[Closed] The NHS isnt working

This was all predicted.

We're all doomed to obscurity unless you win the lottery before you lose your marbles

Pay peanuts-you get monkeys, and three monkeys can't do the work of ten monkeys......
We need more nuts and monkeys
Oook!....

Privatise it! That's proved the solution to the problems of every public service. I mean.... just look at the railways

Or spend £2 billion on a re-organisation that definitely isn't privatisation. Oh no. definitely not that! Perish the thought

my uncle has recently been paralysed (knocked his motorbike)from the waist down and has two broken wrists & collarbones and has spent the last few weeks in HDU. both wrists are in casts and he cant feed himself.

some times the nurses have not been available to feed him.

mental.

Nice of that piece to tell us that 20% is one in five, shows the level of people its aimed at.

My first thought on reading that was - [i]I wonder how many nurses/carers could be provided if we didn't have to pay for a separate body of penpushers to roam the Country dropping in unannounced?[/i]

I'm pretty sure they won't be on nursing grades!

^^^^^ agree with Woody^^^^^^

Nice of that piece to tell us that 20% is one in five, shows the level of people its aimed at.

Strange thing to say. Care to elaborate?

I'm sure we don't need to worry about this though. David Cameron has said how much he loves the NHS so I'm sure he'll look after it.

Oh shoot the messenger then. Desperate.

Has someone been shooting Guardian journalists? And why were they so desperate?

Nurseing and care staff always use the lack of staff as an excuse, yet the management who are paid to manage, never say theres not enough managers, despite half of them having no idea what a patient is and what their needs are, as long as they have a desk and a vdu screen theyre happy.

So if care standards didnt make unanounced visits, then who would protect the rights of the frail patients, perhaps when youve been to visit a freind or relative in a hospital; and seen the very good care and the very poor and useless staff that also share the same space, that get paid the same or even more, then just perhaps you will see the need for care standards.

Just imagine if nobody officially went into your local takeaway or curry house,to check on food hygeine standards, think of all the people who would get food poisoning,

Lets also scrap the Health and safety inspectors, they just stop buissnesses making more profits, by having safety rules.

Too many nurses in hospital are doing roles at used to be performed by docs and not enough nurses/ auxillaries/ hcsw are around to feed the patients. Tbh you dont need a highly qualified nurse to feed the patients bu you need carers to feed them. Or a relative even.

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

Think you find its the NHS bosses working with new government ideas
to make the NHS fail and use private contractors that will cost the NHS
out of existence.

doctornickriviera - Member

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

i spend too much time in hospital.. ( last time it was eight weeks..) as in all walks of life and jobs there are good and bad great and in different. when you experience this in health care it is frightening.. really frightening.
those less able to fend for themselves the very ill, ageded etc are frankly left to them selves there is no feeding no drinks offered no effort at stimulus or offers of support
i have seen patients ridiculed by being forced to walk up and down wards in soiled pyjamas and deliberatly missed by those delivering food
hospital is a real survival lesson you must provide for yourself food drink entertainment and only your resilance and attitude will mean you get a positive outcome.. dont complain as you may need that nurse to make a fair attempt at CPR on you one night ( this is a genuine fear )
nurses are far too high up the tree to nurse thier role is to work 9- 4 monday to friday and do as much decsion avoiding as possible and just enough practical work so that the next shift have still got plenty to do..
understaffed .. your having a laugh.. on the day shift for 36 patients there were 25 nurses, on nights 1.. guess when most people die?

fundamentally nurses should be nursing anne nightingalle led the way but that caring helping role so vital for recovery has been lost in the rush to educate to degree level a job that can be done by anyone with compassion and an understanding of maintaining dignity in adversity.

Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

No it's not great, especially when you then see ward staff doing exactly the same.

druidh - Member

doctornickriviera - Member

I often do housecalls at homes where elderly frail patients have been fed by their carers. What you find is that the carers have left a plate of food in front of the patient which has gone Cold because they cant feed themselves. Bonkers! carer visits puts meal in front of vulnerable old person but doesnt stay to feed them! Then they get admitted to hospital with weight loss/ dehydration. Great isnt it!

