How to "save" the NHS

"Got a cough? It's probably nothing, but might be lung cancer, see your GP." as one recent advert goes.
How much time, effort and money is wasted confirming it actually is nothing, not lung cancer?
Treat those who are injured or sick, not those who might be.
Isn't that basic triage?

SWMBO was an osteopath at the time this event happened:

Me at dark o'clock: "Darling? Sorry to wake you, but I've just had this rather annoying experience ..."
Wife: "Umm ... could be x or y but more likely cauda equina syndrome or spinal cancer."

Wife: <goes back to sleep>

Me: <stares at wall for the rest of the night contemplating the term "spinal cancer">

Me at 0830: "Hello? I'd like to see my GP, please"

Trust me, from a mental health point of view, it was worth every penny the NHS spent to diagnose something other than spinal cancer! 8 months later I was in a neurosurgical ward and some of my fellow patients weren't so lucky.
 

jarrod248

LE
Gallery Guru
Among my dubious array of random qualifications I have one at Level 1 Catering and Hospitality (NVQ).

I therefore have a a certificate to say I know how to cook a chicken breast and not kill an elderly person by giving them Listeria with their lunch. Somebody slightly more qualified than me should therefore be able to predict with a reasonable level of error what quantity of food will be required given the current type of patients occupying beds in hospital. The private sector would never cook 100 chicken breasts and throw 25 away.
Hospitals probably aren’t cooking expensive chicken breasts though, it’s often cheap and rubbish so private contractors make more profits. Chefs and catering staff used to be directly employed and food was much better.
 

jarrod248

LE
Gallery Guru
SWMBO was an osteopath at the time this event happened:

Me at dark o'clock: "Darling? Sorry to wake you, but I've just had this rather annoying experience ..."
Wife: "Umm ... could be x or y but more likely cauda equina syndrome or spinal cancer."

Wife: <goes back to sleep>

Me: <stares at wall for the rest of the night contemplating the term "spinal cancer">

Me at 0830: "Hello? I'd like to see my GP, please"

Trust me, from a mental health point of view, it was worth every penny the NHS spent to diagnose something other than spinal cancer! 8 months later I was in a neurosurgical ward and some of my fellow patients weren't so lucky.
If it is cauda equina then you need an operation urgently, don’t have it, have a wheelchair and add on care costs forever. Quick consultation can decide which it is, very cost effective.
 
If it is cauda equina then you need an operation urgently, don’t have it, have a wheelchair and add on care costs forever. Quick consultation can decide which it is, very cost effective.

Indeed.

 

TractorStats

War Hero
Bear in mind that although the requests from a ward will go into the kitchen early in the day, patients have a habit of being admitted and dscharged throughout the day thus buggering up the figures.
I have no time for 'oh its too hard' excuses. Out of 500 beds there is a bit of variation day to day but cover that and people being admitted late with a choice of what's left, shepherds pie, sandwiches, pasta, salads, rice dishes and veggie/vegan alternatives. Its just public sector thinking that holds it back.
 
Interesting post. Reading between the lines RMAC and QARNC do what they do very well but that is probably more akin to true emergency A&E with some GP work on the bases? Their role is tightly defined.

If the NHS was like the motor industry it would actually have four parts:

Hand built luxury and super cars = specialist medicine

Mass produced cars = routine elective surgery

Recovery and crash repairs = ambulance plus A&E

Routine maintenance and annual repairs = geriatric care and community health

The problem the NHS has is that it tries to do everything with the same business model. Could you imagine a sports car manufacturing facility suddenly trying do mass production. Expensive and chaotic.

What it needs to do is bring in the private sector to do 10,000 hip jobs at lowest cost. Keep ambulance and A&E 'in house' but make it work like RMAC and triage out low level stuff with well trained QARNC type staff. The big teaching hospitals do specialist medicine only and geriatric care needs totally different facilities in the community. GP care scrap it all together and put them at the hospital A&E and local geriatric care centres.

Breaking up the NHS into parts and bringing in the private sector to do the routine bits in high volume and lowest cost with minimal delays is surely the way to go.


