NHS - oh dear!

The BritishMedicalAssociation (BMA) survey 2022 says Australia and Canada are top destinationsfor UK doctors. The main factor for leaving the NHS is pay and that the majority of doctors feel professionally undervalued. It's a lengthly and costly procedure to emigrate and to obtain a licence to practise but Canada welcomes UK doctors as described below. Quite an interesting article.
www.timescolonist.com/local-news/bc-government-entices-uk-doctors-with-double-the-pay-8368607

growstuff

If the average person is not an expert in the field of NHS organisation, why do they persist in coming out with soundbites about "complete reorganisation"? If what you say is true, they haven't a clue what they're talking about.

PS. That's my point really.

Because to the untrained eye, that seems like an obvious solution?

They know that various initiatives and policies have not improved services because of what they read and hear so have come to the conclusion that root and branch reform might be what is needed.

I don't know if an enquiry or Royal commision could be framed in specific enough terms to be useful. What, specifically ,are they investigating? And there is such variation, from hubs on Scottish isles that function as GP's district nurses,midwives & emergency care right up to the big teaching hospitals in the big cities. There is much more specialism in healthcare as treatments & diagnostics become more sophisticated. That reduces the amount that GP's can oversee. Having different specialties in different hospitals, centres of excellence, does improve the success rates but also increases the logistical challenges of co-ordinating it all. Perhaps an enquiry could address how best to use & co-ordinate IT admin, as that crops up a lot on the above posts. But IT and medicine are 2 of the fastest-changing sectors, & such an enquiry would take at least 4 years from setting terms of reference to report implementation, would the recommendations still be relevant? A good start would be to overhaul social care and mental health provision, if these worked well it would take some pressure off hospitals.

Dickens

growstuff

If the average person is not an expert in the field of NHS organisation, why do they persist in coming out with soundbites about "complete reorganisation"? If what you say is true, they haven't a clue what they're talking about.

PS. That's my point really.

Because to the untrained eye, that seems like an obvious solution?

They know that various initiatives and policies have not improved services because of what they read and hear so have come to the conclusion that root and branch reform might be what is needed.

The problem with that kind of opinion is that people will then accept something because it seems like a radical change (so must by definition be good). They don't have the expertise to understand all the consequences.

growstuff

Dickens

growstuff

If the average person is not an expert in the field of NHS organisation, why do they persist in coming out with soundbites about "complete reorganisation"? If what you say is true, they haven't a clue what they're talking about.

PS. That's my point really.

Because to the untrained eye, that seems like an obvious solution?

They know that various initiatives and policies have not improved services because of what they read and hear so have come to the conclusion that root and branch reform might be what is needed.

The problem with that kind of opinion is that people will then accept something because it seems like a radical change (so must by definition be good). They don't have the expertise to understand all the consequences.

They don't have the expertise to understand all the consequences.

... well that's certainly true.

For my part, to fully understand the way the NHS functions (apart from the obvious) I'd have to make a detailed study, looking at all aspects - like procurement, etc - and that would be mammoth (for me anyway). I don't pretend to have any answers other than the belief that whatever is required to make it function effectively for the end-user, the patient, has to be properly funded and staffed. How that can be achieved, I have no idea.

I had a consultant write to my Doctor explaining that he'd seen me, and that the patient (me ) is a smoker who admits to smoking 60 cigarettes a day.

I don't smoke.

Ailsa43

I had a consultant write to my Doctor explaining that he'd seen me, and that the patient (me ) is a smoker who admits to smoking 60 cigarettes a day.

I don't smoke.

Dickens Understanding what is really going wrong would be a mammouth task for anybody. That's why I groan when people write such as a "complete re-organisation is needed". They don't know what's needed any more than you or I (and I suspect most politicians) know. A complete reorganisation would throw everything into chaos.

growstuff Follow the link.

DH has just spent an hour filling in the form for an appointment to speak to a GP, any GP will do, to get a referral to a private consultant, because after waiting three years for a referral for a CT scan by the NHS, which showed how seriously misaligned his breast bone is after bypass surgery, he will probably need to wait as long again before one of the many different doctors he sees to realise he has the power to put him on a waiting list for surgery, by which time they will probably say he is too old for it.

Even though all he wants is a referral, but the form contained hoards of irrelevant questions that he had to answer. I have now to go through the same process for a separate referral for a problem, caarpal tunnel syndrome, I have been trying to see a GP about this for over a year without success.

Maybe those who are able to pay should pay and the money going into the coffers put towards hiring more staff and improving equipment and buildings? Here they make you either pay for private health or they deduct money from your pay if you don’t choose to do that. Not ideal but one way of funding better services. Trouble is, no one will bite the bullet and suggest it because it would be electoral suicide.

Well, I have just filled in the booking form for my surgery. To begin with it didn't recognise the words 'Carpal tunnel syndrome', I had to tick 'pain in wrist. It then asked me innumerable irrelevant questions and finally told me to choose an appointment, all before lunch befor telling me a doctor would ring me before 6,30pm.

