Present state of NHS

Well my friends as the news says another winter and our NHS is struggling to meet demand. The reports once again suggest we the patients are attending A&E instead of other options, however it also suggests the newly formed 111 ADVICE Service is suggesting patients go there. A summit has been called for review of the situation, talking is not the answer in this case action would speak louder than words. More speed is needed in introducing services to meet the community needs of this generation including training staff to meet that need and attracting more staff to the career, including doctors. How to finance this is a large issue that needs to be addressed before a major disaster occurs. I would love to hear peoples feelings about the future of the NHS and what action they think should be taken.

32 Replies

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  • I don't know if this will help with the situation as there are no figures to go by, but our CCG have instigated this winter 'Winter Surgeries' in four areas that they come under starting in November through to March. They are Saturday and Sunday surgeries from 10:00 - 13:00 and 5:00 - 7:00, there is a designated phone line which you phone and are then given an appointment at your nearest location. They do say that the surgery will not have your notes so it is only for emergencies and to use this facility instead of going to A&E.

    I would be interested in the figures to see if it has helped to take away people from A&E, as we still have the walk in centres in two areas plus this new addition for this year.

    As to the community, where I live they have gradually moved away from caring to enablement, which I think is wrong as do the 'carers' who used to do the job of caring for the elderly and the affirm. You still need the caring side as that frees up the beds in hospitals.

    I may have answered your post incorrectly but this is my take on what you have asked for my location.

  • Well Georje, that sounds like a step in the right direction to keep people away from A&E during out of hours time and to meet an emergency need. In my area we have a walk in which although very good is a long way to travel if you are very ill in fact our nearest A&E is over an hours journey away on public transport. I agree we still need community carers or facilities to free up hospital beds when elderly need to go home. As a disabled pensioner I do not feel enablement is the answer, many of us just manage the daily tasks as best we can, the level of care often borders on negligence as defined in the manuals. It is not just A&E that is under pressure both the NHS and care facilities are crumbling which is not good news for patients, carers or staff, after all even staff have to use these services too. The point being made is that all the services are faltering and we need a long term solution not a temporary one to keep the wolves at bay.

  • I used to be a manager in the NHS. It will always be that telephone advice services will advise to call an ambulance or go to A/E because they do not want to take the responsibility of someone falling dangerously ill or dying. To some degree I can understand their predicament, especially as some of the advisors had no clinical knoweldge. The ambulance service in Scotland put Paramedics into control rooms in an attempt to lessen the pointless need of every patient being transferred to hospital because they used their clinical knowledge to make that decision. That only worked until those not requiring hospital treatment were transferred to the non emergency line and yes, you have guessed it they Then requested an ambulance to take the patient to hospital putting a strain on both ambulance and A/E. Until the mindset is altered nothing will change.

  • I have a son working as a Paramedic and listening to him I get the impression that the 111 service is responsible for many ambulance call outs.

  • That's right, but many of us question the ability of 111 staff to decide that. Again it is debatable whether the current system that was only recently introduced is best for the user or even cost effective in the sense of value for money. After all medical staff would normally be presumed to be the best to decide what is an emergency need. I feel outreach minor illness and injury clinics would serve a better purpose in relieving the strain on GPs and the hospital services, but that's just a personal opinion.

  • Very much agreed

  • BBC radio 4 Today prog this morning had the Chief ex of 111 he has figures, and stated them, to prove that its not 111 that's causing the problem.

    I see two issues coming together, firstly we are in a 'need it now' culture and the NHS is behind the curve when it comes to customer expectations.

    Secondly, the NHS has done a wonderful job of making themselves indispensable - people need to take responsibility for their own health instead of running to the NHS at every whim - of course being indispensable has a nice warm feeling about it and it serves the BMA* in their constant quest for more of your money.

    *BMA is the doctors trade union they have no legitimate remit to look after the benefit of patients, improving/maintaining doctors conditions of service is their primary role - hence the constant whining by them for more money.

