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.

From the limited personal experience I have of hospitals I would say that it is far more often the other way round - patients who have no respect or patience with nurses, who in most cases are doing a difficult job when they are understaffed and working in poor conditions.

Scoobysnax - agree with you 100% about agency staff.

My earlier point re. rationing healthcare services - I do think there needs to be some kind of national debate on this issue. It needs to be decided exactly which treatments are available free of charge and which should be paid for or means tested. As an example, I have varicose veins - they don't trouble me at all, except for what they look like. I could get treatment on the NHS without any problem at all. But I don't actually need it.

I personally would put children and young people (say under 30) at the top of the pile when it comes to treatment. The elderly, maybe when it's costing more than x amount per day to keep someone alive hard decisions need to be made.

And re IVF, I just do not understand why anyone would not wish to adopt rather than go through such a procedure.

judetheobscure - I don't want to start a war here, but (and yes, there's always a but) I think your comments re IVF could be deeply upsetting to several mumsnetters. I might be wrong here but, I think you have four children and are considering a fifth. Now maybe I'm jumping to conclusions, but I'm presuming from that that you don't have any difficulty conceiving. In contrast, there are quite a few mumsnetters who have conceived, or are hoping to conceive, through IVF. Maybe if you were in their shoes you would be able to understand why they have made that decision.

Anyway, as I said, I don't want to start a war - I just thought it worth mentioning.

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tend to agree with willow- it's very easy to see adoption as an alternative when it's not a choice you have to make! Also adoption is not that easy. You very rarely end up with a sweet little baby. You normally take on a troubled child (and maybe a baby sibling granted). Some people may not feel they have the skills to provide what these children need. Usually you are asking yourself whether you are happy to take on special needs as well, so it is not an easy choice.

And yes I think robinw has hit the nail on the head.

You're quite right willow - I have found it easy to conceive. However, if I could persuade my husband, I would have adopted maybe 2 children by now rather than having "our own". He doesn't want to and I have to respect that.

Of course I appreciate that many children up for adoption have special needs, and that is something which takes a lot of courage to take on. I still think that IVF should not be paid for by the NHS. And I also think that all potential IVFers should be asked to consider adoption or fostering.

So if you respect your husband's decision not to want to adopt, why not respect the decisions of couples involved in IVF not to adopt?. Given what IVF involves, I cannot believe any couple pursuing it haven't given alternatives such as adoption and fostering a great deal of thought.

Perhaps I was too harsh in saying that IVF shouldn't be available on the NHS.

It's just that with all treatments of this kind (big and expensive treatements that is), part of the problem is that the more they are available the more people demand them. It is this spiralling demand which is the NHS's biggest problem after staff shortages, I think. People hear about some new treatement and then go along and demand it - in the case of IVF, it should be used (I think) only as a last resort, but I know people who mention it after trying for a baby for less than a year.

Also where do we draw the line between lifestyle treatments and quality of life treatements? Jimjams - your son should get his speech therapy / treatment (I can't believe he hasn't), but should Viagra, for example, be available?

As the world of medicine progresses it will be harder and harder for the NHS unless it draws a clear line now.

Of course I respect the decision of couples pursuing IVF not to adopt. But I don't think an NHS which is crippled with spiralling costs should put things like IVF ahead of things like palliative care and speech therapy.

In an ideal world, overflowing with money, the NHS would pay for eveything. But in the real world, decisions have to be made about which treatments are most beneficial. And the postcode lottery needs to be ended.

I've been avoiding this thread since it started. I am an NHS Consultant Surgeon, working in a DGH. I don't (usually) treat cancer patients, although if I diagnose it, I refer them on ASAP. My waiting time for routine surgery is 9 months, for an outpatient appointment is 26 weeks. Urgent cases are treated as necessary.

