How is the NHS doing?

[Tonk]

Given that those of us who are Lupus patients tend to be regular service users of the NHS, I was wondering whether our attitudes towards the NHS have changed due to the Covid pandemic.

I have read some real horror stories on here and in other media and could not believe what I was seeing when I watched the BBC series "Hospital."

Clearly, front line staff are under a lot of pressure and that pressure is likely to increase as Covid infection levels continue to increase, I don't think any one will dispute that but I was truly shocked by the sheer number of managers and the number of meetings these managers were having.

My own GP practice is a very large with tens of thousands of registered patients and I get the impression that the management of the practice have used the pandemic as an excuse to restrict the levels of services and appointments. Clinicians perform very few face to face consultations and will only see you if you've had a telephone consultation first. They are also keen to transfer more and more services online.

General hospital appointments are being completely cancelled or moved to telephone consultations including rheumatology appointments that those of us with Lupus so rely on for our continued wellbeing. At the start of the Covid19 outbreak, I was on fortnightly blood tests due to issues with kidneys and other things. I was told that these tests were critical and necessary for my future health and well-being however, without warning or consultation, they were changed to twelve weekly. At the next set of tests three months later, the same issues remained and I was told to have future tests at monthly intervals.

I think as a service, the NHS does emergency care well. I would always say that I would rather need to phone an ambulance in the UK than in any other country.

I would welcome your comments on the following questions.

Is throwing more money at the NHS always the answer?

Is getting better value for money just as important or more so than more and more money?,

Do people expect too much sometimes from the NHS?

Has the NHS been given almost a religious status where it is blasphemous to criticise it?

Have some areas of the NHS used the pandemic to restrict services more?

My career was in psychiatric nursing from which I retired over a decade ago. It was always said that mental health services were the poor relation of health services and we're starved of funding... Is this still the case?

Originally, the NHS was set up to be a health service which was free at the point of use has this ideal, in reality, become more a health service free at the point of rationing?

[PMRpro]

More money isn't always the answer - but more money to pay for more staff and NEW equipment is. A lot of the problems are due to old equipment that is no longer state of the art and difficult to keep running. Plus simply not enough beds and staff to run those beds. New hospitals were built with fewer beds - all based on a theoretical pipedream of day surgery with very quick turnarounds that hasn't turned out to work as well as non-medics thought. Nor is the community care that is essential for it available. Whatever BoJo and Tigger tell us about how many more nursing staff there are - there aren't really. Highly skilled and experienced staff have gone back home to EU countries or gone elsewhere - some replaced by trainee/student nurses, You know as well as I do - they are supernumerary for the first 3 years. Stirling university turns out degree qualified nurses who have NEVER worked on a ward - you know as well as I do, that is a skill set in itself. Put them in endoscopy and they are fine - but that isn't much help when the need is on a ward. My daughter has 10 years experience, 10 years ago she worked for 2 years on a chest ward - so knows what CPAP is and has been tipped onto Covid ICU as a result. No training, no orientation - here are your patients on O2, get on with it. Two days later - here, shadow this ICU nurse with 2 ventilated patients...

People do expect far too much from the NHS - there isn't a pill for every ill and self management is also required. I live in northern Italy - free healthcare with small copays but very strict on what drugs are reimbursed. No painkillers - private prescriptions and pay the cost. NHS standard but better in many ways. So yes - the NHS is free at point of rationing ...

[Tonk in reply to PMRpro]

Interesting thoughts and nothing to disagree with.The obsession with numbers started before I retired.. The number of nurses is less helpful than the number of nursing hours. One full time nurse working thirty-seven and a half hours a week on my old ward was replaced with two part time nurses, each working sixteen hours. Result.. Nursing numbers increased actual hours of nursing reduced and by more than the headline figures suggest when hand overs were taken into account.

[PMRpro in reply to Tonk]

Exactly! Massaged numbers ...I'm speaking as someone who worked in, is married to one and mother of 2 HCPs. We sat there 15 years ago in despair, it made OH retire early because his job was no longer to diagnose but to balance impossible budgets which were being cut year on year and dance to the tune of a CEO (who later was exposed in a fraud case) who turned down the request for a fully charity funded dexascanner on the grounds the funding didn't cover the staff - who were already part of the department anyway doing other things and had been for years. Pure nastiness because he disliked the department which he subsequently destroyed.

I could have written 3 times as much ...

[Tonk in reply to PMRpro]

I retired from the NHS in 2005 and already at that time, I noticed that I was spending less time hands on and more time sat behind a computer screen completing endless forms and ticking boxes.

[PMRpro in reply to Tonk]

We wanted to go in 2006 but they took so long to sort out his pension (had he got enough to live on after Gordon Brown's raid?) it took until 2008. He got a letter of apology - but it will cost me if I outlive him as we missed a cut-off point.

