I love the NHS but is it broken?

I came across a man this evening who had just collapsed in the street. I stopped the car along with a couple of other people. We called 999. The man was unresponsive but breathing.

Long story short – after answering questions as best we could no ambulance was going to be sent out. Instead we were asked to wait for a paramedic to phone back. In the interim we checked his id, went to his house and brought his daughter.

Still no call back from a paramedic so we called 999 to provide new information. The man is 51 and had a stroke 6 months ago. With this an ambulance would now be sent. But… not straight away. It would be 30 minutes before an ambulance could be dispatched, so any chance we could bring him to hospital?

We got the man off to the hospital in a car and hopefully he will get the care that he needs. By the time we lifted him into the car he was starting to “wake up” and could say a few words but was clearly really unwell with a suspected stroke for the second time.

I’m not posting this as a rant. I really do love the NHS, my daughter is alive today because of it and will need the care of the tremendous people throughout her life. I’m just a bit shocked by the first hand experience of how a person could be lying in the street with the thought that no one was quickly coming with emergency care. It was a real sinking feeling of despair to be told no ambulance was being sent out.

Is this the reality of what is happening everywhere?

Yes.

Being deliberately broken ?

Yes.

Firstly well done for being a god human being and helping another in distress.

The NHS is not quite broken but it is right on the edge. Getting that initial access is the major issue as once you are inside the system it is generally ok. The staff, on the whole, are doing their absolute best with what resources they have but that is the main issue: the resources just aren’t there. Blame the current lot in Westminster for that. The light at the end of the tunnel is that hopefully by the end of this year we will have a different set of people holding the strings and with it the possibility of things changing direction for the better.

All of the public sector has been broken. Wilfully.

Yes.
Problem isn’t necessarily the NHS being broken as such, but social care is certainly broken, and successive governments have done nothing to address this when we have a population which is living longer and having more complex care needs.
This then means that hospitals can’t safely discharge, which means acute beds don’t become available, when means the ED is full, which means ambulances can’t offload and so it goes.
Add in long-running staffing shortages because HMG won’t pay enough to retain expensively trained healthcare staff…

Having heard Streeting talking I am not at all confident he understands the actual issues, or that a change in government will help.

Yes.
Wes Streeting, as probable Health Secretary in probable Labour government, is not the solution.

The short answer is yes.

I could make several very personal examples to support my view, but ultimatley we are all at fault here, the actual NHS staff, are generally exeptional, there is just not enough of them and they don’t get paid enough for what they do.

Take My nan for example, she fell gravely ill last christmst during an NHS strike, so the first reponder was an off-duty fire-man. An ambulance was subsequently called, and the fire guy and the paramedics were beyond profesional.. I couldn’t do that for a living, the objectivity and pure cool headed’ness of all of them..

I just don’t know how they can cope with it on a personal level…unless they just go into some sort of auto-pilot mode.

When you hear stories about people assaulting the fire brigade or paramedics… I just cannot fathom it.

I guess this post states the obvious and others here are closer to the issues than me and may have different perspectives but…

As an observer with two daughters and son in law working for NHS in clinical roles… and with heavy use of the system by other family members it seems to me that it’s not broken but it’s creaking badly.  When things align it works brilliantly.  Where gaps appear it falls down.  I have waited with an ill mum in an ambulance for nearly two days and I have watched my dad get amazing treatment for complex problems.

My opinion is that the current state of the things in public services was/is not inevitable.  That the deterioration has significant inertia so will take time to repair and the gaslighting of us all by the people in power, their policy makers and corporate influencers make it ever harder to start the repairs. 

It is hard watching my kids get ground down by the system and as I get older I know that I am getting closer to maybe needing the NHS more than I have done. So I hope change will be forthcoming and we get serious about making sure that we have a health and social care system that is as good as it can be.

Problem isn’t necessarily the NHS being broken as such, but social care is certainly broken, and successive governments have done nothing to address this when we have a population which is living longer and having more complex care needs.
This then means that hospitals can’t safely discharge, which means acute beds don’t become available, when means the ED is full, which means ambulances can’t offload and so it goes.

Having had first-hand experience of looking at the whole system in action these last few months I’d go with that view in general. Obviously there will be regional variances and even variances depending upon the time of day/week these services are needed but in essence the whole system is being held up by the near-complete lack of social care.

It’s a systemic issue…if you think of a country as a whole,  like your own body, you can easily draw some comparisons.

Many things are intertwined, for example, just from an NHS perspective, there’s a lack of policing, a lack of commumity support, etc, etc, etc.