I am left trying to find out whether if the doctor does not ring me before my 11.50 appointment should I go to it, or if the 'before 6.30pm' triage system takes priority. I do not need to see a doctor, I just want a private referral so a telephone appointment will be sufficient. The specialist assessment of my problem and recommendation for surgery are on my notes.

I have to defend the NHS, last year I phoned 111 at a weekend due to balance issues. Was told to get to hospital ASAP. Witin an hour I had a scan that showed I had lung cancer (never smoked in my life), about an hour later was told it had spread to my brain and spine. Biopsy showed I had non small cell lung cancer that although not curable is treatable with tablets. Every 3 months I have a scan and blood tests every month. I am living every day to the best of my ability and glad I am still here. The NHS saved my life and the care and dedication given by my Oncologist and cancer team is second to none.

One they could do is to start training doctors differently so that some of them are able to deal with patients across a range of co-morbidities (as Growstuff suggested). so many patients are being seen by several consultants because they are diabetic, have heart disease and a vascular problem for example Three different specialisms. Also I really do question the use of agency staff and how much they are paid. I had an agency nurse on at night on a big cardiac ward who couldn't fit the leads for a standard 6 lead ECG and she was probably being paid twice the amount of the nurse who came to show her. She also had no idea why the telemetry wasn't working. There were no batteries in it! I also spoke to a student nurse coming to the end of her training but she couldn't find a job yet the hospital is full of agency nurses? Different budgets?DD is an anaesthetist and says the wastage of equipment makes her want to weep. NHS also pays more for it's drugs than it should.

MOnica I've written before about my Kafkaesque experiences with my GP's online booking systems. I couldn't agree with you more that they aren't fit for purpose. My surgery has three new systems over the last couple of years - each one is supposedly an improvement - and each time it's worse than the previous system.

To be fair to the GP, the government has been pushing digital systems alongside triaging and consultations with PAs and the like, so it's not entirely the GPs' fault. I suspect some bright spark in some government office thought it was all a good idea and politicians thought it might save a bit of money (and make a bit for the people providing the systems), so GPs have had to accept it all.

As I also mentioned in a previous post, I send letters marked "urgent" whenever I end up going round in circles with systems. At least the Practice Manager knows who I am now because I complain so often. After I threatened to sue the practice for not recognising my breast cancer, I suspect I get treated with kid gloves.

Nevertheless, once all these kind of errors are unpicked, they're actually clerical errors and IT systems not integrating. Partly that's because the NHS is, compared with other health systems, undermanaged - or at least not managed efficiently. A meeting with a dozen or so patients affected by clerical errors would make the practices aware what's going on and anybody who understands systems could sort the glitches out. I remain sceptical about claims that the NHS needs a "complete reorganisation", which would undoubtedly cause even more glitches and unintended consequences.

I agree with you foxie48.

nanna8

Maybe those who are able to pay should pay and the money going into the coffers put towards hiring more staff and improving equipment and buildings? Here they make you either pay for private health or they deduct money from your pay if you don’t choose to do that. Not ideal but one way of funding better services. Trouble is, no one will bite the bullet and suggest it because it would be electoral suicide.

Theoretically, those who can afford more in the UK do pay more through the tax system.

I have a problem with a curved spine which affects one leg and is painful. There is little - and sometimes none - fluid in the knee joint. I was given an appointment quite quickly and was pleased it was taken seriously. Well, it was the quickest Xray I've ever had - literally seconds - and was told there was nothing wrong. Luckily I attend a rehab Pilates session every week because of my spinal problem and yesterday I asked the instructor for additional help [every patient there is given exercises according to their problems] and I've got an appointment on Friday. He's been great with my spinal problem so fingers crossed he'll at least calm down the pain in my knee and leg. I'm afraid I've lost faith in the NHS

Tiley I do not think anyone has said anything other than that the emergency system is superb, and I would include 111 in that.

It is the non-emergency side of the NHS which is so poor. Like my (and DH's) experience today. I did email the surgery administrator and got a quick reply to ignore the appointment I had to book, and wait for the doctor's phone call. She also admitted that the system was confusing and that changes were planned.

After 111 sent me to A&E with heart problem symptoms in late March, they asked the surgery to arrange a 24 hour heart monitor. They did that and I received a form to book an appointment online, but every attempt gave me a 'fully booked' response and no information what to do next. I contacted the surgery, but again got no response, so I have given up on it.

M0nica

Tiley I do not think anyone has said anything other than that the emergency system is superb, and I would include 111 in that.

It is the non-emergency side of the NHS which is so poor. Like my (and DH's) experience today. I did email the surgery administrator and got a quick reply to ignore the appointment I had to book, and wait for the doctor's phone call. She also admitted that the system was confusing and that changes were planned.