Our Trust has recently undertaken to get our waiting list down to six months. It was in the local paper recently "all people waiting for ops in this department will wait no longer than 6 months". How are we going to achieve this? The penpushers are sending patients elsewhere to have their operations done- mostly to local private hospitals. Unfortunately the private hospital will only do the operation, not undertake any follow-up or treat any complications. Who has to do that ? Me! I shudder to think how much money this hospital has spent over the last few months reaching theses targets- easily enough money to pay for another full-time consultant. People are being removed from the waiting lists in this way, but at the other end of the system they are still being referred in equal numbers, so there will have to be a continuous flux of patients from NHS to Private to keep the numbers static.

I think robinw was a little hard on us Consultants. (I would say that wouldn't I?). Most of us work extremely hard for the system. Our Junior staff all have their hours restricted now, so the added burden goes up the ladder. I work full-time, which means I don't do any private practice. Those who do are only paid part of their NHS salary. I don't think pen-pushers all realise that. If Consultant X is at the Private hospital on a Tuesday afternoon, it doesn't mean that he is operating on NHS time, it means that that session is his free time. My colleagues who are part-time all, without exception, spend a lot more time at the DGH than they are contracted or paid to do. We are not paid overtime to attend meetings that the management schedule for 6pm, so as not to interfere with duties. Maybe the management aren't either, but nurses would be, junior doctors would be, cleaners would be.

FWIW, I don't think the NHS needs to be scrapped, any alternative would be far more expensive. I think the managers need to take a long-term view of the cost-effectiveness of what they're doing-not throwing money at a problem to make it go away short term. We do need better pay for nurses to attract them to stay in the job, we need far more emphasis on family friendly policy as well.
I could go on and on...but i'm not going to. Please don't blame the Consultants for the state of the NHS- expectations of what we can do for people have risen so much, and so much more is demanded of us than 5 years ago.

As far as IVF on the NHS is concerned, only around 1,000 treatments were apparently conducted at its expense least year (18% of all treatments). At an average cost of £3,500, that adds up to around £3.5m, out of a total budget of £68bn. So I don't think that banning IVF would make one jot of difference to the overall service. I would imagine that elective c-sections (i.e. those not done for any medical reason) would cost the service far more.

Well said docincognito!

I believe that there are next to no newborns available for adoption these days, so I'm not sure that adoption is a straightforward substitution for IVF

well I've been super critical of the NHS but I do agree with everything docincognito has written- although I would still prefer to see it scrapped.

lucy- it does become hard to know where to draw the line, but at the moment it is being drawn through basic services so that's obviously wrong. Is viagra available on the NHS as a lifestyle choice? I didn't think it was.

Another vote in support of Docincognito.

And that's coming from someone who has worked as a manager in the NHS - albeit one who came in on a special, supported, scheme encouraging so-called "high fliers" in from industry to learn about the NHS, with a view to then having the necessary skills AND knowledge/experience to become chief execs. (slightly less dangerous for the NHS than coming in as an industry high flier at chief exec level and then finding that you can't hack it).

I've not contributed to this thread because there is SO much that I would want to say. Although I left NHS management, I still believe passionately in the principle of the NHS. I believe that there is good management and there is bad management - just as you find in industry. (My dad, a consultant radiologist) and I once had a vehement argument about efficiency: he just couldn't beleive that we in the private sector also often had to battle bureaucracy or inefficiency (at the time I worked for ICI).

What saddens me in the NHS is the distrust between management and the workface (ie the doctors, nurses and those that actually deliver the services). It is so ingrained that much of the bad feeling must be related to past bad experiences. There are major problems with communications - on both sides (but I have to admit, mostly on the managers' side). I know that my cohort of ex-industry inetrants couldn't get over the lack of genuine communication: our experince of best practice was that you the best results when you all worked together.... and the sad thing was, we saw so few examples of that in practice.

I too don't believe that scrapping it is the best way forward - all the other examples spend a far higher proportion of their GDP on health, with not always a directly comparable improvement in health - and do we really want to go to the American system, where health costs are a major cause of bankruptcy?