  • I agree with you NHSatheist, patients should be more responsible for their own health. But also feel that's how it would be in an ideal world, and we are not in an ideal world. Of course it is bound to be proven the 111 service works, no one would want to be seen to be wasting money or continuing with a service that dose not work. You are correct the BMA is for doctors and to get the best for them not the patient I believe, but they have been around for many years, and have to deal with patient issue that involve doctors too.

  • There needs to be a recognition that patient's need to take responsibility for good health. I pay for some of my health treatment. If I did not pay, I would not get it.

    I have to do research as to what is known about some conditions. The NHS is geared to giving treatment that is relatively fast to give. Many treatments for some conditions are time consuming and require the patient to engage in learning how to manage the condition.

    This creates a problem.

    There is a demand that the NHS should treat everyone the the same. This results in many people who have an education being denied treatment that would be helpful to their condition, because people of lesser educational ability would find it difficult to manage a treatment regime that requires learning how ingrained muscular habits contribute to pain and mental distress. The treatment regime also requires how to replace bad ingrained muscular habits with more beneficial new muscular habits. This takes time to learn. Many people do not want to spend time learning they want a pill to remove the problem. If no pill is available they do not want to know. These people prevent people who are willing to put the work in from getting treatment that would be helpful. Treatment tends to be be what fits the lowest common denominator.

    If more people can take responsibility for their health both mental and physical than their would be a lessor drain on NHS resources. To help more people take more responsibility for their health their needs to be more honesty among NHS management, who lack the ability to tell the story how it is, and try to give a slant that implies things are better than what it actually is.

    I don't have answers only questions which are never answered truthfully by NHS managers who decide policy.

    I now wait to see what people think.

  • John Smith,

    I agree that NHS treatment is designed for the masses, just a conveyor belt system to get the max throughput - I understand the need for this approach. Are you aware that each CCG has an Individual Patient Commissioning Request procedure? This allows non-standard treatment on an individual basis for those that would benefit from that treatment. Search your CCG website.

    The request has to be submitted by a Dr ( which irritates me greatly) and is then considered for funding by a committee based upon cost and evidence of effectiveness. As an individual I have always researched the evidence of effectiveness and copied it to the Dr submitting the form - I like to work in partnership, in a leading role !!

    Last time I looked locally about 50% of the requests were granted. You can appeal, if you do find out exactly why it was refused and fill the gap if you can.

  • NHSatheist, thank you for bringing the new procedure to John Smiths attention and the rest of us in this debate, I was aware of this , guess as the doctor still submits the request to CCG for non standard treatment it does not conform to many peoples idea of individual patient control. Accept there has to be control and sounds a reasonable figure if 50% of requests are being accepted also shows some areas are changing and working to some degree.

  • BBC Radio 4 More or Less programme bbc.co.uk/programmes/b04xf1d5 the first piece is useful for understanding the reasons why A& E is not making it's target.

  • Thanks for that, explains the crisis but we want to know what action is to be taken to avert such crisis in future as this as been a mild winter so far. And it would seem the targets are not being met at any time so the present system is failing everyone. It is action we the public want to see.

  • Is the present system failing everyone? Current figures says that 87% of people attending are dealt with inside the 4 hrs. I don't see that as a failure. We are in an election run-up NHS is an easy battleground for the politicians - figures can be banded by them to score political points.

    Is 4hrs the wrong timescale? Is 95% the correct target? They are both arbitrary values you are not going to die if the timescale becomes 5 hrs or the target reduces to 80%. You will have a lower level of service, but the targets will be being met and there is no longer a news story.

    How to improve the situation? For me local action is needed, the CCG (the commissioners of the service) need to work with Local Authority Social Care Dept which is the aim of the 2012 re-organisation. They need to reduce the number of older more complex patients needing A&E. Some CCGs have been proactive and have systems in place that give older with more complex needs patients better and more timely care in the community, thereby negating the need to attend A&E in a lot of cases. One CCG has funded a telephone help-line where care home staff and patients can skype with experienced nurses thereby getting early competent advice that could prevent A&E Attendance. There are many other schemes about that can be copied. Some, but not all by any means, in the NHS just need to get a grip.