[awareness75]

My personal take on it is its level of efficiency and it's reactive rather than proactive approach. I used to work in production where time is money and spending is only on an absolute necessary basis. Having spent my due time in hospitals, as many, especially as a 3 month in patient, you see a lot of things that in most cases are easy to change.

I feel like overall, the NHS is running as it was in the 50s when there was very few people using it and lots of staff. Now we have the opposite, but the original formula is struggling in the 21st century and very slow to change.

It's a difficult question whether it's the best it can be because there's nothing to compare it with.

An interesting study of data would be to swap the head management of NHS with a top private sector successful business and see what their work structure findings are after a week.

[Tonk in reply to awareness75]

Interesting thoughts. I have worked in both NHS and private hospitals as well as prison settings and have found similar problems in all three.The reason I wrote this thread was because one of my grandsons was thinking about going into psych nursing and asked me what I thought. I am still in two minds what to suggest. I had a fulfilling career in psych nursing but it has changed in recent years.

[PMRpro in reply to awareness75]

It doesn't always work - patients are not commodities with fixed parameters - how long it will take to do a procedure can't always be predicted with great accuracy: passing an endoscope may take 5 minutes for me, 25 mins for the next patient and even longer for another who is nervous, requiring a lot of attention and coaxing. You can't just say after the time and motion man's 15 minutes, tough, you're in the bin. Get two of the third type in a morning and you really are up the creek. Healing post surgery is much the same - and bed blocking is a very real problem for the older frail patient who needs support. UHND was rebuilt under T Blair esq with fewer beds (and parking spaces, so consultants were taking far longer to attend other hospitals for clinics, wasting their very expensive time) - and the care home next door was sold and turned into pricey little homes instead of turning it into a convalescent unit with easy access to the hospital in the case of emergency so all patients who could be discharged IF there was adequate care could just be moved over there. Care home beds are cheaper than ward beds ...

It is very complex - and "Tesco" managers were brought in 20 years ago with disastrous results. They were a lot of the reason that many consultants (my OH included) chose to take a cut on their pension to go as soon as they could at 55 and either go and have fun and regualr hours or do locum work so they were able to not spend hours on red tape and meaningless meetings and be able to say "not on my pay grade".

[Tonk in reply to PMRpro]

Agreed.... In medicine, more so than any other field perhaps, one size does not fit all.Just out of interest, if you were asked by a teenage relative whether you would recommend a career in nursing, what would you suggest?

[PMRpro in reply to Tonk]

Not sure - I sometimes have regrets that we influenced our two so much that they chose the field. But the paramedic daughter's stepson has followed her into the NHS but went into nursing. And is loving it and doing so much better than at school - really good marks so far. I'd certainly point out there is more than just nursing in the NHS - and is it really the right field?

[Tonk in reply to PMRpro]

Good questions.He is not very academic but really goes all out with things he finds interesting. He has taken a course called health and wellbeing or something similar at gcse and really enjoyed it. As part of that course, he spent half a day working in a care home and really enjoyed it.

His mother (my daughter) is a secondary school head of department but, he doesn't want to do something like teaching.

I think he sees me as a father figure because his mother was widowed when he was very young.

I pointed out that nursing is pretty much an all degree profession these days and involves a fair amount of study in order to qualify. I took the enrolled route and later did a conversion course but of course that option is no longer available.

I suggested he should try taking a NA ot hca role and seeing if he really does like it before committing to taking a full RMN training course.

It's a tricky one isn't it.

[PMRpro in reply to Tonk]

My grandson wasn't academic at all either but dad wouldn't have the idea of doing BTecs to get into nursing. He made a total mess of lower 6th or whatever it is called now. Repeated the year and did improve 2nd time round but didn't get what he really needed . Did some sort of conversion course - and at his interview obviously said the right stuff. Asked why nursing he didn't come out with the usual "I want to help people" but talked about the family connections - stepmum is a paramedic, her dad is a medical scientist, her sister i a nurse. So they saw he wasn't coming in with stars in his eyes, he knew what the deal was: long hours, death, not romantic soothing the fevered brow stuff. His father also worked in the ambo service in admin. He originally wanted to do paeds but general was easier to get into and that is what he is doing. So far, so good.

The best thing they could do is turn back the clock and have enroled nurses again - the salt of the NHS ... Good nurses are created without needing degrees ...

[Tonk in reply to PMRpro]

Yes I thought a return to the enrolled route would have been a sensible move. I fear we are losing many great potential nurses because of the removal of the enrolled route.

[PMRpro in reply to Tonk]

Absolutely - there are a lot of nursing tasks that DON'T require a degree to carry out and arguably there are enrolled nurse material who can do many of them better. While in charge of a ward my degree qualified daughter always did bedbaths - others laughed at her and told she "didn't need to do such menial tasks". But she pointed out it was an invaluable opportunity to assess physical and mental condtion while chatting to the patient and doing something useful. She never missed bedsores! A good enrolled nurse will do that sort of thing really well - many degree nurses not so much as they believe they are above that.