I’m sure Labour will win the next GE, there’s almost no point even betting on it… but I’m not hearing many encouraging words from Starmer, his message seems to be to gently try to slow the tide of insanity, rather than a paradigm shift.

Maybe he’s correct in his softly softly approach… but there are a lot of people in the UK that just are not ready to be nice yet.

It’s been broken for 5 yrs or so now . COVID was just the icing on the cake.

I don’t think it’s a political thing either, or certainly not a Labour/conservative thing 

People are living longer with more complex heal needs, and there are more people. This all needs more infrastructure/ money and until we all are prepared to pay for it , it won’t improve.

It most certainly is a political issue.  NOt necessarily a party issue tho I believe it is  Its a political decision to waste huge sums on the fake market.  |Its a political decision the means social care is a mess of low pay and underfunding.

If you watch the BBC Ambulance programme you can see the ambulance service has had this issue for years.

About 2.5 years ago we had family (in 90s) who kept falling. The careline numbers just ring the emergency contacts. Both were injured so couldn’t be lifted by family who arrived on scene. One waited over 8 hours with a broken hip on the floor. The other over 12 hours on the floor.

13 months ago my Dad fell down the stairs and broke a lot (stopped breathing, broken neck & skull). He had good care at the Hospital but after 5 days was discharged with a neck brace they expected my step-Mum to change (she couldn’t because she had a fractured arm from the fall), no care plan in place, no referral to GP and so he got zero community assistance. Because he knows the system he managed to call around and get an appointment for ongoing care (e.g. scans to see how the breaks were healing, physio / rehab) but it was really shockingly bad.

As others have said it’s complex but derives from lack of social care places or ability to discharge which is complex itself, and every element of the NHS seems to have some areas just really struggling. I would say urgent care gets very near collapse / halting at points, GP care similarly in some locations but not everywhere.

OP, in the middle of winter, your experience is not so different to most for the last few years. Well done for helping out, most wouldn’t have. Ambulances and A&E both really struggle this time of year, and the NHS has been underfunded for at least a decade now.

Oh, and there’s a 6 day strike on. Up the workers.

Part of the problem with fixing it is that having a serious, national conversation about it is going to be very difficult. The answer is almost certainly not the current structures and systems with more money but discussion of radical NHS reform is very emotive and I’m not surprised the main parties aren’t willing to take it on.

The tories have got closer to their aim of a two tier service with those able to pay jumping queues.  I know of multiple people who have used private medicine including me to jump queues.

Fortunately they will be out before long and the NHS tends to fare better under labour but Streeting does not fill me with confidence.

There needs to be an honest national discussion about healthcare policy and our ambitions and limits.    Healthcare can be ridiculously expensive and many of the population will need some sort of support in old age.  Surely its right to use this accumulated wealth that is held by the elderly to fund old age care?

The answer is almost certainly not the current structures and systems with more money

Perhaps long term.  short term?  Reorganisations drain energy out of the organisation and there is a huge legacy of underfunding.  Pump money in and get rid of the most stupid stuff and then leave it alone for a bit to recover

My aged parents still haven’t figured that my dad’s new £15k knee he paid for privately due to massive NHS waiting times is due to the Tory government they still vote for and the scum rag DailyMail.

Perhaps long term.  short term?  Reorganisations drain energy out of the organisation and there is a huge legacy of underfunding.  Pump money in and get rid of the most stupid stuff and then leave it alone for a bit to recover

Yes, I agree. Some of the issues could be solved by better funding but I think society has changed so much that some sort of restructuring is necessary. The key thing is that it doesn’t create a two tier system and that the poorest and most vulnerable can access the best care.

Yes its broken and the level of care has been variable for years. However according to the NHS and the press it’s been on the verge of collapse for years. Theres pockets of excellance and wide spread mediocrity. There are many reasons for this, the current government being a major reason but there’s plenty of others, ageing population combined with an increase in poor lifestyles combined with an entitlement culture. The NHS staff and internal culture is also a problem, it’s chaotic at best, and every time someone makes a blanket statement that NHS staff are all wonderful it makes things worse. Of course they are not all wonderful, theres a bell curve and with so many employees theres a fair few at the wrong end of that curve. There needs to be political will to decided what the NHS is for and how it will be managed, then the staff need to start to get to grips with their performance issues, absentism for example., engagement with new methods and more efficient ways of working.

I can only speak from personal experience but for me its not delivering what its claims, as mentionned above getting into the system is a lottery, once in and its a big barrier, things can get better. I’m not sure I buy the it’s been deliberately run into the ground, I’m not sure the Tories are that organised, but culturally something needs to fundamentally change from top down to bottom up.