I do believe that the NHS has suffered an intolerable amount of re-organisation in the last 15 years: I would challenge any private sector company to have coped with the degree and frequency of change that has been imposed on it... and through it all, it still has to deliver its core role of caring for people's lives. Our lives really are in its hands.

There is a LOT of work that needs to be done on communication. There is now so much baggage being carried by both "sides" I am not sure how you address it. More interference from politicians and/or yet more management consultants (and I've been a management consultant too!) is NOT what is needed.

There is also work that needs to be done managing the PUBLIC's expectations. An NHS can NOT deliver everything to everyone. Hard choices do have to be made. There is a role for some people taking a strategic view and saying that we will fund this and not this and here's why.

I'm not sure I've contributed any ideas, but I don't think we should throw out the baby with the bath water. We have a basically sound system, with a lot of dedicated people working for it. It is probable that we should allocate some more money to it - at least the LibDems are honest about that. But we shouldn't try to re-organise it YET again - let them try to work through the changes from the last time. At the end of the day, the people working in the health service DO want it to work - and are there at the coal face. The politicians and mandarins DON'T have that experience.

Yes, long term answers are what are needed (as in education).

The only thing is, the voters won't appreciate the results in time.

What we really need is a de-politicised NHS, although how it could be truly depoliticised without risking corruption I don't know (run by a panel whose members are voted for by an electoral college made up of the BMA, nurses' union, patients' groups etc every 8 years or so? )

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Robinw i've worked at boardroom level in the NHS and am married to a consultant and i have never met a manager who worked as hard as most consultants.

Ds1 was delivered by a senior reistrar. (c section). He did his final check on me at midnight, and was back at 7am checking on ds1. I think long hous are a problem for doctors.

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yep agree with you there robinw (about the "I did in my day" ). Also agree it is dangerous. I did ask the registrar when he appeared at my bedside at 7am whether or not he'd had any sleep!

robinw- you seem to have a huge problem with consultants- junior doctors are hard done by saints and consultants are lazy money-grubbing drug-taking scum of the earth. What happens to us when we get out CCST then? Or is it the "How to wring as much money out of the NHS as possible" course we have to go on before taking up our post?

I've only been a Consultant 3 years, and yes, I did do it in my day... I've worked hundred hour weeks, three weekends in a row, non-stop for three days with no sleep.... Consultants were the drivers for the change in the Junior doctors hours, not against it. In fact it was the middle grade trainees (Registrars and Senior Registrars, some of whom are now Consultants) who fought so hard against change, as they felt it would reduce the amount of experience they got, and make them less competent at the end of their training period. To a certain extent this has happened. What I get a bit cross about now, is those Junior doctors who are so focused on the fact that they must work a forty eight hour week that they quite literally down tools when their time is up. I sometimes can't find an SHO on the wards because one is on study leave, two are on annual leave one has phoned in sick, one has taken her obligatory half day and the last has b*ggered off! It does not seem that medicine is a vocation, these days, many of our juniors have absolutely no sense of responsibility for the well being of their patients.

As for management.... well I agree with whoever said that communication must improve. We had a new "Surgical Support Manager" appointed six months ago, and we NEVER see her. I would be hard pushed to describe her appearance to you. The only communication we get from her is by Email, asking why so many patients are breaching the waiting time guarantees. Guarantees, I might add, that the surgeons had absolutely no part in setting. Someone sat in an office somewhere and decided that we would meet these targets, and they then expect us, the technicians, to work twice as hard in the same amount of time to meet them. The system is already at breaking point, there is no slack. It is just not possible. If this situation occurred in industry there would be a strike! If our SSM actually spent some time with us, in clinics and theatres, on the wards, she would know a bit more about how we work, and might be able to make some constructive suggestions about how to improve efficiency. We might then have a bit more respect for the management, and try to implement some of her ideas. This is not exactly rocket science. When I visited a hospital in the States (a University Hospital, not one run by an Insurance company) their department manager was there all the time, doing his job... managing. He dealt with secretarial deficiencies, complaints , doctors rota problems , doctors requesting new equipment, insurance companies queries....absolutely everything. He was friend of the Surgeons, he would sit and have lunch with them and chat over problems, or ways to improve the service. If we had a manager like that we would be a much more efficient department.