    .

    The Govt want all over 75years old to have a named GP responsible for the individual, so things are happening.

    The best advice I can give is to ask with your CCG - Clinical Commissioning Group - what actions they are taking to manage A&E attendance AND are the local hospitals meeting the 95% target. If they are not meeting the targets ask what is there proposed remedy. Each local authority area has a corresponding CCG, eg Liverpool City Council works with Liverpool CCG, search the web for their website and contact details. Those failing will undoubtedly come back with finance as the problem - don't take the crap it is their job as managers to manage the finance - if they can't manage it - it's time for them to move on.

  • Hi again NHSatheist, agreed targets are just a number and often an averaged one which suggests most peoples need is being met including government suggested targets. I don't agree with the government deciding how my local services are run. If we opt for a named GP for older people another service problem arises who deals with it when that GP isn't available, sounds good but not practical is it ?. I see any GP for speed of appointment. You are correct everything is down to CCG decision, we don't even have a specialised area to cover lung and chest illnesses it is lumped in the general care category, when I queried this in the early days of CCGs I was told it would be investigated and a reply sent by email but I never heard another word they just wasted my time and theirs. I know who is my local CCG and they are housed in the local council building, but they are not interested in individual responses, they only listen to local group representation. You are right they have a budget and it is up to the CCG to spend it wisely and purchase good value for money, if not it should be shown CCGs don't meet the need. Must go now have other computer work to do,but thanks for the exchange of info.

  • Katie

    I have the same problem with my CCG regarding getting an answer. CE got a little heated under the collar because I kept on at them - face to face meeting Thurs last went well. It seems they are measured on how many public enquires they get and speed of answer. Suggest you remind them every two weeks until you get an answer.

    I've used FoI (Freedom of Information) request before now - NHS England seemed to think they were above the Law wrt to FoI - an email to the Information Commissioner soon had them answering.

  • WELL i did not know it was dependent on public enquiry, I was given the impression that they could put my views forward, I found the meeting rather personal not about services in general. I have had many meetings with different departments over time including using the health ombudsman service but often felt it was a loosing battle with me labelled as the predator not a concerned patient. I am sure you understand what I mean, eventually you get fed up of trying to get a point across. But somebody must succeed or changes would not be happening. There is no way we can please everyone is there, we have to settle on the best for the majority.

  • Katie,

    ' I am sure you understand what I mean, eventually you get fed up of trying to get a point across. ' Yes I do, but I find, after many years being told by my wife, that just because they don't openly agree with you doesn't mean that you have not got your point across.

    Your point may well be one of a number consider relevant, hopefully it will be put in the decision making process. I know its difficult but small steps in the right direction makes progress. The problem is the small steps are difficult to see as progress. Even if your actions just 'leans' on the direction of travel you have made a difference.

    If all else fails bring the NHS Constitution into play and quote it eg

    Principle 7 The NHS is accountable to the public, communities and patients that it serves.

    That clearly legitimises your actions.

  • Thanks I have made a note of that one for future reference in case i need to confront them again in future.

  • If I'm honest, this system has left me uncertain as to what to do in my case, in the last 24 hrs, I have been experiencing chest pains, dizziness, palpitations, breathlessness, sweats and weakness. Its coming and going in waves. Do I go in or will they say im another time waster.

    More money is needed, better training, and the 111 service takes too long, but with out obs, they generally have their hands tied, 111 team are great at what they do, but have little choice but to send us in. If in doubt check it out is my usual motto.

    The NHS are being blamed for the things that Is actually the governments responsibility. Ok yes pore care and standards cannot be blame soley on them, sometimes it is the trust that is failing. In that situation, perhaps successful business men and women should be used to train the trust?

