The NHS is broken, what should happen?

[Edie]

I know there’s lots of urbs who work in the NHS. And all of us use it. So I think we’ve gotta acknowledge that it’s broken and no longer fit for purpose. Sure, bits of it are still functional and there’s plenty of examples where care is still timely and often outstanding, but enough of it is destroyed that as a healthcare system overall it’s fucked.

Examples off the top of my head:
Ambulance services are now routinely leaving old people on the floor for four hours plus. When my m-in-law had a spinal stroke last year, eventually after hours my f-in-law and a taxi driver dragged her (legs paralysed and doubly incontinent) into a taxi to ED.

Corridor medicine in our emergency departments is now almost normalised. In my trust, nurses can be assigned to the corridor instead of bays. Ambulances and paramedics queue. Four hour target going.

The “winter crisis” now lasts all year. Bed occupancy is 90% plus. Elective procedures are cancelled and it doesn’t make the news, it’s just accepted. Medical patients overspill onto surgical wards, and are seen as ‘outliers’ by medical teams (which is never as safe).

It takes four years to get an autism diagnosis for a child. MH patients who need a PICU bed are sent hundreds of miles away (Yorkshire to Kent anyone?). GPs essentially can’t refer to CAMHS, or rather, it’s pointless and most know it.

There aren’t enough nurses, there aren’t enough doctors, there aren’t enough physios, there aren’t enough OTs. Rota gaps mean staff are doing the work of two or three. Routinely. Staff being moved between wards sometimes on a day to day basis. Unsafe. Staff are leaving like a flood. No one wants to work under that much pressure, delivering substandard care despite superhuman efforts.

I could go on but I’m sure you all have similar tales.

So what’s to do urban? Underfunding is definitely a big part of the problem. But I don’t think money is the only problem. The whole system is too big. I suspect it’s massively inefficient. Other EU countries don’t have this problem. Many have a mixture of public and private insurance. Would we be better off switching to this? Cos we can’t go on. Someone needs to make a decision...

 

[killer b]

Many have a mixture of public and private insurance. Would we be better off switching to this?

no, but it's probably what we're going to get anyway.

 

[Edie]

no, but it's probably what we're going to get anyway.

Why no?

 

[two sheds]

All of the things you mentioned are down to lack of funding. We need more doctors, nurses and ambulance drivers so they aren't overworked and under stress all the time, and we need to pay them more.

There are other problems, but as far as I can see that's the basic problem with the NHS.

 

[oryx]

Increase taxation on higher earners and divert it to the NHS.

Take everything back in house, from hospital cleaning to operations. No profit before people.

A wide review of the functioning of the NHS including staff recruitment and retention and IT because I think you are right in saying the problems are more than financial.

The NHS needs to be fit for the future in terms of people living longer and there being more treatment available - one thing that makes my blood boil is people having to crowdfund their treatment.

 

[killer b]

Why no?

Because it will inevitably end up with people who can't afford to pay getting a poorer service, or no service at all.

 

[Edie]

Because it will inevitably end up with people who can't afford to pay getting a poorer service, or no service at all.

But the people getting a ‘poorer service’ in Germany, are still getting a better service than us.

 

[Poot]

Because it will inevitably end up with people who can't afford to pay getting a poorer service, or no service at all.

Immediately some people leave the nhs, so will the equivalent amount of funding. This is a tory government.

 

[Athos]

Increase taxation on higher earners and divert it to the NHS.

Take everything back in house, from hospital cleaning to operations.

This.

 

[Athos]

But the people getting a ‘poorer service’ in Germany, are still getting a better service than us.

Are they? Which people?

 

[killer b]

But the people getting a ‘poorer service’ in Germany, are still getting a better service than us.

I don't know the german system, but would be interested in seeing some comparisons. they seem to spend about 25% more per capita than we do though, fwiw - maybe that might be the first place to look.

 

[Athos]

There's absolutely no reason why any improvement measures that could be implemented by private businesses can't be implimented by a publicly owned and run NHS.

Money lost to private profits is money lost to patients.

 

[Edie]

Increase taxation on higher earners and divert it to the NHS.

Take everything back in house, from hospital cleaning to operations. No profit before people.

A wide review of the functioning of the NHS including staff recruitment and retention and IT because I think you are right in saying the problems are more than financial.

The NHS needs to be fit for the future in terms of people living longer and there being more treatment available - one thing that makes my blood boil is people having to crowdfund their treatment.

Everything back in house is a bad idea. We already have large variation in procurement, despite Supply Chain. Some trusts paying ridiculous costs for everyday items. I do not know why. Does anyone? The enemy is being Too Big.

 

[Edie]

Are they? Which people?

 

[oryx]

. Some trusts paying ridiculous costs for everyday items. I do not know why. Does anyone?

It's called being ripped off by the profit-orientated private sector.

 

[Edie]

It's called being ripped off by the profit-orientated private sector.

Don’t be daft. It’s not the sellers problem it’s the buyers.

 

[killer b]

Don’t be daft. It’s not the sellers problem it’s the buyers.

I don't know if it's the case with all the silly prices paid by the NHS for some things, but the ones I've seen are generally because of contractual restrictions on who they can buy from due to PFI.

 

[StoneRoad]

Take everything back in house - patients before profits, but also build a lot of smaller hospitals ie decentralise care, especially A&E / walk-in centres / long term care of the elderly . Get rid of expensive layers of unnecessary admin / management and buy generic not branded drugs.