Careful! It's against the rights of the patient/client to force them to eat. This is a situation often encountered by carers (and nurses).

Posted 2 minutes ago # Report-Post

Let us all hope its documented on the patients/clients, visit sheet, and on their notes at the surgery/office, just to ensure that the staff are actually asking the patient if they want a meal, and the quality of the meal is of a suitable standard for them to eat, eg minced or liquidised, vegitarian, and it actually looks edible ,etc.

totalshell - Member

i spend too much time in hospital.. ( last time it was eight weeks..) as in all walks of life and jobs there are good and bad great and in different. when you experience this in health care it is frightening..

Yup. But I've experienced it [i]far[/i] more in private healthcare than in the NHS.

Rubbish no ones forcing patients to eat!! I aggree that you cant force someone to eat but people are not being assisted with feeding on the whole. Food is placed in front of person who cant feed self and food goes cold and patient isnt fed! This happens widely at home in social care packages then the patient gets admitted with illnesses related to malnutrition.

Families could do alot more in hospital and at home too to help with feeding.

Lots of patients give up and lose the will to live. It would be wrong to force feed these patients against their wishes.

The ratio of nursing staff to patients in this country is a disgrace. I was amazed by how much time aussie nurses had for their patients then realised there were 5 or 6 qualified nurses per ward rather than the 2-3 in the uk.

Going by the above descriptions, there must be some [i]other[/i] NHS which I've yet to encounter. Having had both parents in hospital in the last two years, I have to say that the standard of care was superb and the staff could not have been more helpful and attentive.

As far as I can see, the main issue regarding non-hospital "care in the community" is that we are now expecting society to look after our aged and infirm, whereas this was once a family role.

Nickriviera +1

Poor bed managment is also a factor: wards may have 'cpapcity' in terms of clinical comploication/risk, and manual handling needs but not how well the patients can feed themselves. You can cope with the medical and care (moving/handling/toileting) needs of a suprisingly ill and incapacitated bunch of people with three staff nurses and 3 health care assistants, but that does not translate to feeding what with the particularly small window of time you get with hot meals.

Typical 'acute' medical ward in a district general hospital:

-Six nursing staff (3 of each).
-35 patients.
-Meal trolley takes 20 minutes to get from one end of the ward to the other.
-Hot main course takes 10 minutes to get cold and is cleared up 20-25 minutes after it is served regardless of what is or isn't left on the plate.

How many people unable to feed themselves do we reckon the six nursing staff can feed in that time frame, if they run to the next patient/feed as soon as they have finished the last one and follow the dinner trolley up the ward?

In practice, with the phone, the doctors, other hospital workers coming in and out of the ward needing help/stuff doing, the immediate/acute clinical needs of the poorliest few patients, and the magical process by which old folk sat in hospital beds all day always need an urgent plop about six forkfuls into their dinner, means those six nurses/HCA's can feed about eight patients if they are really on it and the planets are all in alignment. On a ward like I just described in my experience, any more than eight that need feeding and you barter with housekeepers to be able to clear up cold dinners a bit later than they are told to, you bend the visiting hours considerably to draft in relatives to help or old folk go hungry.

I no longer work in general but was well used to having to move patients to adjacent beds so I could sit between them and feed 2 at a time, (literally, a spoon in each hand!) and then go to the other end of the ward and do the same again, and we still often couldn't manage to get everyone fed. I really hope things ave moved on in those eight years, but in my old and overall really rather good hospital (lord knows what it was like in the Mid Staffs' of the NHS...) we were still well used to having ten or twelve 'feeds' per medical acute ward and the numbers for mealtimes simply didn't add up.

Take all your staffing budget and spend it on GPs consultants and NHS managers instead of the people who really make a difference day to day.