After 111 sent me to A&E with heart problem symptoms in late March, they asked the surgery to arrange a 24 hour heart monitor. They did that and I received a form to book an appointment online, but every attempt gave me a 'fully booked' response and no information what to do next. I contacted the surgery, but again got no response, so I have given up on it.

Have no faults with our GP surgery either.

The NHS is being failed by this gov't who want to force us to go private so they can reduce taxes for billionaires.

This was not in their manifesto of 2019, we have been conned when they forced a hard Brexit on us and conned that they said they'd protect the NHS.

If the Tories get in again our GP service will be like the NHS dentists, non-existent or something like you can see a minimally qualified patient associate or pay to see a GP.

I can't wait to vote this gov't out and get in the party that started the NHS -Labour

I’m afraid the emergency service is also broken. Three weeks ago my husband had a heart attack at home. With a history of heart disease it was very obvious what was happening. I called 999 to be told ‘there’s a minimum 2 hour wait, if you can get him to hospital by car I advise you to do so’. Exactly what we have always been told we shouldn’t do. I’m afraid A&E were less than bothered, quick ecg and blood tests and then left to wait for several hours, no one bothering to tell us what was happening. At one stage he was removed from a cubicle as someone ‘needed cardiac monitoring’. My husband was not monitored at any time. He spent two weeks in hospital where the care he received was excellent, but he could have died there and then for all the A&E staff cared.

Well Labour will have a massive job on to improve the NHS.
I don’t think the current government want to force people to go privately either, because any government that did that would be on to a hiding to nothing, and they all know that. I have no idea how the non immediate health care needs side of the service could be improved, and I’m not sure either party know that either. As said previously, when you need urgent care, the service is world class. When I was treated in hospital for Covid I couldn’t fault the service and likewise when I had Clostridium Difficile, which is a life threatening condition. I also had emergency treatment as a child, but the non emergency, but necessary treatment side of things is dismal, with people waiting years sometimes, suffering and in pain. Quality of life seems unimportant. I don’t know what the answer is, and I’m not sure anyone else does either. The only suggestion I have is to train more staff. Perhaps also it might help if managers (who are often medics themselves) stopped devising circuitous routes that prevent people from actually getting a diagnosis and treatment.

If anyone cares to look at the service from the point of view of doctors and clinicians, etc - it's worth reading what they have to say about the various systems, directives, etc, that have been imposed on GP surgeries. If you look at PULSE the site that is for the professionals only - it is quite revealing.

One doctor, on calling 999 for one of his patients who was clearly in need of urgent attention, was told by the 999 service to 'call back when the patient stops breathing'. I doubt it was because the call-handler was callous or indifferent - more likely that there were no ambulances available - for reasons we're all aware of.

He twice had to take patients to the local hospital himself.

The question that needs asking is - why is the whole system of care in such a dreadful state?

Most of us are aware that the needs of an ever-growing ageing population is putting a tremendous strain on it - but so are the government. They have the stats, the figures - this has been an escalating problem since they took office, as has social care, and care-in-the-community which local councils with constrained budgets have been dealing with for years.

So what have they actually done about it? Apart from apply sticking-plaster solutions like roping in local pharmacies, or PAs?

Of course we - us patients - have a duty - to self-manage those health problems that do not need the immediate attention of a clinician, and I believe that many of us are doing just that. And, I might add - in view of my own experience in A&E at weekends - so do those self-centred, careless idiots (and I make no apology for using that word) who drink themselves silly and end up prone on the pavement who have to be ferried by ambulance to their local A&E. If you doubt they are much of a problem, just ask the crew or nurses next time you are unfortunate enough to have to be in that department on a Friday or Saturday night.

But they are only part of the problem, not the sole cause of it.

growstuff wants to know how we would sort out the problem when we talk about a complete re-organisation of the NHS - well, I for one have no bloody idea because I don't know enough about the structure to be able to make an intelligent recommendation. But we pay our politicians to do that for us - all we can do is comment on what we see and experience ourselves.

But if I was compelled to give an answer, I'd start with looking at how other European nations manage their healthcare systems. Especially those that appear to fare better than we do.

I moved from an area where we had a very good and very caring practice, to one where the local practice had been put under 'special measures'. I have now had some experience of the renewed efficiency of the said practice, recently combined with another very widespread practice. There's quite heavy reliance on using IT to contact patients and for patients to contact the practice. While I sympathise with patients who have neither the opportunity nor the expertise to use email, so far I have found that messages are promptly dealt with and queries answered. Results of a wide-ranging blood test took longer than I expected to come through but when they arrived on my NHS app, they were more informative than any I've ever had before. Apparently I am 'normal' on all counts! But I do worry about those (mainly older) patients whose 'can't be doing with' the methods of communication I'm at home with.

Dickens My real problem with leaving a complete reorganisation of the NHS to politicians is that we'll end up with something we really don't want, which forgets the principle of a universal healthcare service - but it will fulfil the demands of those who advocate a complete reorganisation. I think we should be very careful what we wish for.