What state is the NHS in? How can we improve it

StanleyAccrington

The NHS must be fooked. I retired from it 2 years ago. Today I receive a letter asking if I will consider returning! Smacks of desperation to me.

ESBlonde

If all health care was private it would be like Gyms. There are some one might not want to put a foot inside.
Health care is best kept to a needs basis, I had need of a visit to the acute eye surgery at the local hospital yesterday, made the appointment by phone and rocked up 5 hours later. Then I had to wait while a difficult case was attended to before me. It took nearly an hour which then made the other 3 people before me later. I got seen and treated and sent on my way with a prescription.
Wonderful service if a little odd in the admin stakes.
Many private hospitals use second hand equipment which is Ex NHS who largely have very good modern equipment. If you attend a private clinic and it goes wrong you are immediatly passed to the safty net that is the NHS.
It is not unreasonable that a person can pay extra for private health care, but the fact that the NHS is and remains the primary care source is important I think.

hywelg

A week ago I had to accompany my mother to A&E. 

We arrived at 8am and it was quiet but within an hour or so there was a queue. Now the ambulance paramedics have to wait with their patients until they have been handed over to the nurses. This resulted in, at one point, 10 highly trained, highly paid professionals standing around for up to an hour each. 

They couldn't go back out on the road because their, no doubt expensive trolley wasn't free. The simple solution was to buy some spare trolleys and let the paramedics get back out on the road, so the system could.then probably manage with quite a lot fewer ambulances. 

This is just one example the waste that is endemic in publicly funded businesses. I sawothers. 

ourmaninthenorth

I can't be doing with the vast majority of people when they're well, let alone when they're poorly. Thank God there are some, on the front line services that can. I tip my hat to 'em. 

And when, not if, I need them, I'll be as grateful as fook. 

Like a previous poster said, that paying your stamp thing looks bloody good value. 

Oh, and I like women in Nurses uniforms...always makes me feel better. 

the_twin

Yep. More trolleys to park in corridors with no-one to look after the patient and no handover of information about that frail confused old lady just brought in from the nursing home.

The difficulty with A&E is mostly an inability to move patients into beds in the hospital in a timely fashion which results from an inability to discharge patients who need ongoing social care. About a fifth of beds in your local DGH will be occupied by patients who no longer need acute medical care but are waiting for appropriate social care.

I don't think it is helpful for this thread to descend into a public sector bad, private sector good (or vice versa) argument. The issues are far beyond that. On a simple level we spend a lot less per head than similar countries and have far fewer doctors and hospital beds. The system is unsurprisingly now showing signs of significant stress. We can expect a winter of bad news stories and the closure of services due to lack of staffing. 

Rocker

@Lodious my deepest sympathies for your loss. 

Lodious

Thanks Rocker. I'm going back to the family home to visit my teenage bedroom tomorrow with a guitar and amp and make a shitload of noise like when I was 15 ;-)

mellowsun

More joined up care is needed. That means joint working for health and social care. Some trusts do that well, but it needs to be done properly at national level.

despite billions spent/wasted ( I used to work for a Connecting For Health contractor under Blair's spending spree), IT is still in the 80s or worse. But part of that is because of public resistance to sharing data.

Hootsmon

it's in the UK silly

Tone71

I haven't read the whole thread but the one thing that you need to remember is that THE time you need specialist care in emergencies in this country, they are there, the service, doctors and medical attention is there.... and its it essentially free (I know it isn't,,but)
  
Once you get passed the front line that are there to divert and repel the time wasters, the care is second to none.

I personally think if you could take 1 penny from every lottery ticket then there would never be an issue (apart from the age old "skim of the top" brigade)

chrispy108

https://www.theguardian.com/uk-news/2016/may/24/national-lottery-sales-record-camelot-lotto-euromillions

The lottery had sales of £7.6bn in 2015. 1% of that is 76 million.
They already give £1.9bn of that to good causes anyway.

Health expenditure in 2014 was £179.4bn. http://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem

So no, 1% off the top of lottery tickets wouldn't make much difference at all. The numbers involved are just enormous.

chrispy108

Just an example of the waste:
Daughter is born by emergency c-section, spends 2 days in intensive care, very grateful etc etc.
Her belly button was a bit weird, get discharged anyway, told to keep an eye on it and point it out to midwifes when they visit.

• The midwife who visited didn't like the look of it, so arranged an emergency GP appointment.
• GP refused to do anything until it had been swabbed for infection (Midwife could have done this - she took a swab from my wife).
• Results came back over a week later, needed antibiotics.
• Baby had antibiotics for a week. Went back to GP as still looked odd, but less inflamed.
• GP then referred to specialist at hospital, as she didn't want to burn it off in the GP (her exact words).
• We changed GPs a few weeks later, and the new GP said it would probably sort itself out, antibiotics weren't needed, results were perfectly normal for what happened, and they don't "burn off" odd bits of belly buttons on kids under 8 anyway. She said she couldn't cancel the referral as she didn't make it, but just phone and cancel when it came through.
• 10 weeks later we get a letter from the hospital apologising for having to cancel our appointment.
• Phoned up, said we didn't need it, but were a bit confused as we didn't know we had one. She said that happens sometimes, not to worry.
• Got a letter through in the post a week later saying our appointment had been cancelled (another one we didn't know we had), and to phone up to ask why and reschedule.

What have all those missteps along the way cost the NHS? If the first midwife had just said to do nothing until they were 8 unless it was hideous it would have saved them at least £100s.

WezV

  I have been for 2 issues in the last year so when I received another  consultant appointment I was a bit surprised, but assumed it was just a follow up.