As for funding.... my specialty is one that spends a lot of money on equipment. If we want something big, even if it is essential, such as a new operating table, because the one we have is 20 years old and dangerous ( I actually had a bone in my hand broken because the table was faulty, due to its extreme age), we have to apply to a capital expenditure committee, where it is decided whether or not we will be lucky. If not, we just have to struggle on. They know damn well that I wouldn't attempt to sue the hospital for my injuries, apart from anything else I don't have the time.

Another example... I recently wanted a new piece of equipment for my patients, which would cost about £100 per patient (peanuts in my department). This piece of equipment, in my view would significantly improve the quality of care that my patients get, compared to the way the treatment used to be done. I had to put a business case to the managers before the equipment was sanctioned- it was not good enough to say that the patients would be better off, more comfortable, happier. Luckily, I was able to justify it financially, but I feel that it would have been refused had I not been able to do so. Quality doesn't mean half as much to the managers, it seems, as cost.

As for Consultants pay... yes we are reasonably well paid, I suppose. As I said before, I do not do private practice, and my dp is a nurse also working full time. Our major expenditure is our mortgage payment on our three bed semi, with the nursery fees coming in a close second. We are comfortable, but not rich, we have not had a foreign holiday in 2 years and still look around for ways to save money. Those consultants who drive rollers and live in mansions are few and far between, I can assure you. Most do not send their children to private schools, although may be able to make sure that they live in areas with good state schools, I suppose. People do NOT go into medicine to make money. Anyone with the A level grades to get into medical school could earn far more money, in less time, and without so mush stress and sleep deprivation in Industry. I don't blame those who want to earn extra from private practice- the system is there and it's difficult to turn down the fees that they offer, but it is mostly done in the Consultant's free time, having given up a good chunk of their NHS salary for the privilege. They may be some who abuse the system, but most don't.

And, robinw, I must have led a very sheltered existence. In the 17 years since I qualified I can honestly say that I was not aware of any of my colleagues or consultants who were drunk on duty or taking illicit drugs. I was aware of colleagues who worked on, when they should have been home sick, out of a sense of responsibility. Of course a manager would say that he/ she shouldn't be there, should be at home making sure the patients don't catch any thing and sue the hospital (yes, someone did actually sue a hospital recently for having caught a cold from a doctor in the outpatient clinic- it was not an immunocompromised patient who might have been made iller by that cold!). That same manager would be back the next week making sure those patients cancelled are squeezed into the next already full clinic so they don't complain too much. We can't win.

Got to go and get some work done now!

docingognito I have to say I think anyone who works within the NHS must spend half their time banging their head against a brick wall (I know I do trying to use it). I'm impressed that anyone carries on trying to work within the system. I've had to consult quite a few consultants over the last 4 years (5- I think- 1 was bloody awful, 1 was OK, 2 were very good, and 1 was excellent- like anything I'm sure they vary). I think everyone agrees that the NHS needs more money- how would you reorganise things so that the money actually went where needed.

Actually I think NHS equipment is a joke. I've had 2 sections, in both it took the staff ages to get a bp reading from me because the automatic one wasn't working. In the 2nd op the anesthetist said to me "you should be fainting with that bp, but you don't look that bad so I guess it's the machine." Then it completely stopped working and she said "well you are now officially dead". If thhey can't even have functioning blood pressure machines (and these ops were almost 3 years apart in the same operating theatre) then I dread to think what half the equipment is like.

Recently an operating table broke during heart surgery at our local hospital.