  • If I were you Geoff_mpnfamily, with the symptoms you state I would have contacted my GPs surgery by now and see what they advise. Hope you feel better soon. For Chest pain they do say ring 999.

  • One of the problems is that most politicians are strangers to the truth and they refuse to accept that 111 is a cheap fix that does not work. There is also the question of Doctors earning close to £100,000.00 a year who do not offer a weekend service.

  • Agreed Bricky, as the post Christmas news reads the 111 service does not work, if they are asking questions like "are you concious " to the caller seeking advice. A nurse at Cardiff Hospital, said the Iraq war zone is less bogged down than A&E s in this Country. Not all doctors get those high wages however as illness and accident are unpredictable I think medical staff should be prepared to work weekends including senior doctors, other national services have to work weekends including the care sector. I used to have to work weekends, in an hospital environment , social services and even hospitality services as they are called today. Rotating cover is how it's achieved.

  • I'm going slightly off track here but my GP said to me, during a recent appointment, that if people had to pay a £1 for an appointment the surgery would clear and appointments would be easier to get instead of waiting a week. I would be more than happy to pay a £1 to see my GP if it eases the amount of time I have to wait for an appointment.

    People, it seems, visit their GP's when a visit to the pharmacy could solve the problem on some occasions. Are we taking advantage of our NHS which I would never knock as I have nothing but praise for it, maybe I have been one of the lucky ones.

    Jacqui :-)

  • In Canada, US and Australia they pay to attend the GP, so it is not new thinking by your GP. Whether it works I have no idea. There is the extra workload of collecting the payment - you will probably find that the payment just about covers the cost of collection and admin. Then you have those too poor to pay who would need an exemption certificate of some form.

    Will a delayed visit because they are unwilling or unable to pay result in poorer health that needs hospitalisation at a greater cost?

    I think part of the solution is for the GP to assess how many patients consultations s/he felt were not necessary then take action to deal with those by either better education of the patient or using less qualified staff for the more mundane and less serious issues leaving the GP for the more complex patients that need his/her expertise.

    Of course, that needs a degree of management ability on the part of the GP, some have it and it shows in their response time to patents, sadly some couldn't manage the proverbial

  • I am going to have to disagree with you on this point, who is at fault the GP or patient?

    I was in and out of the GP's office for years with little to no help - at one point even breaking down into tears with a condition that was untreated or ignored by various GP's. Once I was referred to a nurse for help with my condition and that was the biggest waste of time ever - she googled my condition on the internet with me!!!

    Only after getting private medical treatment through my company and paying was I able to resolve this problem - which severely affected my quality of life and health (both physically and mentally) for many years. I should have been referred to a private consultant years ago, but never was. My current consultant is brilliant and was surprised that I hadn't been referred earlier. I no longer have this private medical insurance but the consultant is still happy to see me through the NHS for on going treatment if necessary. My health is about 90% better and so is my life.

    I feel like this is a way of blaming the patient and does not offer any real solutions. In this case, this is certainly no fault of mine. Never mind the 5-10 minute limit given and how some GP's will only allow patients to address one issue per appointment, forcing them to make multiple appointments.

    Other than this I have had very positive experiences with the NHS. The telephone helpline is also fantastic, a family member was rushed to A&E on their advice for something that turned out to be very serious and emergency surgery (thank goodness!) and another was able to treat themselves at home for an accident.

    Education is always an effective tool. Children at school should be taught about their health, diet and how to look after their bodies, preventing some problems in the long run. Public service announcements and health education workshops in the community and via media would also be a great idea. Prevention is better than cure.

    I don't think charging patients is they way forward...today it is £1 tomorrow it may be £100. Although I have no problem paying £1, who will implement a cap on this fee? My previous surgery had a 3 strike ban for no-shows.

    From experience of living in different countries where you pay for all/some of your medical treatment, I can say that sometimes the treatment is better and sometimes it isn't. But, it isn't right or fair.