The obvious and immediate problem there, is that (pre-C19, when they apparently worked properly) GP health locations were almost always more local and more numerous than hospitals, so you then create a lot of transport problems and logistical difficulties in hospitals to locate the GP/triage clinics. Oh, just build on half the car-park? The car park is already always full, even without all of the GP traffic being added to it. There aren't any quick and simple fixes available. It is a bit surprising to hear about the GP access problem as it doesn't seem to have affected my relatives in UK. Possibly it is regional -- in which case looking at causes and patterns may be illuminating.

A quarter of a century ago I part-timed as a mental-health care-assistant, basically chatting to people in a structured way, helping them through the day and watching some specific people when required. Back then it seemed that the main problem, at ward level, was staffing levels. On one occasion I went for a shift, was asked to extend to a double and agreed, then was asked to extend to a triple (ie. twenty-four continuous hours on duty) on the basis that nights were currently quiet. I refused and complained that it was nuts to call this safe-staffing. The charge-nurse / rosta-planning person was a bit upset at this.
 
I have no time for 'oh its too hard' excuses. Out of 500 beds there is a bit of variation day to day but cover that and people being admitted late with a choice of what's left, shepherds pie, sandwiches, pasta, salads, rice dishes and veggie/vegan alternatives. Its just public sector thinking that holds it back.
The same private sector that produced Carillion Amey, Capita and not forgetting G4S (we won't mention London 2012)...
 
Tackling food waste in the patient catering chain is a tricky one to handle, given that it's difficult to predict how much an ill person will eat.

Many patients will be nutritionally-compromised, some patients cannot swallow solids / need certain textures, then pregnant women are advised against certain foods, old people are often advised against egg products / mayonnaise etc...

The majority of meals served are to staff and visitors*. Patients with dietary problems are known quantities and can be planned*. The unknown part of the kitchen services should be relatively small, if well run.

* Based on working at two hospitals and using their canteens etc, but long ago of course.
 

Mbongwe

War Hero
I have no time for 'oh its too hard' excuses. Out of 500 beds there is a bit of variation day to day but cover that and people being admitted late with a choice of what's left, shepherds pie, sandwiches, pasta, salads, rice dishes and veggie/vegan alternatives. Its just public sector thinking that holds it back.
Not true, as evidenced by the significant market share held by Medirest, Compass, Sodexo and Serco to provide patient catering for NHS hospitals.
 

TractorStats

War Hero
SWMBO was an osteopath at the time this event happened:

Me at dark o'clock: "Darling? Sorry to wake you, but I've just had this rather annoying experience ..."
Wife: "Umm ... could be x or y but more likely cauda equina syndrome or spinal cancer."

Wife: <goes back to sleep>

Me: <stares at wall for the rest of the night contemplating the term "spinal cancer">

Me at 0830: "Hello? I'd like to see my GP, please"

Trust me, from a mental health point of view, it was worth every penny the NHS spent to diagnose something other than spinal cancer! 8 months later I was in a neurosurgical ward and some of my fellow patients weren't so lucky.
Not sure if this entirely appropriate here but your wife deserves a :D for calmness under pressure and you deserve a :applaud:for not bothering her the rest of the night with urgent follow up questions. Hope you are both fully recovered now :snuggle:.
 

jarrod248

LE
Gallery Guru
I have no time for 'oh its too hard' excuses. Out of 500 beds there is a bit of variation day to day but cover that and people being admitted late with a choice of what's left, shepherds pie, sandwiches, pasta, salads, rice dishes and veggie/vegan alternatives. Its just public sector thinking that holds it back.
Most catering staff are private if not all.
 
The same private sector that produced Carillion Amey, Capita and not forgetting G4S (we won't mention London 2012)...

The problem there is that the contracts were structured in such a way that made it impossible for other companies to tender, and also that the duties and responsibilities implicit in the contracts have been consistently badly specified and poorly managed. And ultimately the same failing companies were selected for the work because they knew how to tick the right bureaucratic boxes, rather than on proven/provable ability to actually do the tasks that were required.
 

jarrod248

LE
Gallery Guru
The problem there is that the contracts were structured in such a way that made it impossible for other companies to tender, and also that the duties and responsibilities implicit in the contracts have been consistently badly specified and poorly managed. And ultimately the same failing companies were selected for the work because they knew how to tick the right bureaucratic boxes, rather than on proven/provable ability to actually do the tasks that were required.
But you blamed the public sector when it’s private, so are you now going to blame the private sector?
 
