Suggestions for an ailing NHS?

[WideWebWitch]

OK, following on from the state vs private health thread and the 'solving the crisis in state education' thread I thought I'd start a similar 'solving the crisis' thread for health, since Woozle asked me to.

I can see why people are seduced by private health care when the NHS service is terrible and treatment often depends on postcodes. For example, I couldn't have an NHS nuchal fold scan here but could have had I lived 50 miles away in the next health authority. As has been said elsewhere, the NHS doesn't have the facility to take money to perform this scan, had I wanted to pay them rather than a private clinic, so I paid a private clinic. I know, ideally I wouldn't have to pay anyone, I do agree. (Gilli, I did take your point on the other thread too, thanks for that).

So, any suggestions for improving the NHS? This isn't meant to be a thread for arguing about private vs NHS though - for that see the other thread under Health.

It's too bad to be saved. Scrap it and start again.

GET RID OF THE PEN PUSHERS IN THE NHS
It must cost a fortune to employ these people. I go to the hospital alot and you see the same people walking around with filofax and/or folders in their hands not knowing what to do with themselves and walking around in circles.

START MODERNISING HOSPITALS
If anyone has been to the wards of Alder Hey, they will understand what I mean.

I will think of some more in a bit.

Admittedly I don't have a lot of recent first hand experience of it, but I'm not at all sure the NHS is "ailing" and I think that possibly the constant argument about what's wrong with it is part of the problem.

NHS cancer care is excellent, post natal care is much better than in Spain (I know some HVs aren't brilliant, but it's batter than having no home visits at all) and nursing care generally is excellent, even though some areas don't have enough of it. Most GPs are good too and yes (I've had 4 good Gps in the UK out of 6. In Spain the score is 2 out of 4 and one of the good ones was a locum). You may have to wait a couple of weeks for an appointment but do we really expect instant service given that healthcare needs are so unpredictable? It seems to me that people expect the NHS to run like a well-oiled corporate giant, forgetting that well-oiled corporate giants charge large sums of money for their services and waste a lot too.

In Spain, nursing care is minimal - they resent being asked to do anything beyond the absolute necessities (like changing my newborn dd's nappy when I was told not to get up). There are also no breastfeeding counsellors or anything like that.

I know this isn't a debate about public/private but i would also like to point out that Spanish hospitals are mostly privately run, but paid for on a per-treatment basis by the state. Hence the minimal care (as it goes, the rooms are great, like a hotel, but I'd rather be in a 200 bed ward with good care than a private room without). It drives me mad when British politicians point to it as a good system (and the Tories have been flirting with the idea.)

However the "internal market" system (or whatever they call it, since they did at least get rid of the worst parts of it) by which individual practice/hospital/regional managers choose what is and is not available is silly. And the current plans for foundation hospitals are also silly for the same reason - health care does not work like a private industry. It also doesn't need nearly as many managers as it currently has. Finally, www - I agree that specialist treatements (? I have no idea what a nuchal fold scan is) should be available at a fee to the NHS rather than not available at all.

So my cure for the NHS? no radical cure - these cause more damage. Just a gradual cutting back of middle management, a more general and long-term approach to quality control (rather than emphasis on specific targets), perhaps a full audit of every department every 5 years or so and charges for currently unavailable treatements.

A bit of equality between geographical areas - so much bad feeling is caused by the well publicised differences in quality, care and services between authorities. I know that this is probably virtually impossible to solve but it strikes me that this inequality causes more feelings of being hard done by than almost anything else. No ideas how to solve it though as I have no real knowledge of the financial structure of the NHS but that doesnt mean that is shouldnt be attempted by someone - after there are plenty employed to make these decisions in each area - perhaps they should all get together...

lucy- are you sure nhs cancer care is good? people are dying because of waiting lists!

I think it highlights the problems. If you can get access to services they are good. Unfortuantely very few get access.

Personally I would rather pay more and then be able to access a service when I needed it. ATM I can't, and I would assume if I was paying more that this would then provide for people who couldn't payt as well.

So action plan

Train more clinicians
Retain them (ie improve their working conditions so they are less than barbaric and they can actually do their job)
Put less money into management and more into clinical staff (I read an amazing fact in the paper once - int he space of about 5 year the number of managers increased by several thousand fold
Remember that the NHS is dealing with people not figures.

At the moment I feel as if I can't acces the services my son needs, and I cna't even pay for it if I chose to (as the therapists aren't there). I would far rather pay more and have my son receive basic service. So OK I've got my video link to a therapist in the States organised- but I shouldn't have to do this.

Scrap it and start again.

Doormat - can you tell us anymore about the wards at Alder Hey. Im bound to end up there sooner or later with my son - forwarned is forearmed etc

woozle, re alder hey: Don't get me wrong it is a good hospital but it needs modernising. The WARDS to me looked victorian. Pipes and old radiators were along walls and were not covered.I was last there a couple of years back but still go over for appts.Quote me if I am wrong anyone but I think it is still the same.Has it changed.

jimjams - the problems you refer to are to do with staff shortages, not fundamental problems in the NHS (and scrapping it and starting agin would not solve those problems, it would just cost a lot of money. How many "failing" schools which were shut down and re-opened suddenly became good schools? very few, because the problems were to do with their reputation (middle class kids all removed and staffing problems), not the buildings).