 

[Edie]

Take everything back in house - patients before profits, but also build a lot of smaller hospitals ie decentralise care, especially A&E / walk-in centres / long term care of the elderly . Get rid of expensive layers of unnecessary admin / management and buy generic not branded drugs.

Emergency care has actually become significantly more ‘centralised’ with establishment of major trauma centres, primary PCI etc.

 

[8ball]

Why no?

Because we just have to fund it properly.

 

[two sheds]

Everything back in house is a bad idea. We already have large variation in procurement, despite Supply Chain. Some trusts paying ridiculous costs for everyday items. I do not know why. Does anyone? The enemy is being Too Big.

Yes costs of everyday items need to be kept under control. The best way to reduce that is centralized purchasing, though, purchasing in bulk for lowest costs throughout the NHS. There the enemy is being Too Small - as you suggest in your post - 'Some trusts paying ...'

 

[IC3D]

I see the problems Edie refers to but disagree with your conclusion.
Outsourcing services should be resolved I've heard though not evidenced it has to be said that each ward meal costs £20 and even a sandwich is £12. Fucking redic

 

[Edie]

Because we just have to fund it properly.

I disagree. It’s not just funding.

 

[Athos]

The enemy is being Too Big.

How and why?

 

[Athos]

Some trusts paying ridiculous costs for everyday items. I do not know why. Does anyone?

Because those things have been outsourced e.g. catering and cleaning, which requires costs to build in profit.

 

[Edie]

I see the problems Edie refers to but disagree with your conclusion.
Outsourcing services should be resolved I've heard though not evidenced it has to be said that each ward meal costs £20 and even a sandwich is £12. Fucking redic

I once tried to buy a chair from ikea for my ward for relatives. After about 6+ months trying via ward manager to get one and being told it was too expensive. I wasn’t allowed in the end. Ridiculous doesn’t even begin to cover it.

Also, bring back coffee for staff. Let us drink shit NHS granule coffee at 3am you arseholes. ‘Patients only’. On coffee granules. And the managers question the morale question.

 

[dessiato]

I'm a great supporter of the NHS, I've benefitted from it a hell of a lot over the years, from minor to major incidents. I've never been disappointed by my care and treatment.

My feeling is that the NHS is being underfunded and that funding which is being input is not going sufficiently to the front line. One of my nieces is a senior (management?) midwife. She thinks this also. She struggles to recruit and retain staff due to the pressure and stress of the role, especially because she is understaffed. She is also finding the EU staff are looking at returning to their home country due to Brexit uncertainty.

I've also been a user of the Portuguese, Spanish and Sudanese systems. From my personal experience all of these worked more quickly and efficiently than the NHS.

I think that the whole of the system needs a major revision. The money that is going into the NHS needs to be more targeted to the front line, especially to recruiting, training and retaining staff. This is what happens here in Spain according to the doctors and nurses I know.

Obviously there needs to be a consideration of the funding. I would be happy to pay a little more tax if it helped. But I think that the richest should pay more tax to fund the NHS (and education).

Here I use private health care a lot, for convenience, e.g repeat prescriptions. But should I need more urgent, extensive care I can use the public system. I pay taxes for this. I wonder if this might work in the UK.

As much as I think the NHS is great, and I cannot fault the care I, and my family, have had, it does need some reform if it is to remain fit for purpose. Only better structuring and funding will do this.

 

[two sheds]

I disagree. It’s not just funding.

You need to start with funding, though. We've had a good 10 years of "efficiency improvements" which have just turned out to be more cuts. There's a lot of duplicated work for lawyers with contracts and ordering and a lot of meaningless management target setting. That can be put down to fragmented service and PFIs.

And yes we should be looking at things like preventing disease rather than treatment. That needs fundamental change to society though - advertisements which push unhealthy foods, parents who already have a couple of jobs so don't have enough time (and now education) to prepare healthy food for their kids. Alcoholism, homelessness, recently we've seen depression from people who've lost their money to gambling - the NHS has to pick up all of that.

All that needs to be addressed, but take a look again at your first post. Every one of those things shows excess strain on services because of underfunding. First we need proper funding, then how we reduce need for the service.

 

[Athos]

The UK spends a significantly smaller proportion of its GDP on healthcare than Germany.

 

[Edie]

You need to start with funding, though. We've had a good 10 years of "efficiency improvements" which have just turned out to be more cuts. There's a lot of duplicated work for lawyers with contracts and ordering and a lot of meaningless management target setting. That can be put down to fragmented service and PFIs.

And yes we should be looking at things like preventing disease rather than treatment. That needs fundamental change to society though - advertisements which push unhealthy foods, parents who already have a couple of jobs so don't have enough time (and now education) to prepare healthy food for their kids. Alcoholism, homelessness, recently we've seen depression from people who've lost their money to gambling - the NHS has to pick up all of that.

All that needs to be addressed, but take a look again at your first post. Every one of those things shows excess strain on services because of underfunding. First we need proper funding, then how we reduce need for the service.

I dont disagree about the funding. But take Germany. Population far bigger than the UK. Do they have a winter crisis, do they cancel elective surgery, do they have a non functioning blue light service. No, they don’t. They get it right. We need to be asking how and why. This save the NHS mantra has become like a religion and it needs to stop and be properly considered.