The problem there is that the contracts were structured in such a way that made it impossible for other companies to tender, and also that the duties and responsibilities implicit in the contracts have been consistently badly specified and poorly managed. And ultimately the same failing companies were selected for the work because they knew how to tick the right bureaucratic boxes, rather than on proven/provable ability to actually do the tasks that were required.
If they are failing companies, why aren't they simply refusing to take these contracts they know they can't honour and fulfil?
 

Dread

LE
Has anyone suggested taking every NHS employee with the word 'diversity' or 'equality' in their job title down to the operating theatres and harvest them for 100% of their organs? If not, why not?

Eyes, kidneys and the other 'traditional' organs can be used to immediately reduce the waiting lists for transplants, the hair can be sold of to wig makers and the skin to tanners and lamp makers.
 
They know they can tick enough boxes not to get hoofed out, and they know they can make a profit. That's all that matters - it's business.
Then sounds to me that they are putting profit above performance, which i'd suggest may not be the best idea when it comes to providing potentially life saving healthcare.
 

bloodgroup_o+

Old-Salt
I've worked in the Ambulance Service in Glasgow for 6 years and I have to say that everything we are struggling with in our local services was predicted and already taking effect before I started.

I'm only a lowly clinician so I can only speak of what I encounter on a daily basis and as much as I'd love to have solutions for the problems, some are well above my pay grade but I can touch on some popular points from my point of view and I suspect some of the madness is reflected elsewhere in the system.

Managers- We (and the rest of the NHS here) appear very management heavy with a "jobs for the boys" culture that sees people who are part of a certain clique retire on very generous pensions only to come back weeks later in a band 8+ post which appears to the rest of us to have been specifically created for those people. Some of those in mid/senior positions having made almighty errors when they were on the road and seemingly promoted and placed in positions to get them out the way or who are regarded by those who worked with them as pretty s**** medics/line Managers who constantly float between different management roles. Then there are the non clinical managers who are given input to things which will effect patient care nationally, and challenge clinicians protests about it despite never having worked on the road. Accountants and physiotherapists can make good managers I'm sure but IMHO have no place in leading a blue light organisation where they fail to take on board the troops ideas or concerns.

Response times- You all have stories either first hand or from the media of long waits for 999 responses and there are multiple issues at play which cov only expidated and brought to public attention. On my patch the Gov closed or downsized 3 local hospitals (ED's and primary care) and replaced them with one huge ego project "super hospital" against warnings by medics that it takes a day to cut beds and years to create them. As a result one ED now covers an area which was once served by 3 and doesn't have the capacity to do so. It was designed with patient flow in mind but when they simultaneously also closed several smaller cottage hospitals and rehab units, the backlog of "blockers" began (several years ago). Social care services dont have the capacity to put safe discharge plans in place for the elderly and frail, or the morbidly unwell who do nothing to care for themselves and so these people remain in hospital beds or they are discharged into unsuitable surroundings and so end up falling again or remaining unwell, just to be taken straight back to the ED days after discharge. Our service response to the at times 6+ hours wait at ED has been to employ several new managers to hang around hospital on band 7 all day and update crews about tea and coffee facilities available.

The response model used by our control staff has been unfit for purpose since I started and several adjustments to it have just made it worse. We often get diverted from genuine calls to drunk people lying in the street who then gob off or try to assault you (often a fun little distraction), or from emergencies to chronic conditions that a person has been having for a week and done sod all about. ;Have you called the GP?......Can't get a GP.....Have you taken your meds?.....Don't have my meds.....Let's call your GP......sorted......But I'm really sore I want to go to hospital can you ring my social worker/housing officer/support worker to tell them I'm going, can you put those crisps in my bag etc.