Tony Blair really did it when he decided to give all his Doctor mates a massive pay rise for working less. Oh how the doctors must have laughed.

the study found that some hospitals/wards/nurses were crap some excellent
it wasnt a blanket dissing of the nhs just that in some cases its very poor
fwiw my experience of the nhs has been pretty good, including when my gran was in for her final weeks

i really hope that lansleys reforms will address the inequality in service, i fear it will just lower it further, opening up the nhs to the private market means awarding contracs to the lowest bidders.?

and more bad news today
[url= http://www.guardian.co.uk/society/2011/oct/13/nhs-waiting-times-rise-cuts ]http://www.guardian.co.uk/society/2011/oct/13/nhs-waiting-times-rise-cuts[/url]

further cuts will only make the situation worse, good old tory government.............

Too many nurses in hospital are doing roles at used to be performed by docs and not enough nurses/ auxillaries/ hcsw are around to feed the patients.

EDIT; julianwilson, nominated for best post of the thread award.

Druidh, some hospital staff perform a lot better than others,due to better management, or just more complaints, that rattles the cage that holds the pension pot of the management.

North Staffs and a few other hospitals seriously failed its patients and allowed them to die in such tragic ways.

Those staff know who they are, and every day that passes they get older, and approach the time when they will depend on caring staff to look after them.

phuckin tories . why not just Privatise the nhs, and take medical insurance paye, that way we can deal with the non-tax-paying population problem at the same time by letting them all die. get rid of those most vulnerable in society and we can all be much better off
"...the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped. "
Hubert H. Humphrey

Going by the above descriptions, there must be some other NHS which I've yet to encounter

Re DrNick's observation on carers/feeding - it is something I encounter regularly too but it is rarely the fault of the carer IME as they have usually tried everything to get that patient to eat/drink before they have to stick to their tight schedule and move onto the next patient. It is often them, as opposed to the family who alert the GP/medic that there is a problem. I have nothing but admiration for them as they do a fantastic and often unpleasant job for, more often than not, the absolute minimum the employer can get away with paying them.

Nurses now think they're not there to nurse; that's what care assistants are for, but in many areas care assistants are uneducated, unskilled & uncivil, not a great combination.
In a lot of areas medical training is becoming more clinical, whilst for the last 15 years nurse training has all been about less clinical time, more theory and "better" qualifications.
Time for more basic nursing care IMHO.
PS I'm a registered nurse at one of the hospitals criticized today by the CQC, so it is quite close to home.

It's my belief that the public generally love it when they find a public service to moan about…moan….moan…moan, the media grab hold and then ram it time and time again down your throats endlessly until it's becomes grossly blown out of perspective. I know >fact< that the health service is full of hard working care giving nursing staff that are really up against the odds, under financed, understaffed, underpaid, poorly managed, to then get home to be tarnished with the media broad-brush with the public lapping it up. It's a thankless task. It’s like blaming the twin towers on the firemen!!

I heard on the news this morning a report criticising staff for putting paperwork in front of the patient’s lunch. I do fear that if the NHS was run like an all expenses paid glorified 5* hotel with room service on tap, the patient’s clinical need and the regulatory requirements for record keeping would suffer and the clinical risk (overall) would be greater, it’s a matter of prioritising with the resources available.

I would also add the nursing profession doesn’t get the recognition and respect it deserves.

...and no I don't work in the health service

I'm going to get flamed here... but... a Dr's view

Two Issues

1) Rapid patient turnover on many wards and increasingly technical treatments combined with shorter stays makes old-fashioned personal nursing difficult. But this does not explain malnutrition on wards full of elderly patients

2) The "Professionalisation" of [i]all[/i] qualified nurses (no ENs, all students doing degrees, the "nursing process", project 2000 etc etc) has enhanced the clinical and bureaucratic skills of nurses whilst not empathising traditional caring and "vocation" enough. And this has left a huge gap where underpaid, untrained auxiliary staff are left to do personal care roles which would have been supervised or performed by trained nurses.