It is completely broken, same as everyone else I have tonnes of anecdotes but the best ones are being told to give up on walking after a leg injury, I ended up going private and am now fully recovered, and being told to “google it” after spending 8hrs waiting in A&E for a serious head injury

My mrs passed out in A&E and would have been left to bleed out had I not started shouting for help and the most recent one is her being referred to an external company of “specialists” by her GP, only to find it is a scam company used by the NHS to reduce waiting lists who never do the referrals and are full of fake reviews on Google and the NHS website

We got scammed by our GP, that is something I never thought was even possible

The NHS is shockingly bad, and while it may not be the nurses and doctors’ fault we need to start saying that to create some accountability somewhere

It’s been teetering on the brink for a few years now.

I’ve had a similar experience as @willq above but with a father-in-law who was found in a confused state and failing a FAST test suggesting a stroke. We called 999 and were told it was a Category 2 call but we’d be looking at around 12h for an ambulance. It should have had a response time of 18 minutes, according to the targets.

I’ve worked in the ambulance service for a decent length of time so I see it day to day from the inside looking out. Seeing it from the outside looking in was quite the eye-opener.

In my opinion the NHS shouldn’t be a politically ran entity, having a “top down reform” every time a new government is voted in is just wasteful and encourages short term views rather than looking at the long-term health of the NHS and the nation. I also believe, controversially, that they already get enough funding, it’s just not spent very well. The waste in some areas is eye-watering.

It’s broken at all levels…. hospitals,  GPs, social care…  the lot. Can’t help but be totally scared to get ill with any thing.

Many things are intertwined, for example, just from an NHS perspective, there’s a lack of policing, a lack of commumity support, etc, etc, etc.

I agree with the intertwined issue.  Ironically if you were to ask many front line cops they’d tell you that they spend a lot of their time dealing with mental health and addiction issues which are really health issues!  BUT the NHS is a sacred cow and parties of all colours will always give it more funding rather than working out where to put the money for the greatest overall impact (justice, social care, education, housing, etc).

Having heard Streeting talking I am not at all confident he understands the actual issues, or that a change in government will help.

No, and he’s already mentioned there’ll be more Private Finance Initiatives/Public-Private Partnerships or whatever they’ll be called this time around. We’ll be in debt to the private sector forever.
Here’s an example of how well it works in the Eastern Daily Press (from 2017). EDP
But of course the ‘get behind the team’ Starmerites will tell you ‘at least we’ll get the hospital built’.

Edit.

many front line cops they’d tell you that they spend a lot of their time dealing with mental health and addiction issues

Yes Poly, that was another great idea, it was called Care in the Community, thank you Baroness Thatcher.

Putting all of the ‘wilfully’ broken politics to one side….

The reality is that the cost of Health Care has increased significantly in the last 75 years.  Driven by people being less tolerant to being ill so using the system greater, the increased medical capabilities and solutions on offer, as well as the increased cost of those services and technologies.

The spend on the NHS as a percentage of GDP has increased through its life but the reality.  The unfortunate reality is that the funding comes through taxes and who really wants to pay for more taxes?

It’s all the same reason as to why there is little of a UK manufacturing industry, the death of the high street and the likes.  We talk a good game but we just don’t want to pay for it.

There is huge amounts of waste and poor management in the NHS (well certainly the Trust I hear about from my wife). Some of the things I hear about would never happen in the corporate world in which I’ve worked. I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

Speaking as a GP, there are a number of issues.

Funding is a very large part of it, we pay less in this country than many other comparable countries. In the past increases in funding have led to better outcomes.

The undervaluing of GPs, both politically and financially is a massive issue. Repeatedly, because what we do looks easy (nodding and listening), we have political schemes to replace us on the cheap (inadequately trained doctors, using other professions in our roles, increasing “efficiency” at a cost to continuity of care, treating us a community based juniors to do the bidding of the hospital doctors) which lower quality and increase overall costs IMV. This misses the fundamental point of being a GP which is that we add massive value both through our depth of clinical experience (no other clinicians come close to us in numbers of patients seen) and through continuity of care. Yes, a large part of our job is nodding and listening, the hard part is knowing when more than that is needed.

I’m not sure that the current situation is deliberate, I think it’s more that the Tories are caught in an ideological bind by their commitment to lower taxes.

Yes, reform is needed in the NHS. The main one being moving the focus and funding away from hospitals and towards primary care. As you can imagine this goes down like a turd in a swimming pool with my secondary care colleagues, who are also overwhelmingly over-represented in the higher echelons of the NHS.

Some of the things I hear about would never happen in the corporate world in which I’ve worked.

With all due respect, bollocks. Waste happens just as much in the corporate world and you’re kidding yourself if you think it doesn’t.