Often the equipment that the NHS will provide doesn;t do the job. So for example I qualify for fee nappies for my autistic DS1, but I haven't bothered getting them becuase the ones they supply are too small (junior)- they won't supply pull-ups and he won't lie down to have a nappy put on anyway. That's a minor point. More serious points are prosthetic limbs which are hideous and hurt etc etc. Many people would rather be given a voucher towards the cost of buying something decent. Of course this is a problem for those who still couldn't afford something decent, but that is where maybe a charity or fundraising could step in.

After reading all these messages, i think one thing is clear: the NHS needs money, money, money.

and some reorganisation thata ctually solves the problems instead of pushing them under the carpet as with the waiting lists targets.

In my not too limited experience of the NHS I musta dmit that I ahve found much greater humanity and modesty than I expected, being used to the Italian system where doctors believe themselves to be gods and behave accordingly. (you're rarely consulted in your treatment, you're told what they're going to do to you, and that happens in childbirth as well). But then again, people vary, you can't blame the NHS problems on its staff, there's bound to be all sorts, it's the system that's the problem!!

But I must say, that as far as quality of care and equipment, the UK looks like a 3rd world country to me.

The first time I had a smear test I was shocked to be invited to lie on a bed covered by a rag of a towel....in Italy you don't see these anymore, every gp or clinic has paper ones instead (thi is just an example).

Also something that shocked me, is the rigidity of PROCEDURES whereby very little freedom is left to the doctor to follow their instinct.

Every illnes has its own procedures and no one will sway from those. If you have something that doesn't ahve clearcut symptoms they just tell to come back if you're still worried....it happened to me. No one says we'll give you this test just in case....because it could be a waste of money if it actually turns out that you have nothing after all.

(and I know this is not the doctors' fault, it's always the b procedures that they have to follow)
Sometimes I think GPs are given 'budgets' in terms of how many antibiotics they can prescribe, how many blood tests they can perform etc, so they are always very cautious in case they've run out just when someone's really ill and needs it.

And I don't think that the NHS lack of money is due to IVF, or people who go too often to the gp(for minor illnesses), or a few missed appointments. I'm sure these happen everywhere, but it doesn't cause other health systems to collapse.

I know this would be an unpopular solution, but in Italy most health services and tests (but not your GP) are contributory. You pay a small fee for the majority of your tests, unless you are on low wages or OAP etc (the usual exceptions apply). Just as they do here with prescriptions. I know it would add to the bureaucratic burden, but it could be a way of getting extra funding.

It's really sad to see the NHS go to waste like this, it's sad that no one wants to work in it, because the are jobs that are better paid and easier to do (I for one would never be a health professional, but not because of the money!)
I wouldn't want to see a private system like the US, anywhere. (And please don't tell me it's fair)

Docincognito, I thouroughly respect your work and I agree with everything you said.

Sorry thi has gone on far longer that it should have, but I am currently experiencing problems with NHS and DD and I am actually flying to Italy to have her seen by a private doctor there (which by the way is far cheaper than in the UK).

I can very easily see why people would prefer IVF to adopting - and I can't see why anyone who has their own children finds that hard to understand. If it was the same, we's all adopt instead of carrying and nurturing our own precious genetic children. I think it is particuarlarly harsh coming from anyone who has several children and used NHS resources to pay for their antenatal care, childbirth, postnatal care, care throughout childhood and education etc etc. Should we then limit the number of children people can have -to say, two - in order to release funds for the NHS? I think it's a bit dodgy for those of us with easily conceived children (esp several of them) to criticise IVF on the NHS. We - again, particularly those with several children - will almost certainly cost the state a great deal more over the years than those who struggle to have one or two children via NHS IVF. After all, infertility is a medical problem, surely, and IVF is the treatment. Not all NHS treatment is purely life-SAVING, much of it is, like IVF, life-IMPROVING. And, from the experiences of friends going through the infertility experience, it's almost impossible to get IVF on the NHS anyway. BTW I have read research that IVF parents are particularly good, so it could well be that their children will grow up to make particularly fine contributions to society in the end.

BTW, I think there is no better system than the NHS, flawed though it is.