I spent the best part of an hour waiting to be seen. No-one knew why I was there, they suggested there must be someone with a similar name.... Which is quite unlikely, but I hope they are okay    

My wife also received an appointment for a diabetes clinic a few weeks after giving birth. Spoke to the midwife who checked the records and confirmed there was no hint of any concern in this area.

So that's two random computer error appointments for the same household within 3 months of each other.

the_twin

Better IT in the NHS would help. Blair's grand plans came to nought and cost billions. Paranoia about data security is a major barrier to progress in terms of an electronic patient record accessible across organisations. There is now no money to invest in capital projects such as more efficient buildings or modern equipment as much of it was used to prevent last year's overspend breaching statutory limits. 

ESBlonde

There was and interesting item on R4 this morning about 'red to green' which goes some way to resolve what @mellowsun made mention of. Essentially sort out downstream and discharges so that people can go straight from A&E to a specialist ward. The savings are said to be enourmous. Why someone has to have this pointed out is beyond those of us that survive in the commercial sector. I understand the need to have qualified medical people in management to stop stupid or impractical ideas, but why aren't the professional administrators able to work!

Evilmags

Stop doctors pressure groups from preventing pharmacists to do the job they are trained for would save a lot of money and time. 

Fretwired

Interesting comments on waste ...

http://www.express.co.uk/comment/expresscomment/653888/NHS-waste-continues-we-suffer

holnrew

Mental health care is severely underfunded, it seems to be you need to be at risk of harm before anything happens rather than preventing it getting that bad. I can't back it up with figures, but I think that if you catch these things earlier it's better for the country in terms of productivity etc.

As for physical health stuff, ten years ago I had bad testicle pain after a car accident, I had several misdiagnoses, lasting the span of two years or so, during which time I was released from my job, had minor surgery (which was very painful as I didn't receive adequate local anaesthetic), and became incredibly depressed. After all that I saw the head of urology who said it was likely a compressed nerve and after a few physio sessions I was much better. If somebody had spotted that much earlier things could have been so much better for me. I don't know if I can blame the NHS for that, but the urologist I saw initially should have picked up on something like that. He was Pakistani, I don't know whether he was trained here or over there, but that might have a bearing on things. Junior doctors trained at our universities should be held on to for dear life.

Other experiences include a couple of times where I went to A&E with bad self harm wounds, I had to wait for like two hours to be seen, should have received stitches, but they glued the wound shut, basically told me off saying I'm healthy there's no need to do that and sent me on my way. Within five minutes of leaving the building the glue would fail and I'd be back to square one.

Both those things happened in Somerset though, I've had much better experiences here. Less built up areas tend to get shafted with all services really.

ThePrettyDamned

ESBlonde said:

There was and interesting item on R4 this morning about 'red to green' which goes some way to resolve what @mellowsun made mention of. Essentially sort out downstream and discharges so that people can go straight from A&E to a specialist ward. The savings are said to be enourmous. Why someone has to have this pointed out is beyond those of us that survive in the commercial sector. I understand the need to have qualified medical people in management to stop stupid or impractical ideas, but why aren't the professional administrators able to work!

 

But where do they go? 

The state declares nhs duty of care. If they discharge and something bad happened (say, they couldn't get home, they could but couldn't cope, they don't have anywhere to go) the NHS is liable. 

There are hundreds of medically fit people who need a nursing home or rehab placement or care at home. But there isn't any. That needs fixing. Which needs money - which the government won't provide. 

Plus, the frequent fliers and folk who don't want to go home - a minority but still. 

The responsibility is shunted onto the NHS - families often do little to care for their loved ones. They often refuse to send them to a home when a place comes up because they don't like it, but won't accept having them back home either. 

It's just a massive infrastructure issue. 

lloyd

holnrew said:

Mental health care is severely underfunded, it seems to be you need to be at risk of harm before anything happens rather than preventing it getting that bad. I can't back it up with figures, but I think that if you catch these things earlier it's better for the country in terms of productivity etc.

As for physical health stuff, ten years ago I had bad testicle pain after a car accident, I had several misdiagnoses, lasting the span of two years or so, during which time I was released from my job, had minor surgery (which was very painful as I didn't receive adequate local anaesthetic), and became incredibly depressed. After all that I saw the head of urology who said it was likely a compressed nerve and after a few physio sessions I was much better. If somebody had spotted that much earlier things could have been so much better for me. I don't know if I can blame the NHS for that, but the urologist I saw initially should have picked up on something like that. He was Pakistani, I don't know whether he was trained here or over there, but that might have a bearing on things. Junior doctors trained at our universities should be held on to for dear life.

Other experiences include a couple of times where I went to A&E with bad self harm wounds, I had to wait for like two hours to be seen, should have received stitches, but they glued the wound shut, basically told me off saying I'm healthy there's no need to do that and sent me on my way. Within five minutes of leaving the building the glue would fail and I'd be back to square one.

Both those things happened in Somerset though, I've had much better experiences here. Less built up areas tend to get shafted with all services really.

IME there's big variance between hospitals and even departments and the service provided.

I broke my leg in Chester and the receptionist took my name and said they'd call me when someone was ready to see me-seriously, didn't even look at it, despite turning up in an ambulance-yeah it was at night on a weekend but seriously?

I took a taxi home after an hour of sitting there.

The next day went back to Wales and had great treatment, pretty much straight away.

I've had good treatment/service in Oxford for an eye problem and Manchester for a nasty cut, although it took 6 hours to be seen in A&E on a bank holiday weekend, but I understand they're stretched and you're seen on a case urgency basis.

 Had a white British junior Doctor speak to us while my Nain was dying, he was fucking shit, sticking his oar in where nothing was needed to be said, I think he just liked the sound of his own voice and to feel important.