I think highly trained autonomous specialist nurses are brilliant and I ask them for help and advice a lot. But equally many of the nurses who are now 25-40 seem to have difficulty seeing past the protocol to the patient, in a way that those aged 50 and above don't. Ironically the training which was meant to make them autonomous has constrained their view by being too reductive.

I believe that just as not every 18 year old or even 50% of them needs to go to university, Nursing might have done better avoiding the degree model for all, and then encouraging the higher fliers/more technically minded/future independent clinicians to move on through a degree path later.

From the CQC Report,

"All too often, we saw variation within hospitals – where one ward got it right, another in the same building was getting it badly wrong. We saw cases where there was clearly some fault in the hospital’s culture that allowed unacceptable care to become the norm, where it should have been an exception. The responsibility for these failings lies with management and leadership.
In the second place, staff attitudes to people (and, by implication, the training and management that nurture these attitudes) are critical. Time and time again, we found cases where patients were treated by staff in a way that stripped them of their dignity and respect. People were spoken over, and not spoken to; people were left without call bells, ignored for hours on end, or not given assistance to do the basics of life – to eat, drink, or go to the toilet.

🙁

So, some people are crap at their jobs, some ok and some really good - pretty much sums up anywhere I've ever worked - plus add idle, impossible and a variety of standard behaviours.

For Managers, see above.

For Senior Managers, see above, etc, etc.

5 people i know who trained as nurses, actually working on the wards, training in the training school , taught by experienced nurses, not uni educated.

1 is a head of social services,

2 are univercity lecturerS, teaching nursing, and both say its so wrong to not have proper work based experience,working on the wards, as a job, and getting paid for it.

1 is incharge odf a mental health ward dept,

and the other one is now working on imigrant health issues.

Where was the bit in the report about the overworked underpaid undervalued nursing staff being demotivated and unable to offer patients the kind of care and attention we'd all like to see in an ideal world?

The NHS isn't broken, it's just sick. The Tory scum seem to want to let it get sicker, then switch off the life support, rather than working out how to keep it alive. Andrew Lansley should be imprisoned and/or executed for the good of the UK. Self-serving ****.

I'm a care worker, and strongly opposed to the introduction, of 15 minute calls, which seem to have crept in recently.

You can't assess the condition of someone with dementia, ensure that they are safe, clean, happy and haven't forgot to take their meds in 15 minutes, let alone check sell by dates, tidy up & load the washer.
Then record everything and ensure that the person is safe and happy before leaving.
Food prepared, assistance given if required & washing up as well, don't forget.
Just not possible in a quarter of an hour.

Luckily, our company refuses to accept 15 minute calls, but some do.

Five days a week I am in various hospitals. You do not see more clinicians. You do not see more nurses or cleaners or porters. But year on on year for the last five years what you do see more of is the "Blackberry classes". Professional meeting attendees.Sharp suit and an NHS ID card round the neck, and guess who they require to attend all their meetings? The lead clinicians, the ward Sisters who are therefore never around to see what goes on on the wards.

The only experience in the last few years as a customer was sitting in casualty for five hours with a child with a broken wrist. This is supposed to be a first word country. Bit off topic I know. But there was no major incidents. It was not a Friday night drunk tank. Just the fact that there was one AE Paediatric Doctor on duty. Rant over.

Elfin - I'd love to kick the tories - but this has been going on way longer than that. A lot of the stuff which wasn't being done isn't really in the remit of nurses any more. And that [i]may[/i] be part of the problem.

In my above posts i am not blaming any carer or nurse fot not feeding - i am merely pointing out that people arent being fed. I can imagine it would take a good half hour to assist an elderly patient to eat a meal . In a 40 bedded geries ward that would take upt 20 staff hours per mealtime wihout other interruptions. My point is that community and hospital staff arent given this time.

As for funding gp practice funding has been decreasing since 2006 and i imagine this is being replicated accross he caring sector.

It's often the families you never see on the wards that kick off big time when grandma isnt being fed. If your local and there are a few of you go in and help out!