There are not enough trained doctors or nurses, due to many years (30+ years) of short-sighted policy making (i.e. there were not enough training places). This cannot be fixed overnight, nor can it be fixed by scrapping the NHS.

And I do stand by my comment about cancer care being good (perhaps cancer patients get preferential care over other patients, though).

Doormat - like I say, I'd rather be treated in a Victorian ward with good care than a modern ward with Spanish nursing-care levels. I think additional money for the NHS should first be spent on new training places for doctors and nurses.

Bu the money needed now to make the NHS acceptable - not good- acceptable is so huge that it is beyond repair. I'm afraid the days of free health care for all are gone. Personally I'd rather pay more and then be able to access care when I needed it. I can't even take out private health insurance at the moment as it doesn't cover developmental problems.

System in Japan seemed to work reasonably well- although I paid a lot each month in health insurance, and obviously they didn't have a very big welfare state.

Interestingly on "Ludicrous- rant" thread- an American was horrified to find that I have been fighting for years for SALT from my non-verbal son. Her db/SIL have an autistic child- they are on welfare and he receives stack loads of SALT. If the NHS can't even provide basic services for
all it needs to go. People who can afford to pay more should do, and good free care should remain for those who can't.

I don't know anyone who has tried to use the NHS in the last few years who is happy with their care- in any area.

And people are dying from cancer because it takes so long to get the initial appointment.

My son was referred to a dermatologist- My GP looked it up and said "well it's 10 weeks wait for an appointment or 16 weeks for the fast track cancer clinic!!!!!" We paid and went private (at least we had the choice that time).

I read last week that the NHS has had an 18% boost in funding over the past few years but there has been only a 2% increase in efficiency. So what are they doing with the money??

But there are good stories about the NHS, (I can supply a couple if you want!) and my ds who has moved to America is now convinced of the superiority of the NHS to the US system. The NHS does need an overhaul and it needs to be made to work properly but I think the basic idea is sound.

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Robinw- agree. It is obvious the state can no longer afford the NHS. It needs to be abolished and replaced with something that works.

But replace it with what, jimjams?

A German/French/Spanish style puclic insurance/private hospitals system? These are much more expensive than the NHS, or in the case of Spain, in many ways not as good.

A US style fully private but some state subsidy for the poor system? I find this frightening. Means testing never works completely (see threads on student fees) and many people would simply not get the healthcare they need because they can't afford it (or go without other things to get it). Also a fully private system takes away the motivation for preventative healthcare - this saves a lot of money in the long run.

We can afford a decent NHS, and the extra money being put in now should start to show some results in a few years.

However it is obvious that some areas are currently underfunded. They should stop bothering with things like "24 hour clinics" - these are expensive and I don't see why people can't take a morning off work if they are ill. They should also take the emphasis off targets in favour of rolling audits - these divert money and resources for not much gain.

I would rather pay extra tax than high medical insurance premiums - and I am young and healthy. What about the premiums for people "at risk" in some way?

But lucy have you actually tried to use the NHS for a complex condition in the last few years? It is so far away from what is needed it needs more that money. Or the amount of money that is needed is not ever going to be raised within a State system and a policy of it being free for all. I do take your point about the inequality within the US system, but talking about the area I know, children in the US who are reliant on the welfare state are receiving far superior services to my son - far far superior, and we have money to pay for some care. So god knows how they compare to children reliant on the welfare state over here.

Now if a paying system was introduced, I personally would be one of the groups most affected by it- as we earn too much to qualify for state care, but not enough to have spare cash. However I would far rather pay more and be able to access services than spend the next 10 years watching my son not reach his potential because he has been ignored as his problems are too "compex". I'm fed up of seeing child after child after child forgotton. I met someone yesterday who has to begin some sort of assessment with her son, and I felt awful for her, as I know the services she needs aren't there. I gave her the name of a clinic, but I know she'll have a long wait, (if she gets in at all) and then she won't get the help he needs. I;m at the stage where I don't even know what to suggest to people. I can say "you have to fight" but what for? The services that are needed are there to fight for.

And meanwhile a whole generation of children is consigned to the scraheap.

Japanese system seemed to work quite well. People in work paid for it- it was expensive, but it was good. French system seems pretty good. Expensive- but at least you get treatment when you need it. Aus system probably worth looking into. I'm sorry but the days of free health care for all are gone. Even my Argentinian friends (who are often pretty rude about services in Argentina) think the NHS is dreadful. When politicians talk about it being the envy of the world. I just laugh - talk about misplaced pride. Even talking about the NHS wears me out these days, let alone trying to deal with it.

It needs to be scrapped and replaced with a system whereby people who can afford to pay more do. Only then will it have the money to train and retain the clinical staff who are needed to provide any sort of service.