Driven by people being less tolerant to being ill

Is there a reliable link to back that claim up?

And the unfortunate reality is that increased spending does not necessarily result in increased patient care when the extra funding goes towards huge private profit – see PFI.

It’s all the same reason as to why there is little of a UK manufacturing industry

I don’t see the connection. Short-termism, an immediate drive for profit, and a lack of investment for the future?

It’s broken. I had to self fund last year as I couldn’t get seen by our GP. Ended up paying for a private GP to refer me to consulatants for the 2 issues I had. Fortunately the GP’s original guess of skin cancer was incorrect for one, and the other is an issue that cannot be fixed. In total I spent over 1k getting this information. If I hadn’t had 1k available and it had been skin cancer, I would have been an even bigger burden on the NHS than if they caught it early.

To balance things out though, my wife collapsed in a heap on the bathroom floor just before Christmas, unresponsive etc. so called 999. I kid you not, from the moment I dialled to the moment an ambulance arrived must have been a max of 5 minutes, it was amazing, as was the care she got from the paramedics.

I don’t want to see it privatised but I can’t help thinking if it was it would be run a whole lot better.

Because that solution works so remarkably well in the United States?

No, and he’s already mentioned there’ll be more Private Finance Initiatives/Public-Private Partnerships or whatever they’ll be called this time around.

The current PFI deals represent about 2% of the overall budget of the NHS. There’s probably a discussion about how the NHS affords and maintains and builds new properties that needs to be had, and while some of the early PFI deals were shockingly bad, they’re certainly not unaffordable in their current format.

The NHS (like schools, courts, prison, social services, energy provision roads, and so on and on) need to have proper long term funded solutions that have the agreement of all political parties so that they don’t become pawns in the game of Westminster.

while some of the early PFI deals were shockingly bad, they’re certainly not unaffordable in their current format.

Well it’s good to hear that the Tories have made a better job of PFI than New Labour did but its crippling effect on the NHS should not be underestimated:

Some hospitals are spending more on PFI debt than they are on drugs

https://www.newstatesman.com/spotlight/healthcare/2022/05/pfi-repayments-are-costing-some-hospitals-twice-as-much-as-drugs

When I joined the NHS 15 years ago from the private sector I was surprised at both how much money it had, and how inefficiently it was run locally and from the centre. 15 years later the main change is that demand has risen and funding has not – meaning that it is both inefficient and skint. Numerous reorganisations haven’t fixed it, nor have “the best brains”. My conclusion is that it’s impossible to be truly efficient in objective terms when an organisation is so huge and complex, and it only gets costlier if you break it down into chunks. The only solution is to fund it better. 

So many people harp on about waste and inefficiency, but introducing the ‘corporate world’ to the NHS means that even if they manage to run an organisation that size more efficiently, they also run it with the principal aim of generating profit, so none of the efficiencies go to benefit patients.

After all, our long and proud history of introducing the corporate world to our other utilities has been such a roaring success…you’d have thought people would look at what we are paying for energy, the state of our railways and the amount of shit on our beaches and conclude that maybe, just maybe, the private sector is not the solution to our ills that people say it is.

Make no mistake, parts of the NHS have always been on the verge of falling down, even in eras of decent funding, and there is certainly a role for better management. But the last 10 years of defunding have pushed these over the edge, there is not even a pretence of a service in some areas – and pretty much everything else is sitting on the edge of the precipice.

And now the death spiral has started, is it any surprise that our best clinical staff are running for other countries? Staff who genuinely love the idea of the NHS, and are committed to patients, are the ones who cannot bear to see the suffering being caused by its current state.

just in time health care and out sourcing GP appointment to vietnam what could go wrong.

Some hospitals are spending more on PFI debt than they are on drugs

Which makes for an arresting headline without a doubt, but is it a useful measure of either 1. how inexpensive off-patent drugs are, or 2. how expensive running a hospital [and the surrounding] building are? All the studies I’ve seen put PFI funding at more or less the same as the budget for upkeep for non PFI funded buildings.

Is 2% of the overall budget an outrageous amount for running the estate?

 even if they manage to run an organisation that size more efficiently

IME [both working inside and outside the NHS in healthcare] the NHS needs both more and better management, most noticeably at the junior and mid levels. Politicians make headlines from saying things like “All the money will go to front-line service and not bureaucracy ” but in reality what then happens is that doctors/nurses end up with a 2nd unpaid job – The manager of their particular unit. And while I admire and like my clinical colleagues they’re often shockingly bad managers of people, budgets and regulation, and who can blame them? They often don’t want the job, haven’t been trained properly to do it, and don’t get paid to either.