Where was the bit in the report about the overworked underpaid undervalued nursing staff being demotivated and unable to offer patients the kind of care and attention we'd all like to see in an ideal world?

uphillcursing - Member

The only experience in the last few years as a customer was sitting in casualty for five hours with a child with a broken wrist. This is supposed to be a first word country.

You think that's in some way not first world treatment? Sure, faster is better but 5 hours to be seen for a minor injury isn't unreasonable at all.

Actually - for a child it is very poor.

Which is, in fact, bollocks. Anyone going into the NHS knows they will be over this, under that and never the other so to use that as an excuse for poor care of their patients is nonsense.

Only it's not bollocks, it's trying to understand why patients don't get the care they deserve. Where's the bit where the nursing staff get to have their say?

Oh....

Stoatsbrother - Member

Actually - for a child it is very poor.

Wouldn't say so tbh. Not nice but acceptable. But it's the suggestion that it's not first-world treatment that rankles with me, that's pretty absurd.

Doctors are silly expensive because they are so highly trained, on a par with lawyers etc and compared to them we are cheap

Lots of old dr roles have been changed down over the last 10-15 years. Whilst it might be efficient to have more and more specialist nurses, we are getting more and more poorly trained drs because someone els clerks and examines the patient , takes the blood, puts the catheter in etc etc. We have noticed that the newer breed of gp trainees suffer with decision making in practice because theyve never had to make any. When its one patient per 10 min slot it really is sink or swim oclock.

There is no doubt this is also having a knock on effect on surgeon and physician training also.

15 minute calls!!!! 😯 I'm a visiting support worker and as rustyspanner says doing everything in the allotted time isn't easy when you have to do personal hygiene, meds, meals, washing, cleaning and recording, we get an hour and that's pushing it sometimes, 15minutes is insane, I met another support worker the other day who works for a private provider who didn't get traveling time between jobs, her visits could be upto fifteen miles apart and all her jobs were one after the other nonstop, for £6.80 an hour
She didn't have a company harrier jumpjet either, but her boss has a porsche, it's not good at the mo, 😕

Only it's not bollocks, it's trying to understand why patients don't get the care they deserve. Where's the bit where the nursing staff get to have their say?

And for what it is worth, for the most part, the care I have seen in my recent experiences of the NHS (too many and too sad to go into) have been very good.

Northwind.

Indeed I do think it is unreasonable. Have you got kids?

I did type a good few paragraphs of rant. But I shall pare it down to one point. The biggest bottleneck in the NHS is access to many expensive technologies they have on offer from 9 till 5, 5 days a week. Hundreds of millions of pounds of equipment sat idle for more than half the time Monday to Friday and almost certainly idle at the weekend. Tell me what industry in this country operates on similar lines? I am a Socialist at heart too!

Privatise it! That's proved the solution to the problems of every public service. I mean.... just look at the railways

They need to get a company like Southern Cross involved. They can show those public sector dullards how to do care and make a profit at the same time.

Schools and univercities have a lot of equipment, grounds and staff not being used for huge parts of the year, and every weekend as well.

[b]Northwind[/b] Having done 6 months Paediatric Casualty in a first world country (not this one or the US) I'd beg to disagree...

Northwind.

As a gp i would happily work weekends and evenings if the rota was sustainable and i wasnt working 90-100 hrs a week depressed / burnt out /and therefore providing poor care.

To access all services 24 / 7 7 days a week you would need a huge increae in the number of doctors / nurses/ x ray staff ... The list goes on and on to cover a tesco healthcare culture

The country cannot afford/ taxpayers arent willing to pay for this. Therefore most non emergency services are 8-6.

I caught CDiff from the hospital when I had my daughter and had to go back into hospital for a week in quarantine - I was still breastfeeding my new baby yet the nursing staff couldnt be bothered sometimes to bring in my meals (sometimes in a row too so I would go for a whole 24 hours with not even any water) and the nursing staff where shocking - very rude! when i asked for some water they told me to drink it out of the bathroom tap! - they constantly forgot my antibiotics and when I would buzz to remind them (I wasnt allowed out of the room) they would slam the doors. I was left in bloody sheets (they put my iv in wrong) and was refused anything to change my daughters nappy on. But the worst thing was that hardly any of the nurses washed their hands when leaving or wore the protective clothing they should have worn to come into the room and the obs equipment that was allocated to my quarantine room was taken out in the middle of the night so I dread to think how many others in the hospital caught cdiff. Im now very scared of ever having to go to hospital!

uphillcursing - Member

Northwind.