I used to work as a home-care support worker for people with severe learning and physical disabilities (very complex needs). Obviously I was working outside the NHS, but when we did have to use the NHS it was always excellent.

I do feel for you though, Jimjams as you have obviously found an area in which NHS care is poor.

But I just don't think that scrapping the NHS, or introducing a two-tier semi private system is the answer.

As you say, training and retaining staff is probably the key problem, but this is improving (more training places anyway - it's just that it'll take a few years to see the effects. and I know I sound like a loyal Blairista here, but I assure you I'm not! ). Also, remember that Germany and France pay a lot more for their healthcare systems than we do (because the private hospitals have to make a profit, among other things).

Finally there would probably be enough money and greater accountability in the NHS if it weren't for people suing them for ridiculous sums of money. (why should a child whose problems were caused by an accident in a hospital get money when a child with the same condition, of unknown cause, doesn't?)

Fine tweaking is what the NHS needs, not radical change.

OOoh I'm not quite with you on the sueing thing- although I was up to then. If a child has had a condition caused by a negligent hospital of course they should be able to sue. It costs an incredible amount of money to bring up a SEN child (believe me I know- and partly because the NHS is so crap) and if that was someone's fault then I think the NHS should be made accountable.

Does depend a bit on the severity though. For something that is causing passing discomfort- forget it. But for something that say resulted in brain damage of course someone should be accountable for that.

I suspect a lot of NHS "accidents" are due more to understaffing than anything else. If this is the case the NHS has to be accountable.

It's not just me either. Everyone I know country wide is battling for scraps of services. People are throwing themselves and their children off bridges because of the lack of services. OK that was one case, but everyone I knew recognised why that poor woman did that. And the enquiry was a joke.

Thesbridge woman was suffering from a lack of everything. Educational support- certainly social services (I'm meant to have a social worker I discovered last week- never seen hide nor hair of one).

There still aren't enough staff though and the training is a joke. My mum is a community nurse. They have been understaffed for over a year now (she has been doing the job of two people). She recently had someone join fresh from a training course- she lasted a couple of months. I think 6 people from the training course went into the community- only 1 could cope with the work- and she had worked within the community for years. EVeryone talks about management these days- and building skills, the patients are forgotten. Even management are syaing that the training courses aren't providing people with the necessary skills to do the job.

In the meantime people are still leaving in droves as the working conditions are so poor. Newly qualified SALTs for example are being dumped into situations way above their experience, with little support. Both private SALTS we have seen left because they were unable to do thier job, they were sick to the back teeth of seeing children once every 3 to 6 months and unsurprisingly seeing no improvement. I have no idea what OT is like as I can't get near the place. Obviously we need more therapiists- but the numbers needed are frightening.

well, making the jump from training to real work is a problem in all industries.

My sister is a trainee nurse - places are up on a couple of years ago (not sure by how much, but they are up) and the courses are more practical than they used to be. It may not be enough, but it is an improvement and things simply can't move any quicker without causing all sorts of new problems.

Anyway I hope you eventually get the help you need.

But they didn't use to have these problems. People are being taught too much management and not enough nursing.

I had a friend at school who wanted to become a nurse. She had a great cv for it- lots of work in care homes etc. She had a terrible time finding a course because her A level predictions weren't high enough. She was lucky in that she found one of last Pre-project 2000 courses and was able to do ward based training. The last I heard she was doing very well. (and more students actually on the wards= more staff).

And as for getting the help we need. Well I think ds1 was born at least 10 to 15 years too early for that.

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Totally agree with your point about educating to degree level. My Mum's a nurse and points out that if you have a degree you don't want to spend time nursing!

As a former NHS pen pusher myself (couldn't stand by and leave you robinw!!) I also think that a lot of money is wasted by the people who use the NHS - I had lots to do with GP out of hours and Casualty departments and it is appalling the way the patients abuse the system - the same also goes for missing appointments at hospitals and surgery and not practising basic first aid - ie self management of coughs, colds etc. I also agree that someone needs to take some doctors in hand (although there are some excellent doctors in Primary and Secondary care also I hasten to add) who abuse the service too, as described in other posts.

I suspect a lot of the money has gone on bank staff/locum costs which are outrageous, and also fulfilling government objectives - politically led.

IMHO the best thing that could happen to the NHS would be that it became a non-political organisation, as basically it is wheeled out and changed be every new government for the sake of doing something to it to "impress" voters - anyone who has worked in the organisation will tell you that you can never get any project or arrangement going because some politician will change the way you have to do things too quickly.
How on earth the above would happen I don't know!

Being an NHS manager was one of the most stressful things I have ever experienced - maligned, abused, poorly paid in comparison to other non-public sector jobs, and general dogsbody, slagged off for doing what the government demand - being a SAHM is peanuts in comparison.

Did anyone read the front page of The Observer about how various hospitals rigged their figures during the week performance tests were carried out by getting extra staff in etc and cancelling operations to make beds available JUST for that week? A link won't work because of the commas but the story is at www.observer.co.uk/nhs/story/0,1480,953395,00.html