    Many people can't afford to pay for treatment and medication and are less likely to seek healthcare or buy medication. The ones that are most affected are those on low income and the elderly. This does not solve anything, as their health issues may deteriorate and cause more expense to the government hospital systems and the patients in the long run.

  • Couldn't agree more Jacqui, I would be happy to do that too. The last time I visited my local hospital for tests, there was a notice saying that over 1000 patients had not attended their appointments in the last month. My GP surgery also posts figures.....87 in the last week. It's shameful.

    Yes, the system needs change but so does our culture of I want it all and I want it NOW!

  • Mamamarilyn,

    The problem here is that the NHS is only gives you part of the information - ie their side of the argument !! From the Annual Report of my local general hospital - a run off the mill hospital - had 430,000 outpatients and day cases last year, which comes out at a little under 36,000 per month.

    If out of the 36,000 only 1,000 fail to attend ie 2.7% fail to attend - less than 3 in every hundred - that to me is damn good record for patients, many of who will be ill, maybe dementia suffers, may have been admitted to hospital, may be a carer for a spouse or relative or may have died.

    If your hospital is claiming that a 2.7% fail to attend rate is causing them problems I suggest you need a new hospital management team, because a small fail to attend should be expected and built into the system. They are whinging about nothing whilst putting up a smoke screen to cover poor management.

    I am sure the same goes for the GP - some just like to whinge it takes less effort than remedial action on their part.

  • Couldn't agree more Jacqui, I would be happy to do that too. The last time I visited my local hospital for tests, there was a notice saying that over 1000 patients had not attended their appointments in the last month. My GP surgery also posts figures.....87 in the last week. It's shameful.

    Yes, the system needs change but so does our culture of I want it all and I want it NOW!

  • I live in Scotland.

    When I took my last bad turn,,,, I phoned 111 they asked my wife a few questions about what was going on and what health issues I had.

    She then said she would be sending a doctor to the house ( 4:30am ) he arrived, and straight off it was apparent he had no idea of COPD.

    He said the preverbal " take these tablets, and if it doesn't improve by Monday, see your own GP "

    Well Sunday 3:30am taken to hospital on Blues and two`s..

    This is worrying, a doctor who,, had read my notes before coming out dismissing me as " a bit unwell " I think he should have been concerned when my sats were at 88..

    I cant fault NHS 111 they were very good, but on call doctor , that's a different matter.

  • No doubt many of us could improve how we maintain good health, avoid or reduce unhealthy habits and thus reduce the burden on public health services. Also in no doubt, services in general could be more pro-active, better coordinated and better focused on individuals. However, I have seen some brilliant examples of leadership in achieving effective improvements within our health services, but unfortunately these are often undermined by circumstances in other social systems, such as housing, social care, criminal justice and social services, employment and benefits. After several decades of relentless consumerism and the wreckage of our public infrastructure, it is remarkable that on the whole our NHS is still a public service with public service values, whose workers strive to look after us as best they can. What let's them down more than anything else in my experience is political interference and ideology that imposes unworkable and badly coordinated changes, with numerous unintended consequences. These would be avoidable with better change management and teamwork between agencies and at a higher level between departments locally and nationally. The cuts in community care are a significant factor responsible for greater workload on acute and emergency services. We could also reduce that workload significantly by addressing social factors that undermine wellbeing and add to problems in mental health, or exacerbate over-eating, excessive alcohol use and other bad habits. Solving these by introducing better treatment will not remove the underlying social ills but we need to take some steps in that direction as well as encouraging our political leaders to be more responsible in leading positive social change that puts public wellbeing higher in priority than profits for the few ( I am tempted to finish this with a picture of the famous cartoon of all the fat cats laughing as one of them says "and then we promised that the wealth would trickle down" but I think you will get the idea)

  • Sorry as I have been of line for several weeks I am out of touch as to how this post has progressed, now BT have sorted out the mess on my telephone line I will try to catch up later in the week. Hope everyone is well to spite all.

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