Indeed I do think it is unreasonable. Have you got kids?

No, but I was one once. Apologies, I hadn't realised this was one of those subjects where only parents can have an opinion.

But I think this highlights the problem... Any system whereby a five hour wait for a nonlifetheatening injury gets classed as "3rd world", is clearly never going to meet people's expectations.

danadem

Did you report any of that to the hospital?

i hate to be one of them moaners about the nhs but my mothers just come out of hospital and i'm not happy with what i saw, my mothers not that old either.
no water even after promises from the staff to bring it along, my mum didnt want to make a fuss..!!!.!!
medication delivered late and delayed.
they did tell me to leave though when i turned up and the rest of the family was still there as there was 5 of us in total, fine i except that and left but my blood boiled as earlier that day she had no water for a few hours!
the food was horid, but i guess you kinda except that, but the nurse did even complain about that.
some of the nurses were excellent though i'm not sure i could work in that environment, must be difficult but is that an excuse for not delivereing on the basics

Peeps complain when they get poor service at tesco, or a pub, or a hotel, yet when in hospital and theyre discharged they very rarely complain.

Reason being you can go to asda or morrisons or another pub, you have little chance of going to another hospital, if youre suddenly taken ill.

Same staff same ward, and probably same crap management.

Northwind.

Nothing to do with only parents being allowed an opinion. I can quite happily sit in A&E and wait my turn. I have had plenty practise over the years. When my child is sobbing with pain it awakens far more primitive emotions. Fundamentally 5 hours for a Paediatric case, even a minor injury is something more suited to Stalinist Russia than a 21st Century UK.

It may have changed as was there a while ago.

Having worked in Oz and UK as a hospital doctor over there they would have 7-8 nurses for the same number of patients that over here we would have three nurses.

As has been mentioned above the proliferation of specialist nurses has provided an excellent service. The downside is they are highly expensive - often per hour more than reasonably skilled junior doctors (i.e. anything below consultant). At the end of the day the more money you spend in one thing the more you have to save elsewhere - i.e. on ward staff.

The message very much seems to be that 'just' being a ward nurse is not good enough and unless you are in a specialist or management post you have not done well. It would be better if some of the very senior nursing staff could be kept on the wards.

uphillcursing - Member

Fundamentally 5 hours for a Paediatric case, even a minor injury is something more suited to Stalinist Russia than a 21st Century UK.

Don't agree in the slightest. I waited for longer when I was a kid, maybe we just had more realistic expectations.

The solution's simple though- the problem's been identified as them only having one pediatric consultant. So just have 2 on all the time, that'll only cost double and require twice as many doctors, easy.

A break is not a minor injury. especialy in a child. Should be dealth with as a priority and in less time than that.

TandemJeremy - Member

Should be dealth with as a priority and in less time than that.

And I agree. But third world? Come on now.

5 hours is too long for anyone to sit in A_E with a broken wrist, speshly a child, but what were the reasons for this? I'm sure staff din't leave the child there suffering on purpose, just to be nasty...

Mind you, I sat in A+E all night once with a half-severed finger before I received medical treatment. It was very unpleasant, but not as unpleasant as the experience of the two serious head injury cases that were brought in (with machines that go 'PING!'), the stabbing victim, the shooting victim and various other breaks and leakages...

But is it too long simply because nurses don't care?

Lots of slagging off going on here, but not many attempts at offering possible solutions....

Jet 26 you are spot on! Not enough staff end of! Nurses in aus were less stressed and narky because they werent so hard pushed as the ratios werent so high.

