• Obesity being treated via a nutrition & well being service, an add-on to the education service.
• More elder care available so bed blocking happens less often.
• Three strikes and you're out for appointment wasters.

Remember last lockdown, when A&E was deserted because the pubs were shut and the timewasters were scared of getting covid at a hospital. That gives the best illustration of what is wrong.

@Chewbunn

We shouldn't hero worship the staff

To be fair this was largely taken over by the government for a purpose. Seeing staff as 'angels' gives a bit of a pass for the lack of ppe and great risk there was because it removes people's view that staff are human with families and fears who are doing just a job. It really perpetuated the ah they're happy to do it and what arses if now we have called them angels they refuse to- it put pressure on to carry on. They could have said well done everyone.

Right. Calling people angels and heroes is a great way to obfuscate the fact they are humans doing a job in which they are not being adequately supported or protected.

FME it's the patients/public that waste NHS appointments and money, not the staff.

Many many patients who DNA to appointments for stupid reasons (attendance is always worse when it's raining, or close to xmas, or there's a local event on that they may have forgotten about etc).

Patients who come in for minor conditions that are easily treated at home with a bit of patience. E.g. conjunctivitis. They know it's that, they come in saying they've got that. So it's not a diagnosis they need. They just want to get free antibiotics to get it to clear up slightly quicker than it would just bathing the eye. Hence wasting an appointment slot, money on unnecessary drugs and fuelling the antibiotic resistance problem.

People who are in good money (will buy designer gear, have massive houses, tell me about their far flung holidays) but won't pay 19p for paracetamol if they can get it for free on the NHS etc.

The big issue is that it's so hit and miss depending on where you live. It was be world class and brilliant or it can be awful.

Before I had my child I didn't use the NHS that much except for routine things like smear tests and the odd small procedure. Hospital and specialist care I've received has always been really good. The area I've noticed the starkest difference is in GP care. I had absolutely awful GP care during my pregnancy and post natal period. Then when giving birth midwives on the Labour ward were fantastic and the post natal ward was awful. I've since moved to a new GP and have noticed such a difference.

My new GP practice is brilliant with both me and my child. This to me sums it up, care is so patchy it's just luck of the draw. I was lucky to go to a world class fetal medicine unit when pregnant and their scans equipment and knowledge was world class, but again that was just luck due to living in London.

The NHS should NEVER be privatised, it's such a scary slippery slope. I am more than happy for my tax to go towards it, but agree it's inefficient. I agree however that things like GP apts could be paid for with a small fee (for adults and not children). I also think we should have yearly check ups to look for any issues and have a look at overall health/lifestyle. Mental health provision is the NHS is also crap and needs an overall (I'm especially aware as work in this space).

@wyleee,

I think it is interest that people are so against ‘privatisation’.

The reality is that we have had a two tier system for years.

If you have insurance (or money) and need a hip replacement, you can probably get it within a few weeks, under the surgeon of your choice, and recover in a comfortable private room with a menu of delicious food served at a time of your choice.

On the ‘wonderful’ NHS, you could wait in pain for 1 year plus and recover in a ward, with crap ‘dinner’ ‘served’ (sometimes thrown) at you at 5:30pm, to suit the convenience of the hospital, not the patient.

Even cancer can be treated better privately (in general), with v quick diagnostic tests and immediate chemo, even in the time of Covid

The US, even, does not allow acute patients to die in the street. There is free acute medicine even there.

The main difference is that we do keep emergency medicine and acute care the same for all.

The idea that our system is so much better than others is a lie, really, an opiate served to the masses so they don’t get uppity.

@TheReluctantPhoenix
Good points about the two tieredness of the NHS. We do have in part already. Just like the education system, and no one questions that (well no in the same way at least).

Definitely we need to reform the NHS to a co-payment system. What people mean when they say properly funded often is that other people need to pay more.

I now pay for private medical insurance - not because I want to spend £150 per month but because I dont want a sub standard service.

There is something between completely free and the US system. But people moan on about Google, Amazon etc paying their fair share of taxes (yet continue to buy from Amazon and use Google!). Its always for someone else to fund.

Does anyone know. What % of the population have private medical insurance? Is it 10% or similar??

We could also tie in nurses and doctors to the NHS for x number of years after being trained by us.

@Franklin12 Its 11%. Most are tied to employment like mine and DH. So we don't pay for it but our employers do...

Does anyone know. What % of the population have private medical insurance? Is it 10% or similar??

Don't know the answer to that but DH and I have it through work. Whilst we don't pay for it directly we do have to pay extra taxes for the benefit.

I am always very happy at the difference in attitudes and treatment every time I have gone privately compared to the NHS.

I do think its broken.
But if these are your friends some of the comments are pretty awful knowing that you work for the NHS, really rude.

It is actually quite sad that the same consultant s treat their private patients as educated consumers with choices and their NHS patients as charity cases (they should be grateful for getting the treatment).

‘Free at the point of use’ is frequently assumed by NHS workers to be free (they forget the tax bit) and forget that their patients are paying their wages (albeit indirectly).