Example: Yesterday we book on at 0700 and are sent to an Amber call (non ilt but requires a timely response) for an 84 yo gentleman recently discharged who has fallen and is trapped behind his bathroom door, query hip fracture. The job has been sitting since 0345 and nobody has been able to get access to the property to see him. He has spoken to someone via his falls alert system but is difficult to make out so his condition is unknown but he is breathing so hes an Amber. We make every effort to make progress to this gentleman and get within 500m of his address when we are diverted to a Red call (ILT) 12 miles away for a 24 year old female who is not conscious with difficulty breathing. We arrive and her man answers the door quite intoxicated to tell us they were on a bender and she collapsed and now won't wake up. She wakes up no bother with some gentle but firm encouragement and precedes to tell me she can't breathe. They had a barney and she has had an anxiety attack and went on to (I suspect) pretend she is unconscious presumably to arouse sympathy from her man. I'm not taking her to hospital so we spend an hour and a half on scene while she unloads on us about her poor MH. She then kicks off as we cannot refer her to the MH team because A)she's not a danger to herself and B)she's pished. She already had a MH worker but hasnt engaged with her because she says theres no point. She then pretends to have some sort of strange seizure where she can't open her eyes and her hands twitch for a minute or two. Her clinical obs were better than mines. We find out later that she is a regular caller and due in court for assaulting a female collegue last year.

Our shift continues with much of the same until lunchtime when we get our first patient genuinely in need of an Ambulance who has COPD but despite struggling to breathe for 2 days has managed to smoke 2 fags that morning, her son pointing out he knows she's really unwell as she would normally have smoked 5 by now. We treat her and contact her GP (to avoid using the ED and to arrange some antibiotics and a steroid) who tells us she isn't complying with her own treatment plan or collecting her meds and so the best option is hospital for an assessment. Ultimately we end up finishing 2 hours past our shift in another health board area with a dementia patient who is an ex bootneck and has phoned the police because he thinks he's being held prisoner in his flat. He gets carers in twice a day and his evening meal consists of some sandwiches and his family (who live down south) have been told he doesn't qualify for further home support and will just need to be put into a home. We end up taking him to the toilet, washing him as this hasn't been done that morning and making him some scoff and a brew while he goes through his photos and tells us about the time he got lost in weymouth and pumped a lassie who worked on the buses just for a bed that night. Most genuine and rewarding patient of the shift and a delight for me personally and why I go to work, but certainly not an ambulance job.

Staff- We have issues with staff absence largely with stress and msk injuries rather than covid and the service response has been to take on more students without putting in place any support for the mentors of these students to get them qualified and on the road. If you take on a student you are expected to do all your face time and course work with them in your own time unpaid after your 14 hour shift ends or on rest days. The goodwill to do that was there before but is now lost as you give enough of your time to the job at the cost of your family. The ability of new folk coming in to finish their course work seems to be getting lower as we go and several don't even last 12 months before jacking it in for something without the stress, abuse and demands from a very demanding public and inconsistent management.

Paramedic students who tend to be about 19 with no life experience have often fallen for the TV stuff or notions of being a hero for their social media profiles and many of them lose interest in the job quickly and see opportunities to take their degree elsewhere but the Gov are relying on them being the solution to our staffing issues. I personally worry about their MH in the long run as I was fortunate to already be a nutter before I joined and I'm sure many will take the opportunity to prosper elsewhere when GPs start taking on more paramedics to take up the slack there.

The longer term staff who book off with stress after say a traumatic pediatric job or being assaulted have had the TRIM pilot removed and many have had funding for councilling removed as well. Thats something I hope to work on personally when I've the time as I know how effective intervention can be with trauma and you can definatelty go back to work if you have the support in place. Peer support is great but the employer has to step up and put their money into their people when it's needed, the Army learned this and now the MH support is improving and starts in training to build resilience in people, something the NHS does not do or encourage. The absence process effectively punishes you for returning to work early and encourages you to take 6 months on the biff instead leaving others to pick up the workload.

I'll leave it there as a wee snapshot of things as I could go on but as I said much is above my paygrade and I don't have the statistics to back anything up. Fwiw for those who have been failed by the Ambulance Service and lost loved ones please understand we share your anger and as I said, we've been warning about it for years but the ones who make the noise don't get into the positions to change anything and suggestions are usually forgotten or aren't heard unless they come from management or an outsourced data company.
 
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Grownup_Rafbrat

ADC
Kit Reviewer
Book Reviewer
Reviews Editor
Not at all trying to set you up, more highlighting the absurdity in your argument. There are things in life that we must try to prevent in order to stop further (expensive) damage down the line. Shrugging your shoulders and disavowing yourself of preventative measures is not something I believe is morally or practically correct.
You'd think so, wouldn't you. But as I said, how have the messages that 'smoking kills' '7 units of alcohol a week', and 'don't fill your children with fat, salt and sugar' actually worked?

Because from where I sit, they haven't. And they are costing more every week.
 

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