Things are going to get worse cos the cuts havent hit yet!

had some great service at a&e myself but its not about a&e so what if you break your arm from a bike accident and have to wait a few hours, it will mend, try being in hospital for weeks months with inadequate water food, care, dignity etc

Elfin - ok

Fewer Bigger A&E units (make capacity issues dealable with) Less NIMBY "don't close my unit" crap.

Triage by experienced Drs or Nurses freed from protocols - and I've seen this rubbish from a parent's side too.

Don't get rid of the 4 hour A&E target ( a Tory decision) as the evidence is that the death rate is higher in units (irrespective of turnover) with a >4 hour wait.

Stop making [i]all[/i] Nurses do degrees as part of their training. It's not necessary, and I really think it does make them miss some of the unique qualities that Nurses can bring as carers, clinicians and advocates.

Senior A&E staff present at night. In fact there is very little place for any Dr with less than 5 years under their belt in a Hospital at night.

Imaging needs to be running full on 24/7. A major cause for delays - but not in sensible countries.

Less management is not an issue - the NHS is under-managed compared with other Health Services and Private Sector industry. Crap unaccountable management is.

And hang any MP who bases his reelection policy on keeping his local St Shipman's open.

Elf,

There were no major incidents that came in that I could see. To early for the drunks but sadly just the wrong time of day to find fully staffed departments. One on duty radiographer so seven of the available X-ray rooms sat unused constituted nearly two hours of wait.

Let me put the same point in a slightly different way. Most of the people on here ride bikes between bouts of bitching on here. Some of them fall off and hurt themselves. How long have they had to wait to get access to an MRI scan? An ultrasound scan or a physio referral?

Lets have a straw poll out of interest.

Simple but unfashionable fact, the NHS is not actually valued realistically by a significant proportion of its service users. To see a GP, or have an ambulance attend, or to see an a&e doctor out of hours has a real monetary value that is simply not considered by many people, leading to abuse/misuse of services which in turn leads to resources being inefficiently allocated.
This could, IMO, be simply addressed by asking everyone to pay a small contribution towards the initial cost, even if we're only talking £20 or so. A kind of compulsory national insurance excess. Within my own sphere of experience, I know* that if ambulances were more expensive than taxis, their workload would drop by 60-70% overnight. I hear GPs and A&E staff tell similar stories of people unable/unwilling to engage their common sense and tying up services that could be better directed all the time.
So doctors are comparable to lawyers? I think so. However, imagine a world where access to lawyers was completely free for all for any trifling issue and the state picked up the tab, every time. An unaffordable model?
The NHS worked when it was appreciated for the amazing, valuable commodity that it is. Unfortunately that is no longer the case for large sections of society, and something has to give.
*i obviously don't [i]Know[/i] this, but would be willing to bet large quantities of cash, or body parts on it.

There were no major incidents that came in [b]that I could see[/b]

Well, I wasn't there, so can't offer an explanation, but I do know there's loads of stuff going on in hospitals that you [b]don't[/b] see, that affect things.

Fewer Bigger A&E units (make capacity issues dealable with) Less NIMBY "don't close my unit" crap.

Hmm; longer journeys by patients, ambulances out longer, longer response times, those in already cut-off locations even further from emergency health care, yeah, great idea.... 🙄

Actually, one thing I think would help in big cities especially poorer areas, is if patients could use taxis to get to A+E, in situations which aren't life-threatening but otherwise leave them unable to get to hospital under their own steam, and if the taxi fares could be reimbursed/paid at the hospital. This would mean that a broken leg, for example, could be ferried to hospital by taxi, which would, I imagine, cost far less than an ambulance journey. People I know who can afford to, have done this, as have I, but poorer people might not have this option and would have to call an ambulance. Surely this would relieve some of the burden on the ambulance service, and ultimately save a packet, not to mention helping out taxi and cab drivers.

Just an idea. Dunno if it would work or not.

Heh! Great minds, V8ninety... 😀

I hear GPs and A&E staff tell similar stories of people unable/unwilling to engage their common sense and tying up services that could be better directed all the time.

I know of one case, where an ambulance was despatched to an address, as the patient was apparently 'dying', only to get there and discover it was in fact an earache or toothache or something. 🙄 I'm sure there's loads of silliness like that. Another problem in the area I live in, is the ignorance of medical stuffs by certain sections of the community, which sees GPs and A+Es burdened by some very trivial matters which don't require medical attention at all, just a basic knowledge of how to treat certain things yourself/at home. This is down to education, and not everyone has had the privileged advantage (!) of a decent UK education. Unpopular with the Right and the bigots, education and information resources in other languages have actually helped see a reduction in the burden to the NHS for all sorts of health issues.

TBH there's loads of answers/possible solutions, but not enough people really thinking for themselves.

I work on an elderly care ward. The care couldn't be better - i'm always totally amazed by how good the nursing staff are - both qualified and unqualified.

I think one point that needs to be made here - that even on a really good ward plenty of our elderly patients are getting malnourished - mostly because its often part of the dementia process that the patients simply lose their appetite - no amount of forcing/encouraging them to eat makes any difference. I dont know whether this report addresses that issue?

If someone cannot feed themself - they need help being fed. Now lots of dementia patients will not eat that much as they detiorate. But I have heard enough from intelligent professional, and sometimes ex-nurse patients who have witnessed food being left out of reach of patients etc etc... to believe this story...

and the key issue is why some wards and hospitals succeed and others do not...

This could, IMO, be simply addressed by asking everyone to pay a small contribution towards the initial cost, even if we're only talking £20 or so. A kind of compulsory national insurance excess.

Can't say I'm in favour of that, BUT, how about just telling people how much(ish) their treatment might have cost them had they had to pay for it? (edit: of course I know they do pay for it, indirectly - but I mean if they had to pay directly as they used it)

Could be done per visit to the GP, or at the end of a stay in hospital - no need for much extra admin, just a quick print out / tally of the cost of a few procedures like you might get on a bill from the garage.

Might help some people to focus on what resources they are using and/or help people to decide whether or not they were actually getting value out of the NHS.

Well, I wasn't there, so can't offer an explanation, but I do know there's loads of stuff going on in hospitals that you don't see, that affect things.

Here are my thoughts (not that anyone will be interested):

Nursing is now a technology/process based job rather than the caring vocation it used to be.

The ludicrously expensive technology bought by the NHS sits idle for more than 50% of the week.

I can see the same consultant at the local Nuffield Hospital sometimes 12 weeks sooner than I can at the local NHS one for the same ailment. I can also see them when it suits me.

I know the people dealing with patients really care. It is the staffing levels, time quotas and bureaucracy that is killing the NHS not the front line staff.

Bugger! incoherent ranting again.

Elf, edumacation is definately part of the answer, but unfortunately 'educated' people can be just as guilty of under appreciating and misusing the NHS. In my personal experience, some of the worst (because it's disgusting that they don't know better) misusers of ambulance and primary are resources are GPs, sometimes at their own practice (999 because it's home time, anyone? Patients 'mis-sold' to admitting medics to wangle an inappropriate social admission...) but mainly the £100+ per hour, almost unaccountable out of hours locum GPs who will admit anyone, usually by ambulance, just for an easy life.
In the interests of balance, I think most GPs are hard working, concientious and just as frustrated as everyone else...

Can't say I'm in favour of that, BUT, how about just telling people how much(ish) their treatment might have cost them had they had to pay for it? (edit: of course I know they do pay for it, indirectly - but I mean if they had to pay directly as they used it)

Having recently spent 3 days in hospital, including A & E, for a cycling accident, I was pretty happy with how I was treated. My only observation was that some staff needed to work on their people skills.

Most people here don't seem to know the worst part about the US system... the fact that almost everyone's cover is actually limited. So even if you're covered you're only covered for so much money, then you're on your own. So basically crap cover for almost everyone.

Anyone who thinks the US system is good needs there head examined.

But not in the US as the care would not be as good and it would cost you a shed load.!!!